Ethical, Legal and Social Implications in the Use of Digital Technology for Mental Health Applications

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Digital mental health technology (DMHT) –digital devices (smartphones, sensors) that can monitor and collect personal data from patients (tracking location/voice/motion, self-report), apply algorithms and machine learning (“ML”) to generate and integrate health and risk information (from genomics/family history), and even mediate care (monitoring treatment adherence or chatbot therapy)– is being integrated into mental health clinical care, with the goal of improving access, diagnostics and treatment for mental illness. DMHT poses novel ethical challenges because (1) use of DMHT disrupts traditional frameworks, such as the physician-patient dyad, for addressing ethical obligations and challenges in mental health care; (2) DMHT will contribute to the creation of novel and massive amount of behavioral data and risk categories, particularly when combined with other technologies, such as WGS, which may be difficult for clinicians and patients to evaluate and meaningfully use; and 3) behavioral health data will be created and used outside of frameworks for protecting the privacy of health data and may be experienced as surveillance by patients. The goals of the project are to: (1) examine how key stakeholders – DMHT developers, clinicians and patients – conceptualize and operationalize the ethical, legal and social implications of DMHT as it is translated into clinical care for the treatment of mood and psychotic disorders; and (2) use qualitative and quantitative methods to interview and survey clinicians, patients and consumers who use DMHT to examine the ethical, legal and social implications of the technology, particularly in relation to trust, privacy, data protection and management, and surveillance; and (3) provide improved understandings of how developers, patients, and clinicians perceive and manage ethical, legal and social implications of DMHT, that can be used as a foundation for further research and to provide guidance for ethical and safe use of digital technology in mental health care. he long-term goals of the project are to: 1) develop a research program exploring the ethical, legal and social implications of digital health technologies in mental health care and the potential impact on ethical frameworks in healthcare; 2) generate empirical research that improves understandings of the ethical, legal and social, implications of digital health technology; and 3) to improve understandings of the ethical issues involved in the use of DMHT to inform guidelines and social policy for the use of digital health technology in research, clinical, and community settings.