Abstract
While the implementation of digital technology in psychiatry appears promising, there is an urgent need to address the implications of the absence of ethical design in the early development of such technologies. Some authors have noted the gap between technology development and ethical analysis and have called for an upstream examination of the ethical issues raised by digital technologies. In this paper, we address this suggestion, particularly in relation to digital healthcare technologies for patients with schizophrenia spectrum disorders. The introduction of digital technologies in psychiatry offers a broad spectrum of diagnostic and treatment options tailored to the health needs and goals of patients’ care. These technologies include wearable devices, smartphone applications for high-immersive virtual realities, smart homes, telepsychiatry and messaging systems for patients in rural areas. The availability of these technologies could increase access to mental health services and improve the diagnostics of mental disorders.Additional Instruction In this descriptive review, we systematize ethical concerns about digital technologies for mental health with a particular focus on individuals suffering from schizophrenia. There are many unsolved dilemmas and conflicts of interest in the implementation of these technologies, such as (1) the lack of evidence on efficacy and impact on self-perception; (2) the lack of clear standards for the safety of their daily implementation; (3) unclear roles of technology and a shift in the responsibilities of all parties; (4) no guarantee of data confidentiality; and (5) the lack of a user-centered design that meets the particular needs of patients with schizophrenia. mHealth can improve care in psychiatry and make mental healthcare services more efficient and personalized while destigmatizing mental health disorders. To ensure that these technologies will benefit people with mental health disorders, we need to heighten sensitivity to ethical issues among mental healthcare specialists, health policy makers, software developers, patients themselves and their proxies. Additionally, we need to develop frameworks for furthering sustainable development in the digital technologies industry and for the responsible usage of such technologies for patients with schizophrenia in the clinical setting. We suggest that digital technology in psychiatry, particularly for schizophrenia and other serious mental health disorders, should be integrated into treatment with professional supervision rather than as a self-treatment tool.
Highlights
25 Page 2 of 22 mental health disorders, should be integrated into treatment with professional supervision rather than as a self-treatment tool
Mhealth software is a rapidly growing market, with a significant part being represented by technologies for mental health, including technologies for schizophrenia spectrum disorders. (Chivilgina et al, 2020)
In light of the quick technology development, there is a panoply of ethical questions related to the adoption of such technology among patients with schizophrenia, such as (1) the lack of evidence on efficacy and impact on self-perception, which means that not every technology can provide beneficence to patients; (2) the lack of clear standards for the safety of their daily implementation,which can potentially lead to harm; (3) unclear roles of technology and a shift in the responsibilities of all parties; (4) no guarantee for confidentiality and privacy of sensitive data; (5) the lack of a user-centered design that meets the particular needs of patients with schizophrenia
Summary
Asystematic literature review was performed to retrieve a comprehensive and the up-to-date list of digital technologies with application to schizophrenia. We excluded telemedicine and SMS-messaging, as they do not represent an innovative technology To achieve the purpose of the review, we examined the presence of ethically-relevant considerations for each digital technology. Using qualitative thematic analysis we clustered all retrieved ethical considerations into main thematic families. Our analysis identified four main thematic families: (1) privacy and confidentiality, (2) user-centered design, (3) patient identity, self-perception, and (4) patient-physician relationship. The language used to describe the four thematic families was partly grounded on the principles of biomedical ethics(Beauchamp & Childress, 2009) and adapted to the specific context of digital technologies for schizophrenia.
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