In this edition of Diagnosing the Headlines, we have Dr. Joel Krauss, an emergency medicine physician with Envision, who takes a look at questions surrounding mental health technologies that are becoming alternative support for younger people. Dr. Krauss received a Bachelor of Science degree from the University of Michigan. He continued his studies at Michigan State College of Human Medicine, where he earned his Doctor of Medicine degree, and he then returned to the University of Michigan to complete the residency program there. He also serves as an EM CQC Psychiatric Subcommittee Member.

1. Is there something different about behavioral health or mental health services that has led younger generations to turn increasingly to technology for support? Are you concerned about the trend?

There are more and more mental health resources available on a technology-based platforms than ever before. While the decreased supply of mental health professionals and increased prevalence of patients seeking mental health treatment are certainly primary drivers in the shift to exploring technology-based therapies, there are other contributing factors to this trend. These include an increase in availability in digital resources and treatment options, the ever-expanding role of technology in everyday life, a need for alternative options to traditional in-person treatment during the COVID-19 pandemic, ease of use and barriers to traditional treatment, such as distance, time and cost. There is also the continued yet improving stigmata of seeking treatment for mental health conditions and concerns about confidentiality. Many patients feel that technology can offer a layer of protective anonymity.

About 90 percent of teens use social media regularly, and they are more comfortable with technology than prior generations. This has allowed clinicians to engage with adolescent patients on a familiar and more comfortable platform. It has also removed some of the physical barriers that have limited treatment in the past. Advancements in technology have offered new treatment modalities that haven’t previously been available. These include telehealth visits with mental health professionals, mental health tracking apps, websites, online forums, peer-led groups, text messaging, virtual reality/augmented reality and online resources designed to help locate mental health treatment.

Many of these modalities also give patients access to on-demand care that helps them maintain their treatment and in times of an acute crisis. They can also act as a supplement to traditional therapy by helping patients track their symptoms, complete exercises and provide self-assessments.

Like many forms of medical care, it’s crucial that the treatment is tailored to the patients. A technology-based treatment is unlikely to be appropriate for every patient and should not replace evaluation and management by a healthcare professional. It may, however, help a patient take a crucial step in reaching out to initiate treatment or assist with maintaining adherence to long-term therapy in patients that may otherwise be lost to follow-up.

Many of these approaches have been confirmed by the medical literature to have similar efficacy to traditional therapies, such as video-based therapy, as compared to in-person psychotherapy. Mobile apps can also be effective as part of treatment in managing symptoms of anxiety and depression. While many of these novel approaches have been able to reach a broader patient population, given the relatively new landscape, more studies will be needed to continue to evaluate the long-term effectiveness of these treatments as these technology-based therapies evolve.

2. What role has the availability of mental health professionals and access to services played in this shift?

According to the Centers for Disease Control and Prevention (CDC), in 2021, 42 percent of high school students experienced persistent feelings of sadness or hopelessness. This is an increase from 28 percent in 2011. In addition, 22 percent of high school students contemplated suicide over the last year. Another survey in 2021 revealed that 60 percent of psychologist didn’t have availability for new patient appointments. In 2018, more than half of the counties in the U.S. did not have a psychiatrist. With the increased prevalence of mental health conditions and the limited availability of traditional treatment models, there has been a shift for more novel approaches to mental health treatment, including technology-based solutions.

One of the benefits of technology is its on-demand availability. Like all medical conditions, worsening symptoms can occur at any time of the day. If a patient is having worsening anxiety at 2 a.m. on a Saturday, there are fewer treatment options available than at 10 a.m. on a Monday. This is even more magnified in areas with less access to traditional therapies. Many of these technology-based therapies increase care accessibility for patients regardless of time of day.

In particular, technology seems to be helping patients with underlying substance use disorders. Lack of traditional care, especially in rural areas, has left patients needing to turn to novel solutions. There are apps and virtual options that have been able to help patients begin evidence-based medication-assisted therapy for conditions like opioid use disorder. These types of platforms give patients access to addiction specialists that they would have had to travel a significant distance to see in the past. The initiation and maintenance of this type of treatment cannot be overstated, given the past and current opioid crisis throughout the country.

3. There is increasing empirical evidence that some technology, like social media, negatively impacts younger people. Is there a concern about technology being a source of stress and anxiety while also providing an outlet for help?

Social media companies have made recent headlines regarding their impact on adolescent mental health. This was most apparent with the hearing of the Senate Judiciary Committee in January 2024. There were concerns that social media was providing an avenue for bullying, anxiety and eating disorders as well as contributing to depression, in addition to the addictive nature of the platforms.

There are growing concerns among the medical community, parents, education professionals and the public in general surrounding the negative impact of social media. There have been multiple recent studies examining the mental health effects of social media use on teens and adolescents. Conclusions from these studies have ranged from there being little association to a substantial effect with a dose relationship between time spent on social media and poor mental health outcomes, including depression and suicidality. Many of these studies report confounding variables and that the relationship is complex and multifactorial. More studies are needed to determine the exact degree, but the current evidence supports the concerns about the negative impact of social media.

While there are certainly negative factors associated with social media, some patients report that social media can help support their mental health. Patients have found solace in online support groups and have been able to connect with others suffering from similar conditions.

Given that technology is such a broad landscape, the negative aspects can sometimes overshadow the positive aspects and vice versa. One patient’s anxiety from being constantly connected may give another patient reassurance knowing that there are readily available digital options 24/7.

4. What is the takeaway from the headlines?

The article highlights alternatives to tradition mental health therapy as well as the current shortage of mental health professionals. Patients should be aware that there are novel treatments for mental health that go beyond traditional office and group-based therapies. In many cases, patients may need a combination of both — more traditional therapy that may be augmented by a technology-based treatment.

With technology evolving every day, the medical field needs to continue to monitor the efficacy of these new treatment methods. Most importantly, an app, while it may at times be beneficial, cannot replace the expertise of a trained medical professional.

If patients are suffering from mental health concerns, they should seek out immediate care from healthcare professionals. If a patient is in a mental health crisis, they should contact their local crisis intervention team by dialing 988 for the National Suicide and Crisis hotline or go immediately to their nearest emergency department to seek further care. Many patients do require inpatient hospitalization to help stabilize their acute mental health crisis or initiate treatment for a newly diagnosed condition, which would require more intensive treatment than the current technology-based therapies can support.

Citations for DTH — Mental Health