Big data, brain science and mental health care

The Atlantic recently ran a fascinating article about improving the effectiveness of psychotherapy by using big data to inform practice. In it, the author notes that there is a desire for the “relational art” of psychotherapy—that one-on-one relationship forged between therapist and patient—to defy quantifiability. But, as the article suggests, robust analytics could improve patient outcomes.

At the center of these potential improvements in psychotherapy is the power of big data and how statistical patterns can help develop algorithms to identify when a patient is at risk of deterioration or other adverse outcomes, such as suicide or dropping out of therapy.

The idea is that patients can periodically fill out a questionnaire, for example, before each therapy session, and the results can generate alerts about the patient’s mental state and predict therapy outcomes. The therapist can use these alerts to guide care and carefully inquire about the patient’s mental state, the effectiveness of therapy, and assess what could be done to improve therapy.

The use of big data to help guide psychotherapy may be difficult to accept for many clinicians. Generating alerts about the patient’s mental state based on statistical algorithms may feel reductionist and even insulting to clinicians that are trained to examine and unravel the complexity of the human mind. Additionally, more data needs to be collected to improve the reliability of these predictions and prove their clinical utility with different patient populations.

However, as fiduciaries of their patients, mental health clinicians have a duty to look after the best interest of each patient. If the use of technology could potentially help improve patient care, I believe this fiduciary duty implies that mental health clinicians should at least explore these technologies and make an effort to be open to their use if proven effective.

There are other fascinating ways in which big data may soon transform mental health care.

Billions of dollars are currently being invested in neuroscience research projects with the hope of understanding the genetic basis of mental health disorders. Psychiatric genomics is a field using state-of-the-art genomic testing technologies and big data analysis to identify parts of the human genome associated with psychiatric illness. This is the subject of much of my current research.

The identification of genomic variants associated with mental illness could help identify who is at risk of developing a mental health disorder, prevent the onset of mental illness, improve diagnosis, help select medications that are more likely to improve patient’s symptoms, and identify new drug targets, among other things.

In recent years, a remarkable amount of progress has been made in understanding the genetic basis of mental health disorders, particularly schizophrenia. However, the application of novel technologies to help predict or understand mental illness can generate numerous ethical, legal, social, and public policy challenges. The study of these challenges as they relate to the application of technologies to the brain or brain-related illnesses and functions is called “neuroethics.”

I recently wrote a piece for the American Journal of Bioethics called Responsible Translation of Psychiatric Genetics and Other Neuroscience Developments: In Need of Bioethics Research. In this article, I discuss the following four recommendations for bioethicists to help examine and address the neuroethics challenges these technologies may generate:

• Close collaboration between bioethicists and technology developers and researchers
• Rigorous testing of theoretical bioethics analyses about emerging neurotechnologies through empirical neuroethics research
• Critical evaluation of how policy hinders or promotes the responsible development and translation of novel neurotechnologies to clinical practice
• Involving stakeholders, including patients, technology-decliners, caregivers, researchers, and clinicians, in the development of management plans to promote the responsible development and translation of these technologies

As novel technologies aimed at improving mental health care arise, it is important to be open to the potential benefits of these technologies while remaining vigilant to the potential clinical and ethical risks. The focus should always be on improving the lives and health care of patients. If the responsible application of novel technologies will help achieve this, then that is the way to go.

– By Gabriel Lazaro-Munoz, Ph.D., J.D., M.B.E., adjunct instructor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine