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E-santé mentale: définitions, enjeux, expériences Paris, 13 Juin 2017
Questions éthiques en e-santé mentale
Kyriaki G. Giota,
Chercheuse en psychologie
Université de Thessaly, Grèce
Dr. Kyriaki Giota, Psychologist University of Thessaly, Volos, Greece
Topics of discussion
• Innovations in eHealth & mHealth
• Concerns and barriers on using E-mental health
• Ethical dilemmas
• To download or not to download?
– Privacy & Security
– Reliability & Validity of apps
• What to do?
Innovations in Mental Health: E-Health & the power of Mobile
Technologies
E-mental Health initiatives • Information quality
• Screening & assessment tools for professionals and individuals in general
• Social support
• Interventions
– Promotion, prevention, detection, treatment
– Care delivery
– Therapy modalities
Wearable tech
Concerns and barriers on using E-mental health
• Costly to develop, deploy, and evaluate.
• Possible replacement of important and needed conventional services
– Minimize improvements or funding
• Marginalization of individuals with physical, financial, or cognitive barriers in terms of access
• Financial interests of developers and researchers: publication bias
Concerns and barriers on using E-mental health
• Legal issues
– confidentiality, obtaining consent, licensing, record keeping
• Professional issues
– privacy and maintaining professional boundaries
• Competence and level of technology usage skills
• Crisis risk management
• Therapeutic relationships online
• Appropriateness of the service for the client – Inappropriate or harmful care when there is
insufficient quality control over content
• Online treatment for certain population groups – e.g., patients with chronic illness, severe depression,
psychosis
– Possibility of postponement in seeking the needed conventional care
Concerns and barriers on using E-mental health
• Technology limitations
–Problematic devices
–Battery, memory
• Telecommunication technologies
– Internet connection
• Theft, loss, malfunction
• Personally identifiable data – name, phone number, email address, age, gender,
photos
• History – ip addresses, call logs, browser history, texts,
location
• Lifestyle, daily routine & practices – diet, exercise, pregnancy & menstrual cycle,
appointments
• Professional information
– Electronic folders with history intakes, patient records, therapy session notes, contact numbers & addresses of clients
• Medical information
– diagnoses, treatments, medication refills, insurance
Privacy & Security
• Permissions, informed consent, confidentiality
• Storage and transmission of data
• Tracking location and movements
• Unencrypted data & cybercrime
Are free apps really free?
•Hidden behaviors of free and paid mobile apps • Advertising • Malicious content
Reliability and Validity
• Lack of extended research evidence – Sampling, existence of control group, repeated
measurements
– systematic reviews, peer-reviewed articles
• Small number of evidence-based mHealth applications – designed and inspected by healthcare
professionals or mental health institutions
Certifications
• Importance of measures and certifications (from federal or other third-party institutions)
• Creation of universal guidelines
• Regulatory jurisdiction
• Quality control
• Ethical guidance
It seems that the technology is advancing so fast that research is unable to keep up with every new development
What to do?
• Screen before recommend
• Read user reviews
• Search the privacy policy in the developer’s
website
• Learn about the app or the developer
• Delete the app after no longer using it
What to do?
• Download security software
• Always look at the permissions that an app requires before downloading it.
• Carefully consider whether the app actually needs to do whatever it's asking.
Digital natives vs. Digital immigrants
• “technophobia”: professionals may be unfamiliar with technology and anxious about its use in healthcare
The future of e-Health and m-Health
• Adapting mental health practices to the new digital reality
• Creating specific policies
• Training courses
• Supervision
• Respect and protection of clients
