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VOLUME 3, ISSUE 1     PSYCHNEWS INTERNATIONAL          March 1997
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SECTION D: FEATURE ARTICLE


               COMPUTING APPLICATIONS IN MENTAL HEALTH 

                      Martin Briscoe, MRCPsych

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This article gives a brief overview of the types of computing 
applications being used to help professionals and patients in
mental health. 


ASSESSMENT
Programs that could successfully assess and diagnose mental 
health problems were first written nearly 20 years ago. Ray Ancill 
and Tony Carr who at that time were in the UK wrote one such 
program. It ran on a Commodore 64, a wonderful machine with a 
massive 64k RAM! A brief overview of the development of 
computerized assessment written by Reid Hester can be viewed at:
http://www.ex.ac.uk/cimh/hester1.htm 

Suprisingly little development has subsequently taken place in 
this area but two programs are worthy of mention. The SCAN program
administers the ICD10 by bringing up questions on the screen that 
are put to the patient by a trained interviewer. The patient's 
responses are typed back into the computer as the interview 
progresses. At the end of the session the program reviews
the responses and arrives at a diagnosis.

The CIDI-Auto designed by Gavin Andrews in Australia goes one 
step further. It administers the questionnaire directly to 
the patient who then types in the answers. The computer can then
arrive at a diagnosis. The Author says that over 500 patients have
used CIDI-auto in its self-administered form. No one has refused or
complained. Reliability and validity studies have been carried
out. For more details see a paper by Gavin Andrews at:
http://www.ex.ac.uk/cimh/cidart.htm

Many programs have been developed to administer psychological 
tests, the ERIC/AE test locator http://ericae.net/ is said to be
able to acces details of over 10,000 tests and instruments some of
which are computerized. Other databases can be found at Psyclink:  
http://www.plattsburgh.edu/psyclink
Sibyl:
http://indy1.gamma.rug.nl/sibweb/iecsibfr.html
or at Bob Bischoff's shrinktank which holds many downloadable 
items:
http://www.shrinktank.com 


TREATMENT
This for me is the holy grail. Imagine being able to spend ones
life skiing and sailing while all your patients are being treated
by robots! Professor Isaac Marks has been at the forefront of
this field for many years, his most recent project is BTsteps,
a computer-aided behavioral self-help system for Obsessive-
Compulsive Disorder. This program administers a treatment 
program over the telephone:
http://www.ex.ac.uk/cimh/btstep.htm

Another interesting project is Reid Hester's Behavioural 
Self-Control Programm for Windows (BSCPWIN) which has been 
shown to be effective in moderating heavy drinking over a 
1-year trial period:
http://www.ex.ac.uk/cimh/bscpw3.htm.

Ken Kirkby from Australia is working on computerized treatment
of phobias and obsessive-compulsive disorder:
http://www.ex.ac.uk/cimh/ctp.htm 
Another project from Prof Marks department is Fear Fighter, 
a self-help computer program for treating agoraphobia and panic:
http://www.ex.ac.uk/cimh/fear.htm


MONITORING
In addition to Reid Hesters program described earlier which 
monitors alcohol intake, other programs have been designed to
monitor mood swings:
http://www.ex.ac.uk/cimh/moodmon.htm
There are also programs that administer the Hamilton depression
rating scale, the WHO disability scale and others: 
http://ariel.unimelb.edu.au/~lambertt/


ADMINISTRATION
Just like any other profession health workers have to operate 
in a buisness market. In the last 5 years even the UK health
service, for fourty years the provider of free treatment for 
all, has become financially driven. There has also been a
proliferation of paperwork, some therapists in the US have
reported that 40% of their time is spent filling in forms. 
In an effort to overcome these problems a number of programs
have been developed to schedule work, produce the bills and
build databases of patient details which can be used to track
individuals and monitor progress: Details of some such programs
can be found at the CIMH database:
http://www.ex.ac.uk/cimh/welcome.htm 
Another list of providers drawn up by Ed Zuckerman can be 
found at: 
http://www.cmhc.com/guide/pro24.htm

There has been much debate in the UK about ensuring that 
computerized mental health systems are made to be clinically
useful. Something that is unfortunately all too rare. 
A window on the debate can be seen at:
http://www.ex.ac.uk/cimh/courage.htm


ONLINE THERAPY
Many readers will remember Eliza the computer shrink created in
1966 and other similar projects such as Alice. These were not
intended to be treatment programs but demonstrated how it may
be possible for computers to interact with humans, for more
details see
http://www.ex.ac.uk/cimh/chatter.htm

Many therapists now treat people over the net, there are however
many problems about this form of treatment including, measuring
effectiveness, privacy, monitoring standards and medicolegal 
issues. For a discussion on this see: 
http://members.aol.com/stofle/onlinepsych.htm
or Dan J. Stein's paper about an OCD mailing list:
http://www.ex.ac.uk/cimh/stein.htm


SELF-HELP INFORMATION
This is too big an area to discuss in this paper but the Net 
holds a vast amount of very good quality information about mental
health problems. This should lead to benefits to sufferers and
challenges to the professionals as we struggle to stay as 
knowledgable as our patients. An excellent list of resources 
can be found at: 
http://strauss.ihs.ox.ac.uk/oxamweb.html


FURTHER READING
Fred Cutter's paper from an earlier Newsletter 'Self-Help Software 
on the Web which can be found at: 
http://userpage.fu-berlin.de/~expert/FTP_1_4/PNI4_1.a


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If you know of other applications please let me know. If you want to join
in discussions on this subject then sign up to the Computers in Mental
Health mailing list by sending mail to: 
listserv@MAELSTROM.STJOHNS.EDU  
in the text write:
subscribe cimh lastname firstname

Martin Briscoe MRCPsych
m.h.briscoe@ex.ac.uk
http://www.ex.ac.uk/~mhbrisco

Martin Briscoe is a Psychiatrist based in Exeter, UK. He co-founded the 
Computers in Psychiatry group of the Royal College of Psychiatrists 
in the early eighties and now runs their web site called Computers in 
Mental Health. When not working and/or playing with computers,
he enjoys sailing, skiing and spending time with his wife and two boys

CIMH     - http://www.ex.ac.uk/cimh

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