This document discusses the potential future of psychiatry, including increased use of computerized therapies, virtual reality applications, and brain implants. It outlines how e-therapies could help address issues like rising demand, costs, and wait times by providing more convenient treatment options. However, evidence on the effectiveness of these technologies is still limited, and they raise ethical concerns around monitoring, privacy, and potential reinforcement of inequalities. Overall the document considers the opportunities for innovation in mental healthcare through new digital technologies while also noting important challenges and unanswered questions that need further research and policy guidance.

1. The Psychiatry of the Future: computerized
therapy, virtual reality, brain implants and other
fantasies

2. Are computerized-therapies
the way of the future?

3. The past
• First healthcare revolution 1850 to 1960 –
antibiotics, advances in physiology and anatomy
• Second healthcare revolution 1960 to 2000 – stents,
transplants, randomized controlled trials

4. The present 2013
Problems in healthcare
organisations
Harm
Waste
Variation
Inequity
Failure to prevent
Challenges
Rising demand
Increased need
Financial restraints
Carbon restraints

5. Third Healthcare Revolution
• Driven by citizens, knowledge, personal computing
focused on patients
• Personalised medicine (usually genes but also applies
to habits)

6. The future

7. Why e-therapies
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•
•
•
•
•
•
Sooner, more convenient, no waiting lists
No stigma
Can be tailored for specific groups
Addresses work force problems
Cost effective?
Better?
New treatments?

9. Problems with new technologies
•
•
•
•
•
•
Reinforce inequalities – access and language
Limited evidence of effectiveness
Ethics of monitoring
Rapidly outdated
Privacy and risk issues
Seductive (!)

10. Do they work?
• Recommended by NICE for mild to moderate
depression and anxiety
• But evidence not strong and in non-clinical
populations.

13. Issues with RCT’s
• Sample – “community” versus clinical often self
selected
• Control - waiting list or treatment as usual
• Drop out rates high – 25-40% but comparable to
other psychotherapies
• Little information about acceptability or feasibility

14. E-therapies
1. First generation – “books on-line”
2. Second generation – some on-line interaction – fill
in questionnaires, answer quizzes, learning by
gaming (SPARX)
3. Third generation – integration with mobile
phones/email/smart devices
4. Fourth generation – smart environments and
“mobile therapist”

23. National Depression Initiative
• Reduce stigma
• Educate GP’s – guidelines, training
• John Kirwan – Depression.org.nz
– Social marketing
– E-therapy for mild to moderate depression
– Telephone help line

27. Journal Lesson Activity
#1
13,020
#2
2,350
#3
3,700
#6
650
1,700
1,100
1,200
June 2010 to July 2011
700,000 visitors
20, 000 registered with The Journal
13,020 active users

29. Opportunity for innovation
• Not limited to replicating face to face therapies
• Scope for innovation – gaming, use of social
marketing

30. Virtual reality
• Mainly phobias and anxiety
• But in future possibility of reliving the past

31. Augmented reality
• Google glasses – “reality based feedback”

32. Robots

33. Brain implants
• Brain stimulation
• Memory chips

34. Policy?
• Current IT policy focuses on infrastructure
• No mechanism for rolling out – budget line,
integration into existing clinical pathways, who
would “manage” it; evaluation
• Integration with workforce planning
• Need to plan for innovation and obsolescence
• Confidentiality and risk (need to protect from
legislation)
• Professional and provincial boundaries

35. Contacts
• shatcher@uottawa.ca (email)
• @shatchernz (twitter)
• http://uottawapsychiatry.blogspot.ca/ (blog)