by Ricardo F. Muñoz
Dr. Muñoz is the Founding Director of the Institute for International Internet Interventions for Health (i4Health; http://i4health.paloaltou.edu/) and Distinguished Professor of Clinical Psychology at Palo Alto University (https://www.paloaltou.edu/). He is also Professor Emeritus at the University of California, San Francisco and Adjunct Clinical Professor at Stanford University.
“Is this a good time to talk?”
It’s the year 2025. Your digital assistant has just pinged you. For a few days now, you have been feeling a lack of energy that is different from the usual fatigue when you have been working hard, or the boredom that you have felt from time to time. You just finished talking to one of your friends on your latest mobile device, and, as soon as the conversation ended, your digital assistant inquired if you are available to chat.
It informs you that, according to the health app you activated when you set up your device, your voice tone during the few conversations you’ve had over the last week indicates that your mood level has been unusually low for you. Does that ring true? And, if so, would you like to do something about it now?
You say “Yeah, what have you got?” And your digital assistant immediately connects you to the pages in PsyberGuide that list the apps on depression prevention. There are several depression prevention apps. In addition to the PsyberGuide research rating, the Mobile App Rating Scale, and the expert review, you can also click on a button that says “Drill down.” You click on the button.
The apps are then grouped into three categories: Adjuncts, Guided apps, and Automated apps. Adjuncts are intended to be used as add-ons to regular treatment with a licensed psychotherapist or pharmacotherapist. Guided apps provide live lay assistance via phone, chat, email, or text messaging, to help the user stay with the program (most users have a hard time completing totally self-help programs). And Automated apps are intended to be used without any human support.
You also notice a “Box Score” for many of the apps. It turns out that some of the apps provide effectiveness data on the fly. The Box Score shows the proportion of users whose mood levels have decreased significantly after using the app for a week and for a month. And the data is updated daily. Clicking on the Box Score provides more data: The number of people who downloaded the app, who used the app more than once, their ratings, and their outcomes. You can also drill down and check out outcomes by gender, age, race, ethnicity, education, income, religion, language, and so on, so you can pick the app that has worked best for people like you.
You decide you’d like help from a live therapist. But your digital assistant informs you that your small town does not have mental health providers. The nearest one is two hours away. You decide you’ll try one of the guided apps. But, you see that most of the best-rated apps involve a fee. So, you decide to begin with the best-rated free automated app. And you get started…
Welcome to the future. PsyberGuide is one of the first Digital Apothecaries and thus has the potential to become the premier one going forward. It already takes into account expert ratings and is starting to obtain consumer ratings. Perhaps it will eventually add some of the features that I describe in my time travel fantasy.
We tend to think of the future as a modification of the present. But this constrains us unnecessarily. Our health care practices were developed at a time when in-person care was the only option, when people sought help only when they were hurting, when most health care required payment. Minor modifications to this individually-focused practice will not reduce the burden of disease at the population level. We need to redesign our health care systems with global health in mind.
There is now research evidence that we can prevent half of the new episodes of major depression in persons at risk. Why wait until people are clinically depressed to teach them the mood management skills that will avert a full-blown episode? There is research evidence that we can provide these preventive interventions online. And there are proof-of-concept projects that show that it is feasible to provide interventions for such issues as depression and smoking to people all over the world at no charge to them. This can be done by using digital tools that have been developed and tested with research grants and, after the grant ends, making them accessible to anyone in the world who wants to use them. We have called these “Massive Open Online Interventions” (MOOIs, pronounced MOO-ees), inspired by MOOCs (Massive Open Online Courses).
We need to develop business models that will allow for sustainability of MOOIs that are free and open to all. For example, we could create links from MOOIs to companies that provide guided help for a fee. Those companies could then pay a referral fee to the group hosting the MOOI. This revenue stream would help pay for ongoing hosting expenses and, ideally, for continuing development and testing of the MOOI, so that outcomes for the fully automated version continue to improve.
I wish PsyberGuide a long, successful, and influential life. May it contribute to the dream of making health care a human right.