Mark Matthews

Computers in talk-based mental health interventions

The cost to society of mental illness is substantial. A large scale international study has identified mental illnesses as the second leading cause of disability and premature mortality in the developed world [Murray, C.L., Lopez, A.D. (Eds.), 1996. The Global Burden of Disease: A comprehensive assessment of mortality and disability from disease, injuries, and risk factors in 1990 and projected to 2020. Harvard University, Cambridge, MA]. Unfortunately, research also suggests that the majority of people suffering from treatable mental health disorders do not have access to the required treatment. Furthermore, even when treatment is accessible many sufferers are unable to successfully engage with professional services [Surgeon General, 1999. Mental Health: A Report of the Surgeon General - Executive Summary, Department of Health and Human Services, Washington, DC, Retrieved August 2006, from http://www.surgeongeneral.gov/library/mentalhealth/home.html; WHO World Mental Health Survey Consortium, 2004. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association, 291(21)]. Computer assisted mental health interventions have the potential to help in addressing this imbalance. However, a review of literature shows that to date this potential has been largely unexplored. One of the primary reasons for this is that few researchers from a HCI or technical background have engaged in this area. The primary purpose of this paper is to provide a foundation and set an agenda for future research on the design of technology for talk-based mental health interventions. Theoretical approaches to the treatment of mental illness are reviewed, as is previous research on the use of technology in this area. Several significant factors effecting design and evaluation are identified and based on these factors a broad set of design guidelines are proposed to aid the development of new technologies. Of the issues identified, ethical requirements along with the sensitivity and stigma associated with mental illness pose particular challenges to HCI professionals. These factors place strict limitations on access to mental health care (MHC) settings by non-MHC professionals and create difficulties for the direct application of traditional HCI methods, such as participatory, user-centred and iterative design. To overcome these difficulties this paper proposes a model for collaborative design and evaluation, involving both HCI and MHC professionals. The development of adaptable technologies is an important element of the proposed approach. The final contribution of the paper is to suggest future research directions and identify ways in which HCI researchers can contribute to this work.

Design and evaluation guidelines for mental health technologies

It is increasingly recognised that technology has the potential to significantly improve access, engagement, effectiveness and affordability of treatment for mental health problems. The development of such technology has recently become the subject of Human-Computer Interaction research. As an emerging area with a unique set of constraints and design concerns, there is a need to establish guidelines which encapsulate the knowledge gained from existing development projects. We present an initial set of design guidelines extracted from the literature and from a series of development projects for software to support mental health interventions. The first group of guidelines pertain to the design process itself, addressing the limitations in access to clients in mental healthcare settings, and strategies for collaborative design with therapists. The second group considers major design factors in the development of these technologies, including therapeutic models, client factors, and privacy. The third group concerns conduct of the evaluation process, and the constraints on evaluating mental healthcare technologies. We motivate and explain these guidelines with reference to concrete design projects and problems.

Personal Investigator: A therapeutic 3D game for adolecscent psychotherapy

Although mental health problems increase markedly during adolescent years, therapists often find it difficult to engage with adolescents. The majority of disturbed adolescents do not receive professional mental health care and of those who do fewer still will fully engage with the therapeutic process (Offer et al. 1991; US Surgeon General 1999). Personal Investigator (PI) is a 3D computer game specifically designed to help adolescents overcome mental health problems such as depression and help them engage more easily with professional mental health care services. PI is an implementation of a new computer mediated model for how therapists and adolescents can engage. The model has its theoretical foundations in play therapy and therapeutic storytelling and applies current research on the educational use of computer gaming and interactive narrative systems to these foundations. Previously demonstrated benefits of computer games and interactive narrative systems in education include increased motivation, increased self-esteem, improved problem solving and discussion skills and improved storytelling skills (Bruckman 1997; Bers 2001; Robertson 2001; Robertson and Oberlander 2002; Bers et al. 2003; Squire 2003). PI aims to take advantage of these benefits in a mental health care setting. PI incorporates a goal-oriented, strengths based model of psychotherapy called Solution Focused Therapy (SFT). By engaging adolescents, in a client-centred way, it aims to build stronger therapeutic relationships between therapists and adolescents. PI is the first game to integrate this established psychotherapy approach into an engaging online 3D game. Results of trials of PI with four adolescents, referred to clinics for issues including anxiety and behaviour problems, attempted suicide, and social skills difficulties, are presented.

In the mood: engaging teenagers in psychotherapy using mobile phones

Mental illness is a significant and growing problem throughout the world. Many mental health problems have their root in childhood, and early intervention is recommended. Engaging young people in psychotherapeutic activities is challenging, and treatment adherence is often poor. This paper presents a series of studies carried out as part of the development of a mobile and online symptom tracking tool for adolescents with mental health problems. Teenagers use the system to record symptoms on their mobile phones and can view this information in a clinical setting with a therapist. We focus on a clinical pilot of the system with ten users in public mental health clinics. As well as indicating that the mobile diary tool can increase client adherence to therapeutic activities, the study yields insight into the factors influencing the success of the design and informs the design of other systems to be used as adjuncts to therapy.

Mobile Phone Mood Charting for Adolescents

Mobile phones may provide a useful and engaging platform for supporting therapeutic services working with adolescents. This paper examines the potential benefits of the mobile phone for self-charting moods in comparison to existing methods in current practice. The paper describes a mobile phone application designed by the authors which allows adolescents to record moods on their personal mobile phones. The authors propose that a personal mobile device is more suitable for adolescents than other devices. A pilot study with a non-clinical adolescent group in schools comparing a mobile and a paper diary is presented, along with discussion and analysis of the results. The main finding of the study was that compliance was significantly higher on mobile phones than paper, and the task was not found to be any more difficult to complete using mobile phones than with paper charts. A number of salient issues requiring further research are also identified.

My mobile story: therapeutic storytelling for children

This paper describes the design, evaluation and rationale behind a multimedia message service (MMS) based therapeutic system for adolescents attending therapy. The mobile phone is used to assist clients in engaging with therapy through the completion of structured therapeutic tasks. Content is gathered by the client with the phone, and browser-based software is then used to structure the content during a face-to-face therapeutic session. We discuss initial findings including the potential for engaging clients in remote therapeutic activities and the importance of client control over access to their content. We also consider several practical issues concerning the design and evaluation of software to be used in clinical settings.

FEATURE The invisible user

“Psychotherapy for Children and Adolescents.” Annual Review of Psychology 54 (2003): 253-276. The World Health Organization estimates that approximately one million people per year commit suicide. Mental disorders such as depression are responsible for more than 90 percent of these deaths. In fact, depression is the leading cause of disability in the developed world, and the human and economic cost of mental illness is reaching crisis proportions. The stigma surrounding mental health issues exacerbates the problem, and many people are unable or reluctant to engage in and access effective treatment. Technology can help address these key problems of access and engagement, particularly for younger people. Interaction design has an important role in developing innovative and worthwhile applications that support the user in an effective way. Given the scale of the problem, even small changes in the effectiveness of mental health services could have a big impact. Ethnographies, user observation, focus groups, cultural probes, think-alouds, interviews—these are just some of the tools designers have come to rely on. In mental health cases, the introduction of not just the technology but also the designer could be detrimental. What happens when you can’t talk to the user, when they can’t be approached or observed, when they are effectively invisible? The most significant challenge we have faced working with children and teenagers affected by mental health issues is how to develop useful systems where there is little or no direct access to end users? Software that does not consider users’ needs and is difficult to use can present another barrier to treatment. While the ethical restrictions that limit access are in place for valid reasons, they leave us with a need for new methods to address the lack of involvement of the end user. Over the past five years, our group at Trinity College Dublin, in collaboration with the Mater Hospital Child and Adolescent Mental Health Services, has developed several systems in a range of services that are in clinical use today: “Personal Investigator,” a 3-D computer game; “Mobile Mood Diary,” a personal diary system; and “My Mobile Story,” a multimodal storytelling system. Design and evaluation activities have involved 26 different service providers, including schools, hospitals, charities, and specialist clinics.