Benefits and Costs of Gamification in Mental Health

Gamification in Mental Healthcare

There is no doubt that we have had decades of research geared at developing new and more effective treatments for mental conditions ranging from autism to anxiety, from schizophrenia to depression and so on. What is rather worrying, however, is that we have very little to show for it. Mental disorders such as these continue to impact on the quality of life of a significant proportion of the population, costing the taxpayer millions of dollars every year. Currently, approximately 90 million Americans, which translates to approximately one-third of the population, suffers from some form of anxiety disorder, yet a majority of these fail to seek out treatment for the same owing to the stigma, burden and cost associated with such evidence-based treatments. Mental health professionals are, thus, focusing their attention towards the development of low-burden, effective interventions for mental illness. Gamification, the introduction of game-like elements in mental health interventions, is one of the newest trends in that direction, and one that experts regard as having significant potential. This text examines the various ways through which gamification has been used to impact mental health outcomes among members of the Millennial Generation, who are also the greatest users of smartphones and other mobile devices. It is intent on showing that if properly-regulated and controlled, gamification could contribute significantly to improved mental health outcomes.

Overview of Gamification in Mental Healthcare

Gamification in mental health basically refers to the strategy of translating or embedding interventions into game formats that could range from animated graphics, to software apps and game-like interfaces accessible through mobile devices. A report by the Pew Research Center estimates that approximately 61% of young persons between the ages of 12 and 30 own a smartphone or some form of mobile device (Chan, Torous, Hinton & Yellowlees, 2014). Of these, 31% use their devices to obtain health information from either online platforms or psychiatric patient networks (Chan et al., 2014). Today, there are numerous apps at the disposal of both patients and healthcare practitioners, and which help in among other key procedures patient record-keeping, decision support systems, patient monitoring and surveillance, health promotion, community mobilization, appointment reminders, and treatment adherence and monitoring. The overriding aim of gamyifing mental health treatments is to increase patient engagement and reduce the stigma associated with treatment appeal. Its use, however, remains limited owing to challenges of accessibility and patient privacy.

Examples of Mental Health Information Obtained through Gamification

As mentioned earlier on in this text, numerous software apps have been developed to improve the mental health of the population. With the help of mobile apps and wearable devices, one can track just about every aspect of their mental health just as much as they can track their physical health. The Recover Record App, for instance, is designed as to send reminders and notifications to patients to enable them cope with their psychological disorders. For people with eating disorders, for instance, the app sends a notification at 5 a.m. everyday reminding them of the need to take breakfast (Arthur, 2015). After eating, the patient then records on their phone what they ate, and how they felt. The procedure is repeated throughout the day, and the app acts like some form of online diary, reminding them in intervals to log her supper or eat a snack (Arthur, 2015). By recording their dietary habits and tendencies, patients are helped to cope effectively with their disorders. Besides Recovery Record, there are numerous other apps used to address a range of mental health issues; some for dealing with anxiety through breathing or meditation techniques, others for tracking mood swings and others specific to bipolar disorders, depression, phobias, and so on. Some of the most popular apps and their specific functions have been discussed in the subsections that follow.

StudentLife: the StudentLife Android App, developed by researchers at Dartmouth College, collects location, audio, and motion data from the sensors of a user's smartphone, draws patterns from the same and uses these to predict and alert users of changes in their mental health (Bolluyt, 2014). Algorithms within the app process the data collected to obtain a clear view of their sleeping patterns communication patterns, the places they visit, their level of physical activity and so on; so if the user begins to show changes in any of these patterns, the app takes these to correlate with changes in stress, loneliness, and depression and notifies the users or their registered caregivers that there could be changes in their mental health (Bolluyt, 2014).

SelfEcho: in addition to apps geared at helping users cope with their disorders, other apps and software have been developed to assist practitioners with information about their patients. One such software is SelfEcho, which allows mental health practitioners to enroll their patients to use smartphone sensors and self-reports to record data pertaining to their daily lives. The software provides mechanisms for the practitioner to assess their patients' progress and determine which aspects of the treatment plan are working, and which ones are not (Bolluyt, 2014). The metrics tracked by the software include base models for restfulness, worry, anxiety, guilt, physical activity, pleasure, hopefulness, positivity, and so on (Bolluyt, 2014). Practitioners can use this information to not only track progress, but also identify triggers and make better diagnoses.

My M3: this is one of the few apps that can be used by both healthcare providers and consumers. It provides a simple test that can be used to detect posttraumatic stress disorder, bipolar disorder, anxiety, and depression. Users take the test to help not only their practitioners, but also themselves understand whether or not they are suffering or are likely to suffer from a mood disorder (Bolluyt, 2014). This puts practitioners in a better position to make accurate diagnoses and to consequently administer effective treatments.

MindShift: this is an Android app meant to help teenagers and young persons deal with anxiety. It focuses on getting them to change the perceptions they hold about anxiety and to consequently be more willing to face it (Simon Fraser University, n.d.). It provides tips on how to devise helpful ways of thinking, how to relax, strategies for coping with everyday anxiety and so on, all of which help them control their anxiety (Simon Fraser University, n.d.).

SPARX: this is an interactive fantasy game meant to help adolescents deal with depression and anxiety (Sarasohn-Khan, 2012). Users are required to pick an avatar and then take part in a range of challenges to bring about balance in a GNAT (Gloomy Negative Automatic Thoughts)-dominated world (Sarasohn-Khan, 2012). The game is available on CD-ROM and users play by installing the same in their devices. Research has shown SPARX to be effective in reducing levels of depression and anxiety among adolescent users (Sarasohn-Khan, 2012).

Other popular apps and mental health software include the Therapy Outcome Management System, which provides feedback to practitioners on the outcomes of therapy and counseling; the Sleep Well Be Well App; the Headspace, the Thought Diary Pro, and the My Mood Tracker. All of them, however, work almost in the same way -- tracking users' emotional well-being in correlation with their behavioral patterns (Bolluyt, 2014).

The Impact of Gamification in Mental Health Interventions

The Advantages / Potential Benefits of Gamification

The benefits of gamification in mental health settings can be discussed from the perspective of the patient as well as that of the health practitioner.

Benefits to Patients: Mental health professionals, like any other medical practitioners, have an ethical duty to ensure that any interventions or treatment plans they use on their patients are supported by evidence (Goodman, 2003). Research has shown games to be an effective way to engage patients and enable them cope effectively with psychological disorders such as posttraumatic stress disorder, obsessive compulsive disorder, social phobia, depression, and anxiety (Cugelman, 2013). In her study seeking to assess the effectiveness of SPARX in reducing the level of depression and anxiety in teenagers and adolescents, for instance, Sarasohn-Khan (2012) exposed 117 students to the program for a period of three weeks and found 63% of these to have significantly lower levels of the same upon completion. Elsewhere in Finland, Lappalainen and his colleagues conducted a study to assess the effectiveness of the P4Well App and found the same to have a considerable effect on certain aspects of burnout and job strain, including over-commitment and cynicism (Lappalainen et al., 2014).

There are a number of possible explanations for the effective working of games in mental health treatments. To begin with, gamification eliminates the need to make a trip and communicate face-to-face with the mental health provider (Dennis and O'Toole, 2014). Patients can have their practitioner make diagnoses from the postings they make online, and this essentially helps them reduce the stigma associated with seeking out mental care and having to explain one's problems to a practitioner in a face-to-face communication setting. This helps to maintain the relationship between practitioners and their patient, and reduces the cost of obtaining help, making mental healthcare more accessible to a greater number of people. Secondly, unlike the traditional methods of administration of care, gamification allows patients to self-monitor themselves and ensure that they remain on the right track in relation to their treatment or prevention plan (Lister et al., 2014). Members of the target group spend the highest number of hours with their smartphones and mobile devices compared to members of any other age group (East and Havard, 2015). This makes self-monitoring relatively easy. From a patient's perspective, therefore, gamification enhances psychological services and makes mental care more conveniently accessible to a greater number of people. Thus, generally gamification in the mental health setting improves the mental health status and overall well-being of the population.

Benefits to the Practitioner: the main advantage of gamification to the mental health practitioner is physical workload-reduction. It is estimated that one in every four young people experience some form of depressive disorder before they are 20 (Sarasohn-Khan, 2012). Moreover, approximately 15% of adolescents suffer from depression; however, there is not enough practitioners and counseling resources to address this concern (Sarasohn-Khan, 2012). There is an undersupply of medical resources to address the psychological concerns of the target population, and over 70% of its members end up not receiving appropriate treatment (Sarasohn-Khan, 2012). Gamification basically compensates for this shortage of counseling resources and prevents practitioners from being overworked. This places them in a better position to offer personalized care and come up with more accurate diagnoses and more effective treatment plans.

Disadvantages of Gamification

In as much as gamification enhances psychological services and improves the quality of mental health in the population, it is not without its share of disadvantages. It is these disadvantages that have limited user engagement and made it rather difficult for mobile apps and software programs to diffuse effectively among users and prospective users (East and Havard, 2015). The core ones include:

Difficulty in Securing User Information: mental health gaming programs collect lots of personal information, including names, contact details, health statuses, familial background and so on from users; and with their information-sharing functionality, privacy concerns become almost unavoidable (East and Havard, 2015). Some programs try to increase the security of their users' records by incorporating an anonymous-sharing feature, which allows users to share information with other users anonymously (Sarasohn-Khan, 2010). Others, however, do not have this feature, making it possible for users to share personal health information amongst themselves invariably, and this places them at high risk of falling prey to unscrupulous persons.

The Requirement of Technological Literacy: technological literacy can be defined simply as the intellectual dispositions, abilities, and processes needed for a practitioner "to understand the link among technology, themselves, their clients, and a diverse society so that they may extend human abilities to satisfy" the health needs of their patients (Tyler and Sabella, 2004, p. 5). Whereas the target population of young people aged between 12 and 30 may have high levels of technological literacy, a majority of the practicing and most experienced mental care providers may not be equipped with the same level of understanding when it comes to technology. For this reason, most of these experienced care providers may be unable to take advantage of gaming platforms and hence, unable to reap the potential benefits of the same.

Accessibility of Mobile Devices: mental health games and software programs are meant for use with smartphones and other mobile devices with internet-enabled functionalities. These devices are, however, quite costly and beyond the reach of most prospective users, particularly in the rural areas. In this regard, therefore, the use of games cannot be relied upon as a substitute for face-to-face therapy and treatment sessions because it causes disparities in the administration of, and access to mental care between the rich and the poor.