Tech-based mental health interventions offer new hope for India’s under-served population

Shakoor Rather: AI and machine learning to assess mental health status and even suicidal tendencies, apps and telehealth consults... technology is the new frontier in the battle against mental health disorders and also the crucial bridge between India's 1.38 billion population and less than 9,000 psychiatrists. At an average of 0.75 mental health medicos for every 100,000 people, the anomaly in numbers is reflected on the ground where millions of people battling the spectrum of mental health issues continue to suffer – because of stigma and ignorance but also because there are just not enough trained mental health professionals. And this is where technology-based interventions come in, their use a critical development in addressing the significant gap between the need for mental health services and the availability of trained professionals, said experts. The challenges many but some solutions now at hand.

“The mental health treatment gap in India varies from 70 to 92 per cent across a range of psychiatric disorders,” Dr Alok Kulkarni, senior consultant psychiatrist at the Manas Institute of Mental Health in Hubli, Karnataka, said. "India has less than 9,000 psychiatrists for a population of 1.38 billion. This is where tech-based interventions become relevant," he added.

India's 0.75 psychiatrists per 100,000 population is far less than the desirable number of more than three psychiatrists, according to an article in the Indian Journal of Psychiatry. “Mental health professionals can be reached faster through mediums such as WhatsApp. During the Covid pandemic, a lot of supportive interventions took place through video calls. The pandemic also lent credence to the feasibility of telepsychiatry practice," Kulkarni explained.

Telehealth, social media apps, AI, robots, algorithms, and many more cutting-edge technologies are providing the public, doctors and researchers new ways to access help, monitor progress, and increase understanding of mental well-being. The interventions, experts said, cater to a range of services - from counselling and symptom management to providing treatment options. By leveraging technology, mental health professionals can reach a wider audience and provide more accessible care.

"Using machine learning algorithms, I have developed a model which can predict the chance of attempt of suicide by an individual, by analysing their behaviour," Anju Bhandari Gandhi from Panipat Institute of Engineering and Technology (PIET) in Haryana said. "The algorithms classify the mental status of an individual in different categories and according to their level of stress, the precautions or medication can be taken or given," she noted.

Machine learning is a form of AI that focuses on the use of data and algorithms to imitate the way that humans learn. Gandhi, lead author of a study recently published in the International Journal of Biomedical Engineering and Technology, said posts shared by an individual can be analysed by AI and machine learning to predict mental status. Their behaviour in society or at home can also be recorded, she added. Anxiety and depression are serious mental health problems that a growing number of people are facing.

These conditions can tragically lead to suicidal thoughts and actions. Researchers in the study analysed modern solutions to help prevent such tragic outcomes. Philanthropist Priya Hiranandani-Vandrevala leads the Cyrus and Priya Vandrevala Foundation, a non-profit that partners with organisations to boost community healthcare. "The use of technology such as telehealth will help drive access to people who do not have access to doctors or healthcare professionals or those that have crippling conditions that mean it is harder to leave home or for those who prefer to be anonymous," Hiranandani-Vandrevala said.

"The vast majority of mental healthcare since Covid is now remote and this now can be embraced strongly to reduce costs and drive access. For instance, 70 per cent of people who contact us now prefer to do it on WhatsApp versus the telephone," she said. The foundation's helpline has facilitated 1,14,396 (over 1.1 lakh) conversations and over 1.7 million messages with 61,258 people from August 2021 till January 2023. “Women may find WhatsApp more private for having such conversations than a phone call," the philanthropist added.

According to the World Health Organization, about seven lakh people die by suicide each year. Many more people attempt suicide and the WHO suggests that a prior attempt is ultimately the biggest risk factor for suicide. Gandhi and colleagues have investigated how computer algorithms can be used to analyse data from patients suffering from anxiety and stress. They compared several different types of algorithms to see which might be best suited to predicting suicidal behaviour based on the patient data. The results are promising.

The team explains that their algorithm was able to predict with 95 per cent accuracy which patients were at risk for suicide. This kind of analysis, they said, could be used to screen patients more efficiently, helping healthcare workers identify those who need help on an urgent basis rather than when it is too late. While technological interventions may prove to be a gamechanger for mental health management, there are still some challenges that must be addressed. Hiranandani-Vanderewala admitted that app-based interventions can never be the same as in-person interventions. "The same can be said about online consultations. This is because a doctor needs to clinically examine the patient to reach a diagnosis," she explained.

Kulkarni said many physical conditions can present with psychiatric symptoms which would require a thorough physical examination mandating an in-person consultation. "A large chunk of India lives in villages. Technology still has to penetrate these places. People should also become conversant in the use of such tech-based interventions to seek mental health help," he said. "Lastly, mental health professionals should also become early adopters of such tech for it to work. If there is resistance from this quarter to adopt this technology, it can pose a serious challenge," the expert noted. Besides, there is a legal challenge with prescribing medications via WhatsApp, as not many pharmacies entertain such prescriptions.

"People can start abusing drugs which may have been prescribed for a short duration. Psychological interventions can be safely practiced via tech mediums. The same cannot be said for the use of psychotropic (antidepressants) medications,” Kulkarni said. As far as AI and robots are concerned, Gandhi said reliable data collection and accuracy of the algorithm used is a big challenge.