Responsible innovation in technology for mental health care.

The Editorial entitled “This is not my beautiful house”, published in the March, 2020, issue of The Lancet Psychiatry, about social media platforms and their effect on society, recommends that mental health professionals be vigilant about the promise and perils of these platforms and question how, and why, technology companies operate in the way that they do. We concur. Physical and social distancing imperatives associated with 2019 novel coronavirus disease (COVID-19) further amplified the increasingly ubiquitous and influential role that digital platforms play in our daily lives. We therefore note the genesis and importance of the field of responsible innovation to guide and monitor the implementation of new products and services in mental health. Responsible innovation entails a set of principles and practices in the development of technical solutions for complex problems. It encapsulates collaborative endeavours, in which stakeholders commit to identifying and meeting a set of ethical and social principles, by designing products and services to identify and manage risks to sustainably address the needs of, and challenges faced by, users. How can the mental health field adopt responsible innovation practices?

Responsible innovation is an increasingly prominent initiative. A 2020 Organisation for Economic Co-operation and Development recommendation on responsible innovation in neurotechnology proposed the first international standard in this domain. This recommendation “aims to guide governments and innovators to anticipate and address the ethical, legal and social challenges raised by novel neurotechnologies while promoting innovation in the field”. It articulates “the importance of (1) high-level values such as stewardship, trust, safety and privacy in this technological context, (2) building the capacity of key institutions like foresight, oversight and advice bodies, and (3) processes of societal deliberation, inclusive innovation, and collaboration”.

These principles can be usefully adapted to guide the development and implementation of novel technologies to help resolve mental health problems. Hence, in this Comment, we wish to formalise the field of responsible innovation in mental health (RIMH), provide examples of RIMH in action, and provide recommendations for furthering the field.

One useful example of using RIMH for risk mitigation comes from Pinterest, a social media and app company with around 335 million users. Pinterest operates a software system designed to enable people to save and discover information using graphics (known as pins; eg, images and videos), which users find online and save to their virtual pinboards. People can search for pins by theme, save pins that they like, and click on a pin to learn more. Pinterest recognised the commonality and potential propagation and labelling effects of individuals searching for pins relevant to stress, anxiety, sadness, or other difficult emotions. The company then introduced evidence-based cognitive behavioural practices on its platform for users whose search pattern and themes were concerning. Identification and quantification of privacy and user tracking problems were then addressed by a responsible innovation strategy. Specifically, users' interactions with resources relevant to difficult emotions were made private and not linked to their account, tracking was not used, and records of activity were stored anonymously using a third-party service.

However, there are several examples of problematic technology that could gain by incorporating a RIMH approach. For example, most dementia health apps do not have a privacy policy, so similarly, bolstered safeguards and improved communication about privacy protection are needed to facilitate consumer safety and trust in the apps. Other prominent concerns about technological innovation and mental health include, for example, social media communities disseminating medically incorrect information or promoting disordered eating habits, social media companies using hidden algorithms to screen user content for suicide threat and create alerts sent to emergency health authorities, suicide contagion occurring via digital and social media, and cybersecurity and the hacking of private data. In the figure we outline actions for RIMH (ie, risk anticipation, risk detection, risk surveillance, and risk mitigation) and principles for fine-tuning these actions that could be applied to the above concerns.

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Actions and principles of responsible innovation in mental health

These principles were developed by the Council on Responsible Innovation in Neurotechnology and adopted by the Organisation for Economic Co-operation and Development on Dec 11, 2019.

We note several entities supporting the integration of responsible innovation into mental health. Entities supporting leadership and policy in this area include the World Economic Forum's Global Future Council for Neurotechnologies and Brain Science, which explores the strengths and limitations of artificial intelligence in mental health care, and the Asia-Pacific Economic Cooperation Digital Hub for Mental Health, which works to share, develop, scale up, and evaluate innovative evidence-based and practice-based programmes for mental health support. Entities supporting mental health workforce development include the Brainstorm Lab for Mental Health Innovation at Stanford University7, 8 (with courses on leading innovation in mental health and entrepreneurship, technology, and policy) and the Global Brain Health Institute with the Atlantic Fellows for Equity in Brain Health programme. The responsible innovation activities of these entities can be studied, iteratively refined, and emulated.

We also propose that the new field of innovation diplomacy be adapted to promote RIMH.8, 9 Innovation diplomacy includes helping to build academic partnerships with industry, enabling open innovation and collaboration, influencing intellectual property regimes, building global value chains, and developing and scaling innovative solutions to global problems. To this end, we articulated a model of mental health innovation diplomacy,8, 9 which aims to strengthen the positive role of novel technological solutions, and recognise and work to manage both the real and potential risks of using digital platforms. This initiative recognises that technological innovations relating to mental health can have political, ethical, cultural, and economic influences. Adapted from the Nesta (formerly NESTA, National Endowment for Science, Technology and the Arts) Innovation Policy Toolkit, we elucidated roles relevant to mental health innovation diplomats. Using a focus on responsible innovation practices, the mental health-care field can work collaboratively with technology companies to identify and mitigate risks to users, to build a beautiful house together.