In the post-COVID-19 era, the increased utilization of Telemedicine comes as no surprise; Telepsychiatry and digital mental health applications are no exceptions. The WHO estimates that around 13% of children and adolescents aged 10 to 19 years experience mental health disorders, with suicide being the fourth leading cause of death among those between 15 and 19 years of age.1 Given the uncertainty of the world faced by youth, the correspondingly increasing prevalence of mental health problems, and the exponentially growing involvement of digital psychiatry in managing patients; now is the time to weight the benefits and the risks of applying digital mental health in child and adolescent psychiatry.
On one hand, Prof. Mona El Sheikh, Ain Shams University, backed up digital psychiatry. Her rationale mainly emerged from the increased burden of psychiatric disorders in children and adolescents accompanied by the shortage of psychiatrists specialized in this age group in addition to the “aging-out effect” of the workforce. She advocated for telepsychiatry because of its ability to improve patients’ access to mental health specialties in areas where these specialties would otherwise be unavailable (for example, distant and rural areas), to reduce the need for trips to the emergency room, to reduce potential transportation barriers, to reduce the time needed off work to access appointments far away, and to overcome the societal stigma barrier associated with seeking mental health help. In addition, she pointed out that telepsychiatry enables psychiatrists’ access to providing treatment in countries where they are not licensed to work.
However, Prof. Elsheikh highlighted that telepsychiatry is not suitable for all patients. Eligibility should be based on the ability of the individual to function well in unsupervised settings, the adequacy of their developmental status, and the lack of a history of aggression, self-harm, and non-cooperation with service providers. Further, she stressed that parental informed consent should be obtained prior to any appointments with children and adolescents. As for digital health interventions, she mentioned the following advantages: accessibility, anonymity, prompt feedback, cost-effectiveness, applicability in real-life contexts, and high treatment accuracy and reliability.
On the other hand, Dr. Dina Elgabry, Ain Shams University, was against the widespread employment of Telepsychiatry and digital mental health. She explained that digital psychiatry is inevitably coupled with privacy and confidentiality risks; with the biggest concern being the fate of confidential information shared with third parties. In accordance, patients’ trust in their psychiatrists or psychotherapists may be lost, negatively affecting the doctor-patient relationship. Mentioning the latter, she added that telepsychiatry could possibly blur the boundary in this relationship, given the possible unrealistic expectations of around-the-hour availability of psychiatrists. Moreover, Dr. Elgabry underlined that accessibility to technology is not equally distributed among patients. She explained that not all patients are digitally literate, nor do all have good network coverage or can afford the cost of digital communication.
When it comes to digital mental health technologies specifically, Dr. Elgabry mentioned that they raise the risk of diminishing the patient’s autonomy by increasing the risk of digital addiction and manipulation. She added that these technologies are often unvalidated clinically, which puts their reliability at stake. To date, there are no ethical and regulatory guidance for digital mental health technologies.
The possibility of dependency was also raised by Dr. Elgebaly. She explained that digital psychiatry could negatively influence the youth’s social interactions’ capabilities, diminishing their trust to open up to family and friends, and increasing their addictive behaviors and dependency on clinical support.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
1. World Health Organization. Adolescent Mental Health - Key Facts. Published 2021. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-heal…