Driven by Need for Data and Improved Access, Outcomes, the Future of Psychiatry Is Digital

During a presentation about the future of psychiatry at a meeting of mental health professionals, Arshya Vahabzadeh, MD, asked his audience to raise their hands if they were already practicing telepsychiatry.

Scattered around the packed convention center ballroom, just a dozen or a few more participants raised their hands.

“Telepsychiatry is booming,” said Vahabzadeh, the chief medical officer of Brain Power, a neuroscience tech startup that makes artificial intelligence (AI)—based, gamified wearables for people with developmental disorders, like autism, or other brain conditions. More hands would be in the air at the next meeting, he said.

Telepsychiatry is just one example of how technology, and in particular artificial intelligence and machine learning, is changing the future of the profession.

In Vahabzadeh's view, such innovation is sorely needed when one considers the mental health state of America. Vahabzadeh cited such dire facts as the CDC report from 2018, which showed an increased suicide rate in every state between 1999 and 2016, with half of states having an increase of 30% or more. Along with suicides, deaths from alcohol and drugs have risen; in addition, the burden of mental health challenges are increasingly borne by children and teenagers, and whether the patient is a teen or an adult, few people who need mental healthcare actually get it.

But emerging technologies have the potential to push psychiatry into a new era of evidence-based care, with improved treatment and access, he said.

“There are lots of different technologies, but they’re going to come in different stages,” he said, displaying a continuum of such efforts that we are just at the beginning stages of now—using smartphones, telemedicine, and wearable sensors—which will evolve more into AI, virtual reality, augmented reality, natural language processing, genotyping, and neuroimaging.

He noted that the FDA’s first approval for a digital therapeutic—reSET and reSET-O, 2 cognitive behavioral therapy prescription digital therapeutics for substance use disorder and opioid use disorder, respectively—landed in the mental health field.

“Psychiatrists should be proud that we’re part of the digital future,” Vahabzadeh said. These types of digital therapeutics, which are reimbursable, will grow exponentially overs the next 1 to 3 years, he said.

In the case of telepsychiatry, there are several reasons why its use is growing, Vahabzadeh said. The cost of equipment is lower, and both clinicians and patients appreciate reduced travel time. It enables improved access for many populations, and allows for a more dynamic use of a psychiatrist’s time. It has also gained more societal acceptance. States are more supportive of telepsychiatry, as are employers.

An additional type of telepsychiatry, asynchrous telepsychiatry, involves a therapist or nurse practitioner conducting a videotaped interview with a patient, which a psychiatrist can later review. In the future, the video could be stored in the electronic medical record, and run through data analysis and emotion sensing software, Vahabzadeh said.

Another innovation are chat bots, which he said are showing early signs of value, he said. Chat bots are “conversational partners” powered by AI that emit human-like dialogue and behavior.

They can help with psychoeducation and treatment adherence, and have high satisfaction rates, at least as long as the patient does not realize they are not talking to a human, he said.

In the drive for more objective measures of data, speech analysis can screen for a diagnosis of depression or predict conversion to schizophrenia; speech analysis has 90% to 100% accuracy when predicting schizophrenia conversion, he said.

“We’re at a stage where software, not a molecule, can help us treat our patients,” Vahabzadeh said.