The adoption of digital health solutions has accelerated as a direct result of the impact on in-person health services wrought by the Covid-19 pandemic. Yet research in this area has been on a slow burn for years, as researchers in computing and psychology join forces to determine how digital technologies can improve access to and address gaps in our mental health services, often called the Cinderella of our health system.
Maurice Mulvenna is professor of computer science at Ulster University (UU). His research in digital health technologies in mental health sciences is focused on using machine learning to enhance service design and delivery to people with mental health problems, people in suicidal crisis, and people living with dementia.
Mulvenna tells The Irish Times it was no surprise that the use of text and telephone mental health services “exploded” during the pandemic. He cites research carried out by Ulster University and the Samaritans in Ireland showing that people were making longer calls to the mental health service as counselling and psychotherapy services were shuttered and family and friends were less accessible.
Yet access to health services such as GP services in Northern Ireland is still being stymied by the pandemic response, and many services have yet to resume routine face-to-face engagement, with telephone services being offered as the default.
“Everyone had a right to walk in or make an appointment to see a GP, but now we are seeing queues form because of the impact of Covid-19 on people’s health, including mental health,” says Mulvenna. “It’s a major issue. Health access is being denied and problems are piling up.”
This is where digital interventions can come in, he says, by providing a form of “digital triage” that allows those most in need to gain access more quickly.
“These queues are getting longer and longer and there are waiting times of years. The system appears to be broken but what seems to be a glimmer of hope is that people can be offered access to digital services while they are waiting in the queue. That’s no use to you if you need a physio appointment but if your mental health is affected and you are in one of the less severe categories such as being affected by anxiety, stress and/or depression, perhaps a digital intervention can assist.”
According to Mulvenna, these technologies would allow for a more agile response to supporting those seeking mental health interventions. “People can access a ‘social prescription’ for apps that we know work in those areas, or they can elect to join a different queue that is more fast moving for quicker access to video counselling, for example. They can then choose to try text and chat services while they are waiting.”
Ultimately, ever-growing waiting lists could then be streamlined, he says. “The impact is that people may exit the ever-growing queue as a result of the treatment they get through these new methods and in doing so free up the access to it for those who really need the face-to-face access.”
This sounds like a no-brainer, but Mulvenna notes there has been a “piecemeal” approach in different countries, despite the ready availability of these technologies. “We need the digital ecosystem within the health service to allow this to work in a more joined up way,” he says. “The State needs to have the vision, which can then be backed up by the technology.”
Buy-in among the public is increasingly less of a problem, however. “Since the pandemic, people are very adept at using Zoom and having video meetings, and the view of ‘Big Brother’ and loss of privacy is not as big of an issue. A majority is now used to online banking, for example,” he says. “There are people who will prefer not to use digital solutions, but for people who engage once, the research seems to show that they come back to it.”
Right now, digital technologies can be utilised to ensure health systems are doing the basics efficiently, such as organising appointments, allowing people to self-refer, or rescheduling appointments to avoid DNAs [did not attend], Mulvenna says. “That’s just simple customer relationship management. You don’t need AI or anything for that and it will be de facto pretty soon.”
But following on from this will be what he calls the second layer of technology, which is client-facing technology such as video conferencing or text support. Mulvenna says we are already beginning to see a growth in these types of solutions, which include 50808, the anonymous 24/7 texting service funded by the HSE, which is available free on the major mobile networks (see text50808.ie for more information).
The system appears to be broken but what seems to be a glimmer of hope is that people can be offered access to digital services while they are waiting in the queue
— Maurice Mulvenna
The future layer is where interaction data is used to personalise a service offering, making care more proactive. “This is where artificial intelligence can try and bring some value from analysis of the data pertaining to these interactions so that it could help with diagnosis, for example. But despite some solutions being out there on the market I don’t think we are quite there yet, but in a few years we will start to see the really ‘smart stuff’ coming out.”
These cutting edge technologies are the result of novel collaborations between the schools of computing and psychology at Ulster University. The partnership is also gaining significant traction in engagement with community, voluntary and charitable sector organisations, such as the Samaritans and Action Mental Health. The university works closely with the latter on a number of projects, one of which is developing an app for young people and children to use to support emotional resilience.
It is also being translated into tangible services, such as the company Pneuma Healthcare, spun-out from UU by Dr Colin Gorman. Pneuma specialises in the provision of psychological wellbeing practitioners (PWPs) to provide online and remote support to service users in English mental health trusts.
“The interdisciplinary research that we do between computing and psychology in Ulster is paying dividends,” notes Mulvenna, “not only in terms of national validation in research impact case studies but also international recognition.”