By Colin Weatherby
Mental health practitioners have long sought to extend their services to the poor. The high cost and social stigma of therapy in poor communities has proven to be a major barrier. Aside from the obvious medical justice issues, many policy advocates argue that preventive therapy could dramatically reduce the staggering cost of institutionalizing America’s mentally ill populations living in poverty. A little intervention now could mean huge savings later in life.
The numbers are pretty alarming. In 2010, the Office of Minority Health reported that adults living below the poverty line were three times more likely to suffer from major psychological distress. There is a sizeable demand for mental health services in America’s poor and minority communities that is not being met.
In the past decade, the mental health profession has seen an explosion of technological innovation in the use of Short Message Service (SMS) as a means for delivering and maintaining basic therapy services. Early use of text-messaging began as a simple, cost-effective method for reminding patients to take their medications, but researchers are now experimenting with new software which allows for simple implementation of automated and interactive mental health services at bargain-basement prices.
A study published last month in the Journal of Consulting and Clinical Psychology used automated SMS messaging software to engage bulimia patients in a supplement to their standard therapy treatments. The software was designed to interpret messages submitted by the patients and respond with individualized advice and encouragement. Patients involved in the study showed nearly a 20 percent reduction in relapse rates over an eight month period. Perhaps more importantly, the majority of test subjects had positive reactions to their first experience with a non-human therapist.
A wide and exciting range of research is beginning to coalesce in this frontier of psychological treatment. Interactive SMS is now being used to stimulate memory recall in patients with brain damage and monitor hallucination cycles in schizophrenics. Measurable benefits have been modest, but the research is still in its infancy.
A team at Berkeley is testing SMS technology as a new way to address mental health issues among the urban poor. In a very small cohort study published last year, the researchers found that depressed patients responded positively to an SMS-based addition to cognitive-behavior therapy that was designed to improve self-awareness, track progress, and increase adherence to CBT goals. The team was quick to note that the experimental therapy was provided as a highly cost-effective service in a low-income public clinic, a model they believe has promising implications for the future.
SMS was introduced broadly in 2001 and has since become the most rapidly adopted information technology in human history. Due to its widespread usage, SMS is used for everything from banking to emergency alerts in countries all over the world. The International Telecommunication Union estimates that SMS is now available to more than 6 billion subscribers globally, and a huge portion of the market growth in recent years has been in the poorest pockets of developing nations.
Takeaways from the current research are limited, but it is important to remember that just ten years ago this approach to therapy would have been appreciated by only the most extreme science fiction fans. Today, our daily interactions with artificial intelligence software like Siri make SMS therapy seem like a perfectly reasonable evolution of the technology.
The research is far from conclusive at this point, and while it is difficult to imagine that text-messaging software would ever fully replace the couch, artificial intelligence is rapidly improving. In another 20 years time, could we find ourselves foregoing a typical therapy session for a quick conversation with a computer? It's certainly possible. Welcome to the future: The digital therapist has arrived.