The digital divide

Sometimes adding technology doesn't deliver the results we want

At its launch in 2016, Pokémon Go had over 232 million active players worldwide. You may recall this phenomenon, where people were walking all over, phones out, looking to “catch” a Pokémon. The app was based on your location, and would plant various Pokémon, rare or otherwise, all over your community. There were stories of people driving miles just because there had been a rumor that a specific Pokémon was seen in that location. The company who created this app did quite well, too. Niantic, the company behind Pokémon Go, valuation skyrocketed from $150 million before launching Pokémon Go to $9 billion by 2021, with Pokémon Go remaining the company's most successful and lucrative game.

One systematic review examined the effects of Pokémon Go on our health. Out of 1534 (!!!) articles initially identified, 59 met the inclusion criteria. First, I had no idea that this much literature had been created off of one app where chasing magical creatures was the point, but I digress. Interestingly, the systematic review found that Pokémon Go significantly boosted physical activity, reducing sedentary time and promoted outdoor engagement, though apparently these benefits only lasted as long as you were playing the game. The review also found positive mental health effects, which included improved well-being, reduced psychological distress, and enhanced cognitive performance, with minimal negative impacts noted. And finally, research found that the game fosters increased social interaction, reduced social anxiety, and strengthened relationships. If you ever played with the app, it wasn’t uncommon to find others out on a hunt that you could talk to about the game.

As down as I can be sometimes on mental health apps and technology, there are some wonderful benefits when used properly. While Pokémon Go was not created to improve our mental health, it did have that impact for some. I can’t say this about even some of the best mental health apps out there! But there are some digital tools that we should be looking at for better addressing mental health.

Telehealth, while still a technology and not an app, per se, has consistently shown positive mental health outcomes. It has expanded access to care, particularly for those in rural or underserved areas, breaking down barriers like transportation and geographical limitations. Adding in video increases the level of intimacy and connection, which comes closer to in-person therapy while helping establish and maintain therapeutic relationships. Additionally, telehealth has proven to be effective in crisis situations, giving us that immediate support when it is needed most. It has also facilitated continuity of care, allowing patients to maintain regular sessions with their therapists regardless of physical location - think back on COVID-19 and what a difference this made.

Beyond telehealth, other technologies such as AI-driven chatbots and digital cognitive-behavioral therapy (CBT) programs also show some promise. Like telehealth, these tools can offer support and interventions, helping individuals manage their symptoms in real-time. While the evidence is still building, AI chatbots can provide 24/7 support, giving users access to coping strategies and emotional support outside of traditional therapy hours, which may be exactly what some people need. Digital CBT (Cognitive Behavioral Therapy) programs can offer structured and evidence-based interventions, helping individuals develop skills to manage their mental health independent of their therapy.

To support, and perhaps scale these tools, CMS recently has put out a new proposal that reimburses doctors through Medicare for digital mental health therapies, including apps and software. This marks a significant step forward to help with the broader adoption of digital therapeutics, especially those that are evidence-based and improve outcomes. CMS’s creation of payment codes for FDA-approved digital treatments starts in 2025 and could begin the process to get more consistent insurance coverage. While exciting, I keep wondering if this is a significant advancement in integrating innovative mental health solutions into mainstream care or just another distraction that takes us away from good care?

Sure, technology or more specifically mobile apps offer a platform for reaching countless, but we know that engagement is often low, effectiveness varies, and there are usually a lack of consistent care pathways for someone who gets these tools. How do we better leverage technology to bridge the divide? I think that's something we're going to learn a lot more about now that CMS is paying for this.

The academic in me screams for more rigorous evaluation and continuous improvement opportunities. Having robust frameworks for assessing the effectiveness and safety of these technologies is a good place to start. One article highlighted seven different frameworks for just this, with a focus on patient safety. Beyond frameworks, we also need longitudinal studies to understand their long-term impact on mental health outcomes and find any potential risks or areas where we see disparities. Without collaboration between technology developers, mental health professionals, and policymakers, it’s going to be hard to create standards and guidelines that ensure these tools are used appropriately and ethically.

However, as I have said over and over again, the efficacy of these tools largely depends on their proper use and integration into broader care systems. Simply dropping in technology on an already broken system doesn’t solve the problem. And while technology will never replace human connection, it can be seen as a tool to enhance it, providing additional layers of support and accessibility. But no matter what, it's crucial to ensure that these digital solutions are backed by robust evidence and are used as part of a comprehensive strategy that prioritizes things we often fail at like equity and inclusion. This requires training and supporting mental health professionals to use these technologies effectively and developing specialized training programs and resources that help clinicians understand how to use digital interventions alongside traditional therapeutic approaches.

Furthermore, we need to prioritize accessibility and inclusivity in the development and deployment of these technologies. Designing digital tools that are user-friendly and accessible to diverse populations, including those with disabilities, language barriers, and limited technological proficiency is a must. We also must make sure they are widely available and reach those who may not have access to traditional services.

Finally, it's essential to foster a culture of trust and acceptance around digital mental health tools. This involves transparent communication about the benefits and limitations of these technologies, something we don’t do very well, alongside our need to address the ever present concerns related to privacy and data security. By building trust and providing clear information about how data is used and protected, we can encourage more people to engage with these tools.

While it’s not as fun as catching a Pikachu, technology still holds great promise for enhancing mental health care if we know how to use it right. And who knows, maybe, just maybe there is a thing or two we can learn from Pokémon Go.