Why we offer the Worrinots app free to parents and guardians in Scotland
Date: Tuesday 30 Jul 2019
Technology need not be the enemy in the fight for better mental health
‘Digital interventions are a useful tool, but are not sufficient on their own – they’re simply one weapon in what should be an arsenal of options for young people.’
Effective treatment for children with mental illnesses is a pressing issue – so much so, in fact, that a huge chunk of the recent NHS long-term plan was dedicated to it. It’s long overdue: child and adolescent mental health services (CAMHS) are suffering from both lack of funding and under-resourcing, with young people subsequently forced to wait months or even years for treatment.
The plan has numerous suggestions: more money pumped into services, for one, an overhaul of crisis care, early intervention. But, according to the National Institute for Health and Care Excellence (Nice), there could be another way to combat the issue: apps. They’re recommending that the NHS administer cognitive behavioural therapy via phones and computers – therapy specifically designed to help five- to eight-year-olds.
There are plenty of benefits. Studies have shown that digital CBT is cost-effective – surely a big pull for an NHS currently under so much strain. It also, of course, does away with waiting lists, a huge problem for young people seeking help. Nice also stress that digital CBT should be offered to children “with continuing symptoms of mild depression who do not have other significant health conditions or suicidal thoughts” – which means more intensive services could be freed up for children with more severe problems.
It’s likely that naysayers will bring the age-old issue of screen time into it; too much of it, popular wisdom goes, is actually harming children’s mental health. Surely spending more time on a phone is going to be bad for a child with anxiety or depression? But this has largely been debunked. In January, the Royal College of Paediatrics and Child Health released guidance on the issue that put “sleep, exercise and family interaction” on the top of the agenda – not screen time. A recent Oxford University study published in Nature also found no link between mental illness and technology: in fact, eating potatoes had a similarly significant effect on adolescent mental health, a far more mundane and less dystopian discovery.
That doesn’t mean that children should just be given an iPad and left alone – of course, some young people will have a problematic relationship with technology, and an entirely sedentary lifestyle, perhaps more likely for those always on their phones, also has a negative impact on mental and physical health. Other research points out that the nature of the content young people are engaging with makes a big difference here – not all digital media is made equally. But worries about too much screen time, particularly when it comes to digital CBT, are probably unfounded.
What could be a problem is how the service is used. We all know how stretched the NHS is at the moment, with some reports suggesting that children are being left to “fend for themselves” due to long waiting lists. According to the charity Young Minds, 2017 to 2018 saw more than 500 children waiting over a year to start their treatment. Half of the 11,482 children needing treatment waited more than 18 weeks.
Many of these children could undoubtedly benefit from digital interventions. But – as with face-to-face CBT, or indeed any other form of therapy – they are not a panacea. Yes, evidence suggests that they’re effective. But we have to make sure that they’re not presented as the only option – that they’re not simply being prescribed to avoid additions to already busy waiting lists.
We also don’t know how the service will be implemented; some experts suggest that the NHS is not best placed to deliver digital interventions, and Dr Max Davie, officer for health promotion at the Royal College of Paediatrics and Child Health, has raised similar concerns. The binary discourse around technology rears its head again here: it’s not the end of the world that children are using their phones a lot. But equally, technology is not a perfect solution either.
Mental illness presents in complex, multi-faceted ways; treatment should reflect that. Digital interventions are a useful tool, but are not sufficient on their own – they’re simply one weapon in what should be an arsenal of options for young people. Sometimes, children will need support that isn’t delivered via app – and it’s key that these cases do not fall through the cracks. Technology may not be as dystopian as its critics want us to believe – but it’s no utopia, either. It’s vital that it’s not seen as a quick fix – because sometimes, effective treatment requires more than just a download.
• Emily Reynolds is the author of A Beginner’s Guide to Losing Your Mind