Let's face it. Things have not been the same as they once were. You see the media over-saturating our news feeds about how we are all living in unprecedented, challenging times. They're not wrong. With the obstacles created by the coronavirus pandemic, our globe is undergoing an extreme test not only for its healthcare systems, but also its governments, economies, and most importantly its communities. Especially with the urgent stay-at-home orders in-place by a majority of nations, society is seeing a surge in anxiety and other mental health issues while adjusting to an isolated lifestyle (North, 2020). According to a report from Express Scripts, a Cigna-owned pharmacy benefit manager, prescriptions for anti-anxiety medicine started climbing in mid-February, spiking 34% by March 15 (Luhby, 2020). As people are unable to leave their homes and facing even higher rates of mental health issues, there is a need for increased access to therapists and other psychosocial support services while navigating around COVID-19. Open-source solutions like chatbots and text-support services can bridge the gap in access to mental healthcare by leveraging community-health workers and AI technology.
Source: Vox.com - A screenshot of a conversation with X2’s mental health chatbot.
Reaching Out to Our Devices
While it is a lot more difficult for people to go physically see a therapist, the coronavirus pandemic is fueling demand for digital mental health tools as apps, chatbots, and text-a-therapist platforms. These digital tools report an influx of users who are seeking for much-needed help. For example, TalkSpace, which calls itself an online therapy company, reports that "the volume of users on the platform is up about 25 percent since the middle of February and that growth is accelerating" (Heilweil, 2020). One of its primary competitors, BetterHelp, says the number of new members starting its service has spiked and that the number of new users who mentioned concerns about stress and anxiety during the past two months has more than doubled compared to the same period last year. Although these virtual communication options to connect with a therapist are being utilized, non-human, mental health chatbots are also being used to get immediate feedback to burning questions and worries. For example, WHO and CDC, have also included chatbots in their websites to provide up-to-date information to billions on the spread of the disease and its symptoms. Moreover, many governments are also launching chatbots to provide validated information to their citizens (Sundareswaran, 2020).
Source: Verdict - An Example Interaction of San Francisco-Based mental-health chatbot company, WoeBot
How Open Source is Changing the Game
As chatbots and digital platforms are ramping up their software's capabilities to handle a variety of distressed messages and requests for support, open-source solutions arise to scale up access to mental health resources while making them community-based. This is evident in Liberia--- where citizens had been suffering from mental health problems and suicidal tendencies brought on from a long running civil war and the Ebola epidemic (Jones, 2016). Angie Nyakoon and Amanda Gbarmo Ndorbor, both women who oversee the Mental Health Unit at the Ministry of Health and Social Welfare (MOHSW), developed a SMS workflow that help health workers answer a series of questions about depression and other disorders while on the ground, at the frontline care for patients, and even in the most remote parts of Liberia (Jones, 2016). The information they collected through this two-way, mobile phone-based communication system was used by the Ministry of Health and Social Welfare (MOHSW) to help alleviate the pressing community mental health issues and find solutions.
Applying an open-source solution to the healthcare challenge required many key stakeholders to collaborate and combine their comparative advantages. The Ministry of Health and Social Welfare in Liberia already had an understanding of its frontline health workers capacity and ability through the implementation of IntraHealth's iHRIS, a simple, easy-to-use, open source software system that supplies health-sector leaders with information to track, manage, and plan with the health workforce. And thanks to UNICEF's RapidPro, an open source SMS platform that allows anyone to build interactive messaging systems using an easy visual interface, Liberia has been able to reach health workers using basic talk and text mobile phones. The Liberian MOHSW was now able to use a new product, mHero, created during an interoperability hackathon sponsored by Intrahealth and UNICEF. Other participants in mHero development include USAID, K4Health, ThoughtWorks, and Jembi Health Systems.
Conclusion
While open-source solutions to mental health are still emerging, it is great to see this model has a plethora of valuable applications in expanding mental healthcare. Nyakoon and Ndorbor sought a quick, agile, reliable, software development—and more importantly, implementing open source principles like those to reuse, remix, remake, extend, and most importantly share. These open source principles, and the strong open source technology commitment of multiple international aid agencies, helped countries embattled by Ebola, such as Liberia, implement rapid solutions to support frontline health workers. The same open-source model can help inspire similar challenges posed by the coronavirus.
References
Jones, P. (2016, February 3). Open source app takes on Ebola and mental health in Liberia. Retrieved April 16, 2020, from https://opensource.com/health/16/2/mhero-open-source-healthcare-app
Heilweil, R. (2020, March 20). Feeling anxious about coronavirus? There's an app for that. Retrieved April 16, 2020, from https://www.vox.com/recode/2020/3/20/21185351/mental-health-apps-coronavirus-pandemic-anxiety
Luhby, T. (2020, April 16). Anti-anxiety medication prescriptions up 34% since coronavirus. Retrieved April 16, 2020, from https://www.cnn.com/2020/04/16/health/anti-anxiety-medication-us-demand-coronavirus/index.html
North, A. (2020, April 16). Coronavirus is causing a mental health crisis. Here's how to fight it. Retrieved April 16, 2020, from https://www.vox.com/identities/2020/4/16/21219693/coronavirus-anxiety-depression-mental-health-ptsd-covid
Sundareswaran, V., Firth-Butterfield, K., Digital Trade, & Artificial Intelligence and Machine Learning. (n.d.). Chatbots provide millions with COVID-19 information every day, but they can be improved - here's how. Retrieved April 16, 2020, from https://www.weforum.org/agenda/2020/04/chatbots-covid-19-governance-improved-here-s-how/