Digital Mental Health for Young People: A Scoping Review of Ethical Promises and Challenges

Mental health disorders are complex disorders of the nervous system characterized by a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Mental illness is of particular concern for younger people. The WHO estimates that around 20% of the world's children and adolescents have a mental health condition, a rate that is almost double compared to the general population. One approach toward mitigating the medical and socio-economic effects of mental health disorders is leveraging the power of digital health technology to deploy assistive, preventative, and therapeutic solutions for people in need. We define “digital mental health” as any application of digital health technology for mental health assessment, support, prevention, and treatment. However, there is only limited evidence that digital mental health tools can be successfully implemented in clinical settings. Authors have pointed to a lack of technical and medical standards for digital mental health apps, personalized neurotechnology, and assistive cognitive technology as a possible cause of suboptimal adoption and implementation in the clinical setting. Further, ethical concerns have been raised related to insufficient effectiveness, lack of adequate clinical validation, and user-centered design as well as data privacy vulnerabilities of current digital mental health products. The aim of this paper is to report on a scoping review we conducted to capture and synthesize the growing literature on the promises and ethical challenges of digital mental health for young people aged 0–25. This review seeks to survey the scope and focus of the relevant literature, identify major benefits and opportunities of ethical significance (e.g., reducing suffering and improving well-being), and provide a comprehensive mapping of the emerging ethical challenges. Our findings provide a comprehensive synthesis of the current literature and offer a detailed informative basis for any stakeholder involved in the development, deployment, and management of ethically-aligned digital mental health solutions for young people.

[1]  John Torous,et al.  Confidentiality and Privacy for Smartphone Applications in Child and Adolescent Psychiatry: Unmet Needs and Practical Solutions. , 2017, Child and adolescent psychiatric clinics of North America.

[2]  K. Shadan,et al.  Available online: , 2012 .

[3]  Yusen Zhai,et al.  Addressing collegiate mental health amid COVID-19 pandemic , 2020, Psychiatry Research.

[4]  F. Griffiths,et al.  Ethical implications of digital communication for the patient-clinician relationship: analysis of interviews with clinicians and young adults with long term conditions (the LYNC study) , 2018, BMC Medical Ethics.

[5]  P. Uhlhaas,et al.  Digital tools for youth mental health , 2019, npj Digital Medicine.

[6]  C. J. Carter,et al.  Accessing Online Data for Youth Mental Health Research: Meeting the Ethical Challenges , 2019 .

[7]  Jaakko Hakulinen,et al.  Socio-Technical Aspirations for Children with Special Needs , 2020, ACM Trans. Access. Comput..

[8]  Eduard Fosch Villaronga,et al.  Privacy and Security Issues in Assistive Technologies for Dementia , 2019, Intelligent Assistive Technologies for Dementia.

[9]  Derek Bolton,et al.  What Is Mental Disorder? an Essay in Philosophy, Science, and Values , 2008 .

[10]  Tim Kendall,et al.  Predicting suicide following self-harm: systematic review of risk factors and risk scales. , 2016, The British journal of psychiatry : the journal of mental science.

[11]  J. Trollor,et al.  Barriers and Enablers to Accessing Mental Health Services for People With Intellectual Disability: A Scoping Review , 2018 .

[12]  Daniel Polsky,et al.  Internet-delivered treatment for substance abuse: a multisite randomized controlled trial. , 2014, The American journal of psychiatry.

[13]  P. Henningsen,et al.  Your Robot Therapist Will See You Now: Ethical Implications of Embodied Artificial Intelligence in Psychiatry, Psychology, and Psychotherapy , 2018, Journal of medical Internet research.

[14]  Adrian B. R. Shatte,et al.  Machine learning in mental health: a scoping review of methods and applications , 2019, Psychological Medicine.

[15]  Anne Williford,et al.  Educators' perceptions of youth mental health: Implications for training and the promotion of mental health services in schools , 2017 .

[16]  Nicholas J Carson,et al.  Assessment of Digital Media Use in the Adolescent Psychiatric Evaluation. , 2018, Child and adolescent psychiatric clinics of North America.

[17]  Helen Nissenbaum,et al.  Technology, Autonomy, and Manipulation , 2019, Internet Policy Rev..

[18]  H. Whiteford,et al.  Resources for mental health: scarcity, inequity, and inefficiency , 2007, The Lancet.

[20]  David Brent,et al.  Short-term prediction of suicidal thoughts and behaviors in adolescents: Can recent developments in technology and computational science provide a breakthrough? , 2019, Journal of affective disorders.

[21]  Coronavirus: Impact on young people with mental health needs , 2020 .

[22]  R. Forehand,et al.  Incorporating Mobile Phone Technologies to Expand Evidence-Based Care. , 2015, Cognitive and behavioral practice.

[23]  Nicole Martinez-Martin,et al.  Ethical Issues for Direct-to-Consumer Digital Psychotherapy Apps: Addressing Accountability, Data Protection, and Consent , 2018, JMIR mental health.

[24]  Emily G Lattie,et al.  Digital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review , 2019, Journal of medical Internet research.

[25]  Anne Marie Piper,et al.  Conformity of Eating Disorders through Content Moderation , 2020, Proc. ACM Hum. Comput. Interact..

[26]  K Ann McKibbon,et al.  Health Information Technology to Facilitate Communication Involving Health Care Providers, Caregivers, and Pediatric Patients: A Scoping Review , 2010, Journal of medical Internet research.

[27]  Sarah Bendall,et al.  Online and Social Media Suicide Prevention Interventions for Young People: A Focus on Implementation and Moderation. , 2016, Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent.

[28]  M. O’Reilly,et al.  Applying a ‘digital ethics of care’ philosophy to understand adolescents’ sense of responsibility on social media , 2020, Pastoral Care in Education.

[29]  F. Kay-Lambkin,et al.  Disclosure of suicidal thoughts during an e-mental health intervention: relational ethics meets actor-network theory , 2019 .

[30]  Eduard Fosch Villaronga,et al.  Nothing comes between my robot and me: Privacy and human-robot interaction in robotised healthcare , 2018 .

[31]  B. Pfefferbaum,et al.  Mental Health and the Covid-19 Pandemic. , 2020, The New England journal of medicine.

[32]  M. Ienca,et al.  Intelligent Assistive Technology for Alzheimer's Disease and Other Dementias: A Systematic Review. , 2017, Journal of Alzheimer's disease : JAD.

[33]  K. Berry,et al.  “They Are Not Hard-to-Reach Clients. We Have Just Got Hard-to-Reach Services.” Staff Views of Digital Health Tools in Specialist Mental Health Services. , 2019, Front. Psychiatry.

[34]  John Torous,et al.  Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow , 2020, JMIR mental health.

[35]  C. Depp,et al.  Artificial Intelligence for Mental Health and Mental Illnesses: an Overview , 2019, Current Psychiatry Reports.

[36]  B. Druss,et al.  Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. , 2015, JAMA psychiatry.

[37]  Johnny Downs,et al.  Informing the development of an E-platform for monitoring wellbeing in schools: involving young people in a co-design process , 2020, Research Involvement and Engagement.

[38]  C. Grové Using Social Networking Sites in Research: An Emerging Approach to Engaging With Young People Who Have a Parent With a Mental Illness and/or Substance Abuse Disorder , 2019, Front. Psychiatry.

[39]  I. Singh,et al.  Can Your Phone Be Your Therapist? Young People’s Ethical Perspectives on the Use of Fully Automated Conversational Agents (Chatbots) in Mental Health Support , 2019, Biomedical informatics insights.

[40]  Katherine Isbister,et al.  "I just let him cry... , 2018, Proc. ACM Hum. Comput. Interact..

[41]  Elizabeth D. Mynatt,et al.  Exploring Indicators of Digital Self-Harm with Eating Disorder Patients , 2019, Proc. ACM Hum. Comput. Interact..

[42]  E. Emanuel,et al.  Brain leaks and consumer neurotechnology , 2018, Nature Biotechnology.

[43]  Yun Huang,et al.  Designing a Chatbot as a Mediator for Promoting Deep Self-Disclosure to a Real Mental Health Professional , 2020, Proc. ACM Hum. Comput. Interact..

[44]  B. Druss Addressing the COVID-19 Pandemic in Populations With Serious Mental Illness. , 2020, JAMA psychiatry.

[45]  P. Reiner,et al.  Oversight of direct-to-consumer neurotechnologies , 2019, Science.

[46]  Jukka Varelius,et al.  The value of autonomy in medical ethics , 2006, Medicine, health care, and philosophy.

[47]  J. Geddes,et al.  Ethical perspectives on recommending digital technology for patients with mental illness , 2017, International Journal of Bipolar Disorders.

[48]  Madhu Reddy,et al.  Three Problems With Current Digital Mental Health Research . . . and Three Things We Can Do About Them. , 2017, Psychiatric services.

[49]  Tjeerd W. Boonstra,et al.  Using smartphone sensor technology for mental health research: Clear obstacles and hidden challenges , 2018, ArXiv.

[50]  John Torous,et al.  The Emerging Imperative for a Consensus Approach Toward the Rating and Clinical Recommendation of Mental Health Apps , 2018, The Journal of nervous and mental disease.

[51]  H. Turunen,et al.  Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. , 2013, Nursing & health sciences.

[52]  Jonathan Cave,et al.  Timely Digital Patient-Clinician Communication in Specialist Clinical Services for Young People: A Mixed-Methods Study (The LYNC Study) , 2017, Journal of medical Internet research.

[53]  Jeremy W Coid,et al.  The futility of risk prediction in psychiatry. , 2016, The British journal of psychiatry : the journal of mental science.

[54]  Nitish Thakor,et al.  Empowering 8 Billion Minds: Enabling Better Mental Health for All via the Ethical Adoption of Technologies. , 2019, NAM perspectives.

[55]  T. Suppes,et al.  Online ethics: where will the interface of mental health and the internet lead us? , 2017, International Journal of Bipolar Disorders.