A group of international researchers lead by the Department of Pediatrics, Center for Biomedical Ethics, School of Medicine of Stanford University published a research article about ‘Ethics of Digital Mental Health During COVID-19: Crisis and Opportunities’. The COVID-19 crisis has accelerated the adoption and implementation of digital mental health tools (videoconferencing, e-mental health apps). This paper looks at key areas for an ethical path forward in this digital mental health revolution: privacy, data protection, safety, accountability, access and fairness. The eMEN project partners are aware of these key areas, which are also being addressed in the current project activities. eMEN continues to promote high quality, professional, accessible and safe e-mental health.
Below are some excerpts of this article:
“Mental health data is considered more sensitive than other health data and can often be more personal or stigmatizing in nature”.
“Behavioral health information is a valuable commodity, and it is likely that companies will take further advantage of the lax security and privacy landscape. The potentially unchecked collection of user data through consumer mental health technologies, allowing for personal information to connect individual users to mental health concerns (eg, heightened anxiety for fear of infection), could especially violate a user’s right to privacy. For example, people could be targeted for advertisements that take advantage of their anxieties around COVID-19 by drawing behavioral inferences from their personal information. At a time when the need for trust in telehealth and mental health apps has intensified, it is important to ensure accountability and mechanisms to mitigate unauthorized or unpredictable use of mental health data.”
“There are not yet broadly accepted ethical guidelines for the provision of digital mental health care. Digital technology can have disparate risks and benefits for research and treatment in different populations. Furthermore, the majority of consumer apps are not evidence-based and some even contain harmful content”
“With the shift to telehealth, many mental health practitioners found themselves encountering new terrain with insufficient guidance or training. Difficulties include the need for more careful safety planning for patients who are at high risk, maintaining professional boundaries in the newly informal virtual space, and designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist”
“The relative novelty of many digital health tools means there are not yet established standards that courts can use to determine when clinicians fail to meet their duty to patients. There are unclear legal risks involved in cases where a professional relies on a mental health app in an unsuitable case nor is it established how much due diligence a professional is expected to do into the quality and functioning of mental health apps before adoption of them”
“The impact of COVID-19 has laid bare systemic health inequities and exerted a disproportionate impact on vulnerable populations such as older adults, racial and ethnic minorities, people living with disabilities, and people who are homeless”
“Since the pandemic, there has been renewed focus on how the design of health technologies may unfortunately reflect and reinforce existing biases and health disparities. As with other areas of health research and technology, non-White populations are likely to be underrepresented in the data used to develop digital mental health algorithms and tools. Informational and treatment apps also may not be tailored appropriately for people of different racial, linguistic, ethnic, or cultural backgrounds. Even with digital tools that are simply meant to connect patients with mental health providers, the lack of racial and cultural diversity in the pool of clinicians and therapists can create barriers to mental health care”
“Insufficient resources for adequate training of mental health professionals serving low-income demographics may mean that quality mental health care will still not be accessible despite expansion of digital mental health. It is vital for developers, researchers, and clinicians to address potential areas of bias and plan for how to engage culturally diverse populations as well as vulnerable populations. Given that low-income groups may face worse health outcomes from contracting COVID-19 and greater economic uncertainty after the pandemic, they can least afford this result.”
“There is a pressing need for interdisciplinary, coordinated research efforts to understand the effects of this large-scale shift to digital mental health tools. Multidisciplinary efforts should also incorporate the input of people with lived experience of mental health issues. Policy makers must assess whether to adopt new regulations to protect privacy and ensure transparency or whether modification of existing standards will be sufficient. Policy must be developed in conjunction with service users to avoid creating new inequalities in access to mental health. Ultimately, the current crisis may be an opportunity to unpack the great potential for digital mental health tools to improve public health.”
You can read the full article via the weblink below.
