_________________________________________________________________ VOLUME 3, ISSUE 1 PSYCHNEWS INTERNATIONAL March 1997 _________________________________________________________________ SECTION D: FEATURE ARTICLE COMPUTING APPLICATIONS IN MENTAL HEALTH Martin Briscoe, MRCPsych _________________________________________________________________ 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 ---------------------------------------- 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 _________________________________________________________________