Kerryn Hildebrand Nelson 20th November 2018
If you scroll through the AppStore, you can find a multitude of wellness apps designed to relieve stress, help you cope with depression, facilitate sleep or even put you in touch with counselling services. Virtual reality is being trialled for use with psychosis and post-traumatic stress disorder, online gaming is being developed to help young people deal with anxiety, and organisations are experimenting with artificial intelligence to create simulated therapists. Animation, film, messaging facilities, online communities — the options are endless.
There has been an explosion of interest in mental health technologies, and in the wake of World Mental Heath Day, there is a perfect opportunity to explore the possibilities these emerging technologies have to offer.
An artist’s journey
Wilkie Branson, an interdisciplinary dance artist and film-maker, is seeking to do just that. His new production TOM, which premieres in London at Sadler’s Wells’ Lilian Baylis Studio last week, exploits emerging technologies to explore themes of identity and mental health through the lenses of his personal experiences. Branson plays the role of the protagonist, confronting these issues in an autobiographical expression of his feelings.
“It’s a story about my own experience and it deals with issues around mental health and loneliness,” he explains. “I don’t have a political agenda and I’m not trying to give any answers. I’m an artist that is trying to reflect my own experience and I hope that through sharing, it makes me feel a little less lonely. And hopefully, it will make other people feel less alone, or maybe help them empathise with people around them that are in the same situation.
“I think the messages of the work are quite universal. It’s something that all of us feel: a sense of isolation or struggle to be the people that we feel we need to be. I just hope that people can take the essence of that and experience it through my eyes.”
Branson worked on his own to create TOM, dedicating two years to its completion. Self-taught, Branson took many risks in the process, incorporating a range of technological feats into the production, constructing scale models of scenery, and employing animation, photogrammetry and projection mapping to bring these elements to life. A 3D dance for camera installation, TOM is a representation of Branson’s personal journey into adulthood, providing an essence of his mindset through choreography, animation, music and film.
“At the time, I found it quite difficult to confront the mental health issues that I had, and it’s something I’ve found quite difficult to talk about, particularly with people very close to me. Dance and making this production is the best way I feel like I could express the themes contained within the show.
It’s only really now, after two years, that I’m able to stand back and look at what I’ve done
“I don’t understand enough about it myself to really say it back in words. Being able to represent it by being in this play is a way I can give over the essence of how I feel. Hopefully, that’s something that we can all relate to. To put it into words is just not easy, but it’s also sometimes not possible.”
In this sense, Branson is drawing on techniques that are regularly used within art/creative therapy — which is a form of care that uses art media to confront emotional, behavioural and mental health issues. The production process acts as a therapeutic outlet for Branson, allowing him to express and reflect upon his mental health concerns while also bringing awareness to this issue in the wider community.
“It was quite a journey, to be honest. It’s only really now, after two years, that I’m able to stand back and look at what I’ve done.”
A matter of balance
Art therapy is a growing profession in the UK, and Michele Wood, art therapist and principal lecturer with the MA Art Psychotherapy Programme at the University of Roehampton, says that digital and new media interventions offer many advantages, but they also carry downfalls.
In 2016, she conducted an online survey of 62 art therapists and 34 students undertaking training in this field, evaluating the significance and benefits of digital technology within art therapy. Seeking responses to the “frequency and ways clients use technology in sessions”, the survey found that only half of the respondents used digital tools with their clients.
Respondents agreed digital devices offered benefits, noting that technologies are able to facilitate therapeutic relationships for clients, deliver access to more people and provide additional support between therapy sessions. Wood explains the key benefit of digital media is widening accessibility, specifically for those living in rural communities or people who are too ill to leave their homes.
The survey also demonstrated that respondents are highly aware of the risks involved with using digital technologies, with nearly a third stating that, in practice, it can reinforce avoidance distraction and dissociation; a quarter agreeing that it weakens boundaries for clients; and 14% concluding that it increases client vulnerability.
“Some key issues regarding disadvantages are digital inequalities,” says Wood. “With more services being delivered online and relying on mobile technology, those without these technologies will get excluded. Other disadvantages result from technologies’ impact on relationships and individuals’ relationship with themselves.”
Nearly half of all respondents indicated they were open to the idea of incorporating these techniques into their work. Wood believes this is an area that requires active investigation, particularly because the technological realm is undergoing constant change.
I think it’s a double-edged sword…
Like Wood, Branson recognises that emerging technologies can be used as a meaningful tool for self-expression, but they can also have a darker side.
“I think it’s a double-edged sword… The danger with all of those emerging technologies is that it makes everything so accessible to everybody, instantly, and you open yourself up to a lot of support, but you also open yourself up to a lot of negativity that can be counterproductive towards that. I think it’s a very powerful thing that can be used both for and against you in a way.”
Research is taking place within the e-Health industry, especially based on data released from the Office for National Statistics in 2018, showing 90% of adults in the UK are recent internet users.
One organisation in this field is the NIHR Mental Health MindTech Co-Operative, a research centre working to stimulate the development and evaluation of technologies for mental healthcare, developed as a partnership between the University of Nottingham and the local NHS mental health trust.
Dr Jennifer Martin, programme manager with MindTech, says the use of digital mental healthcare has rapidly expanded over the last five years.
Being able to open up treatment through the simple use of the internet is enabling people to connect with therapists
“We have a really broad brief and we focus on pretty much all areas of mental health and all types of technology,” she says. “That ranges from things like apps, self-care and technologies all the way up to brain stimulations. We have been running for about five-and-a-half years, and the majority of what we do now is digital or has a major digital component.”
Dr Martin explains that online technology is continuing to break down barriers, particularly by opening up access to mental healthcare treatments for the wider community. Nowadays, people can connect with clinicians, seek support and gain information all from the comfort of their own home. This is proving to be highly beneficial for those living in regional areas and, in particular, for those who have difficulty communicating face-to-face
“There are specific aspects about mental health that make digital really relevant and a real opportunity. Within mental health, the big issue that we face in this country is the lack of access to treatment. We know that the vast majority of people with a mental health condition aren’t able to access treatment. So, being able to open up treatment just through the simple use of the internet is enabling people to connect with therapists.”
Last year it was virtual reality, and this year it’s certainly machine learning and artificial intelligence.
Dr Martin says digital media is opening up infinite possibilities within her field, with technologies such as virtual reality and artificial intelligence pushing the boundaries like never before. MindTech is currently working on research projects with both of these technologies and collaborating with researchers, such as Daniel Freeman from Oxford University, who are using virtual reality to help people with psychosis, such as those with a fear of heights.
“It’s interesting that every year there is a new thing that everyone is talking about. When we first started, it was apps. Last year it was virtual reality, and this year it’s certainly machine learning and artificial intelligence.
“What’s really exciting is that they’re using virtual reality to deliver psychological treatments. Not only are the results showing that using virtual reality to deliver treatment is as good as traditional face-to-face treatment, it suggests it could be better. In virtual reality, you can have so much more control over the situations you put people in. You can increase the intensity, you can lower the intensity and you can control it in a way that you can’t in the real world.”
For Dr Martin, a major benefit of digital technologies is the relatively low cost.
“The cost of the technology has dropped in the last few years. Three or four years ago, headsets and all the other kits — you were talking multiple thousands of pounds. Now the headsets are three or four hundred pounds, becoming much more portable, with fewer wires. So, it’s very much a scalable option.
“It’s incredibly low cost. If you think about the cost of seeing someone face-to-face and having a few sessions of behavioural therapy, it is in the thousands. Whereas — and we’re still putting a definite cost on this — somebody can have ten weeks of an evidence-based treatment, supported by an NHS clinician, without having to travel anywhere, for a few hundred quid.”
We want to get people tools that are helpful and give people autonomy
According to Dr Martin, it is not just about recreating or digitising our existing ways of treatment. The aim is to supplement or “blend” digital technology into traditional methods, rather than replacing them.
“The research that we and colleagues have done show that people have concerns. They’re interested in technology, but people have lots of concerns in terms of receiving treatment. They don’t want the human component taken out of that.
“The same with practitioners. They want technology to support them — to be able to deliver more treatment and better treatment but, obviously, not to take away from their expertise.”
But she agrees that despite the dangers, it is clear that these platforms have the potential to revolutionise our approaches to mental healthcare in the future.
“We’re doing some really interesting work about understanding how to use information to give people insights into their own mental health and then helping them develop their own strategies.
“We want to get people tools that are helpful and give people autonomy and the ability to look after themselves, but also recognise that we need to provide people support and that people need access to flexible and responsive health systems.”
Kerryn Hildebrand Nelson 20th November 2018