A virtual mental health community – A future scenario

It is the year 2030. National mental health policies have come and gone but mental health problems remain a major challenge in the community. The retirement of ageing mental health professionals has left in its wake a serious workforce shortage. As predicted by 20th century futurologists (Ferguson, 2007), there has been an increasing trend towards the transition of mental healthcare control from professionals to consumers. Consumers have access to personal health budgets, which enable them to control how they purchase healthcare support and governments across the world have formed a consortium to fund a single e-mental health platform. Technology developments have enabled the collection of personal data in patient-controlled records, populated by information collected by means of wearable biosensors, implanted microchips and manually entered data. Gone are the clunky prototype health robots of 2013 and in their place are wearable or miniature implanted personal coaches which receive data wirelessly and transmit guidance via invisible wireless earphones and optical devices. Prototype neural implants including brain computer interfaces (Hampson et al., 2012; Mattout, 2012), enabling synthetic telepathy and automated relapse prediction, have become a reality for some (Warwick, 2012). Disenchanted consumers have long since deserted the Australian government’s e-mental health portal established in 2012.

Enter the virtual mental health community (VMHC). Run on a platform established with funding from the global government consortium, medical insurance and philanthropic bodies, the VMHC is consumer-centred and consumer-run. It is underpinned by a broad community participatory base, and incorporates peer-to-peer support as well as evidence-based mental health services ranging from diagnosis, monitoring and personalized predictive data, to evidence-based information, technology-enabled preventive programs, self-help tools, and group and one-to-one online therapy. The VMHC also provides platforms for developing collaborative enterprises, for crowd sourcing and research to enable consumer-led research. The community provides consumer-delivered virtual mental illness education in schools and workplaces. VMHC employs consumers, mental health practitioners and a multi-disciplinary team of researchers and technologists. Many private mental health professionals have opted to join the community.

A key feature of the community is its peer-to-peer online support facilities which enable consumers and carers to communicate with and support each other in a safe environment. A number of research studies have confirmed the findings from an early 2013 study in which an online peer-to-peer support group can improve mental health outcomes among its members (Griffiths et al., 2013). The VMHC includes a new type of mental health worker – the Virtual Consumer Consultant (VCC). Moderator VCCs are trained to welcome new members and facilitate and moderate the community with the assistance of the V-bot, an automated assistant which uses advanced information retrieval and other techniques to identify potentially problematic public contributions to the community such as discussion of suicide or self-harm. Program VCCs are trained to facilitate members’ use of online, automated therapeutic tools. Each VCC has access to professionals whom they consult or to whom they can refer more complex matters.

Another key element of the VCC is the member’s personally controlled mental health record. Consumers determine to whom and which aspects of this record are available to others. In addition to selecting their own self-care and mutual support activities, members can opt into a system in which their mood levels are tracked using a combination of biosensory and behavioural or neural indicators, speech analysis and adaptive screening, and an automated analysis of the content and pattern of their forum posts. Those with deteriorating profiles receive a message encouraging them to join a virtual chat room led by a psychotherapist (Bauer and Moessner, 2012). Those who are at risk of self harm or require one-to-one therapy are provided with access to an immediate or timely appointment with an online therapist. Face-to-face sessions are rarely required because the technology can create a virtual experience that closely mimics a ‘real-world’ therapeutic experience. However, if the consumer prefers, virtual therapy can be provided via text or voice. Members can choose their therapists after examining the ratings of their previous clients filtered by relevant attributes such as type and severity of condition (e.g. depression), age of client, type of therapy provided, and the ratings and mental health, quality and other relevant outcomes of previous clients.

A third critical ingredient is that the VMHC is a consumer-controlled living virtual mental health discovery centre. Employing methodologies first introduced by broader online health communities such as PatientsLikeMe (Frost and Massagli, 2008) and 23andMe (Lee and Crawley, 2009) in the early years of the 21st century, data from individuals is mined, processed and aggregated, to enable members to view the treatments that worked for others with similar profiles. Based on their profiles, members of VMHC receive suggestions as to which treatments and online programs may be helpful for them. Participants can conduct and publish the findings of their own research using inbuilt survey functions. For example, Samantha has noticed that since she commenced her depression treatment which is delivered via a neural implant in the brain she suffers from unusual toe cramps. She seeks input as to whether others have observed a similar trend. Research VCCs assist members to engage in research on their condition, facilitating linkages with team researchers as required. In response to consumer priorities, computer scientists and bioengineers have teamed up with mental health researchers and consumers to interrogate and mine databases to continue to refine the current algorithms for diagnosing and predicting the recurrence of mental health problems. Consumers continue to undergo genome testing using kits available from the VMHC, teaming up with geneticists in the hope of generating knowledge that will lead to new treatments (Akil et al., 2010; Lee and Crawley, 2009).

Finally, the virtual community comprises a powerful new proactive political force that facilitates mental health advocacy. When the government proposes changes to funding for mental health care, the community quickly mobilizes to organize flash, mass demonstrations and lobbying campaigns to oppose the changes.

The above scenario is one of many. However, there is only one prediction about which we can be certain. It is that there will be e-mental health developments in the future that we cannot predict today. In 1977, Digital Electronic Corporation’s founding president Ken Olsen famously declared, ‘There is no reason anyone would want a computer in their home’. Only time will tell the extent to which the vision of an evidence-based technology-empowered mental health community is realized in the future.