Dr. Michael Lindsey, Executive Director, McSilver Institute for Poverty Policy and Research, New York University
Will mental health professionals be replaced by robots in 2049? Dr. Michael Lindsey, executive director of the McSilver Institute for Poverty, Policy and Research at New York University, imagines the potential of innovative technology to increase accessibility and scalability to reach marginalized communities, by reducing stigma and providing treatment or alleviation of symptoms.
Dr. Michael Lindsey is Executive Director of NYU Silver’s McSilver Institute for Poverty Policy and Research and is the School's Constance and Martin Silver Professor of Poverty Studies. A child and adolescent mental health services researcher, Dr. Lindsey is particularly interested in the prohibitive factors that lead to unmet mental health need among vulnerable youth with serious psychiatric illnesses, including depression and suicide. He has received research support from the National Institute of Mental Health (NIMH) to examine the social network influences on perceptual and actual barriers to mental health care among Black adolescent males with depression. He also received NIMH funding to develop and test a treatment engagement intervention that promotes access to and use of mental health services among depressed adolescents in school- and community-based treatment. He is also an Aspen Health Innovators Fellow.
Show Notes
Dr. Michael Lindsey describes his background in researching mental health challenges in marginalized communities. [02:38]
How can we bridge the gap between mental health needs and accessing services? [06:29]
With innovative complementary services to treat mental health, will traditional talk therapy still be relevant? [08:19]
How do we train the next generation of mental health professionals to fuel innovation? [14:46]
In what ways can a healthcare professional maintain a relevant role in the treatment of mental health care in the future? [18:47]
There’s a lot of opportunity in the future for mental health services to focus on prevention. [21:25]
In developing innovative technology for mental health, marginalized populations need to be a part of the research to ensure accessibility and scalability. [24:21]
How will Dr. Michael Lindsey’s vision of mental health in 2049 make the world a better place? [27:46]
Transcript
Jason Helgerson: I'm Jason Helgerson and you're listening to Health 2049.
Dr. Michael Lindsey: As we're developing the technologies. We need to be thinking about how are we going to ensure that marginalized populations have access to the technology and then further whatever we develop, does it leave marginalized populations out? And so I think we have to keep the foot on the gas pedal, if you will. It's like you can't be so caught up in the innovation that you forget who is going to be using this, who has access to this?
Jason Helgerson: Today's guest is the executive director of the McSilver Institute for Poverty, Policy and Research at New York University. He primarily focuses his research on child and adolescent mental health and tries to identify the unmet mental health needs among vulnerable youth suffering from depression and suicide.
His unique understanding of the youth mental health world clearly impacts his vision of the future. Will the future of mental health involve tele-psychiatry provided by robots, therapeutic video games, or the creation of pharmaceuticals that will impact not only the chemicals of the brain, but also the coping skills of the individual? I can't wait to hear what he has to say on these and other important topics. And it's my pleasure to welcome Dr. Michael Lindsey to our program. Michael welcome.
Dr. Michael Lindsey: Thank you, Jason. It's a pleasure to be here.
Jason Helgerson: So, Michael, please tell our audience a bit more about your interesting background.
Dr. Michael Lindsey: Yes, Jason as you mentioned, I direct the McSilver Institute at NYU and we are interested in the root causes and consequences of poverty. One of the ways that I look at that is through the prism of mental health challenges that might encumber individuals in terms of their ability to work, to be successful in schools and successful otherwise in terms of their interpersonal relationships and how they function as a general matter.
And so I then in my work bring to bear interventions to address those issues. So whether you're talking about depression and how it influences the success of kids in schools, or you're talking about PTSD, which might impact how mothers are able to parent their children in terms of being a successful caregiver, or if their challenges in parenting might lead them to then become involved with unfortunately child welfare services for allegations of abuse and neglect.
We tend to do this work in highly marginalized communities in terms of the resources and opportunities for access to healthy food options or employment opportunities that might not be there in those communities. So the context of the work is typically in those highly stressed environments that then might influence mental health in consequential ways that are unfortunate. But the reality is that context can really shape those mental health experiences in terms of how one functions. And so that's basically the crux of my work.
I am also, as you mentioned, highly interested in the rising rates of suicide among youth in the United States. And the particular demographic that I have honed in on in my work are black adolescents, which we are now starting to see that their rates of engagement and suicide behaviors are rising to the extent that other racial and ethnic groups are actually seeing a decrease.
I've been really concerned about those trends and both through my research in terms of the epidemiological research that I've been doing, the intervention research that I'm doing. And also my advocacy in terms of translating that research into policy at the federal state and local level is really a passion for me. And I've been able to have some influence at those policy levels based on the work that I've been doing. And so that's basically where I am and the work that I do.
Jason Helgerson: Well, thank you. That's exceptionally important background. And certainly I think sets the stage for our conversation today, which is an optimistic conversation about what health and healthcare should be in the future. And we always like to start with each of our guests with that opening question which is; what does health and healthcare look like in the year 2049? So roughly 30 years into the future and obviously you bring a lot of knowledge and expertise to this question, and I'd love to hear your thoughts, Michael.
Dr. Michael Lindsey: It's such an important question and a great one because it gives me the opportunity, Jason, to somewhat dream and be aspirational in terms of what health care looks like in 2049. But I also want to contextualize my thoughts on that in terms of where we are now with regards to research and innovation in the space of work that I do around mental health, intervention and services research. And so I do think that what we're starting to see now is that we're trying to figure out ways to bridge the gap between need and service use. Because the reality is that most people who need mental health treatment do not receive it. And then when you dig deeper down and look at certain demographic groups, it tends to be the case that marginalized populations are not connected to services and perhaps they need to be connected to services most because they are most challenged by the contextual realities that are shaping their mental health experiences. I think then we're starting to see the sort of evolution of mobile technology and how it might be brought to bear on how one gets connected to treatment, in terms of whether you're building out mobile technology to address stigma or whether you're developing technology that actually provides some form of treatment or alleviation of symptoms.
I think in 2049, you're going to see that sort of work really be the primary means by which we deliver mental health services in our society. Mobile technology then will be transformed into having the opportunity to actually provide the services or the treatment that one might need. So picking up your phone or whatever device of that time, where we would be using, you're going to be able to perhaps use that technology to interface with a therapist-like entity, a robot for example, or some kind of technology, whatever that might be, may actually be the person or the entity that is delivering the mental health treatment to an individual.
It's somewhat scary in a sense because we've developed this whole emphasis around training, the next generation of professionals, whether you're talking about nurse practitioners, or social workers who tend to be the providers that are delivering these services, what does that mean for them? The question remains, but as technology continues to innovate, I think you will find that these mobile technologies will morph into ways in which care can be delivered. It's going to have to be evidence-based and so we're going to figure out a way to deliver evidence-based treatments and really crystallize ways via that technology.
I also think that again, on this technology strand of thinking, you’re going to have opportunities to build out games and other kinds of virtual programming that allows one to receive mental health care, but in a slightly nuanced way that relates to their participation in that gaming or that virtual experience. As I started out with saying there's so much stigma in marginalized communities, for example, but just broadly speaking related to mental illness in our society. I think then we'll consider ways to offset that by gaming and virtual experiences, that allows one to be a part of that type of programming, but experience the alleviation of symptoms. I think that’s fascinating and some of that is actually happening in mental health services and treatment, particularly as it relates to veteran populations, in terms of the treatment of PTSD and so I think that will be fleshed out even further and we'll start to see more of that. And certainly our innovations and the more knowledge we're starting to gain around psychotropic medication and how the administration of those kinds of biomedically-oriented treatments will be able to address depression or address PTSD.
So now, the way we deliver those services is in partnership, we're complementary to traditional talk therapy. There's a really popular adage or phrase in psychiatry in that pills do not teach skills. And so we say that in the sense of wanting to ensure that we're not just medicating an issue, but we're also providing opportunities for folks to reconcile those issues through traditional talk therapies. The combination of those two treatments are typically how we deliver those services, but it could be the case then that, and I hate to say this because I was raised in the tradition of talk therapy, I am a recovering therapist in the sense that I started off my career as a psychotherapist, but will a person be able to take a pill and not have to interface with a therapist. I think that is a reality that we will be so good at fine tuning those psychotropic medications to the point where it might nullify the need for a therapist to be involved in terms of traditional talk therapy. So those are the things that I think we will see.
Jason Helgerson: Interesting. I think that's really very helpful, just to sort of summarize what you're talking about here is technology, in essence, to a great extent, replacing human beings and the provision of service, for the treatment of mental illness. The optimistic aspect of that is this opportunity to address the fact that so many people who have mental health issues today are not getting access to clinicians. They're not getting access to talk therapy. They're not getting access for a variety of reasons from stigma to just a lack of human beings to be providers of service. And so I don't want to put words in your mouth, but it sounds like what you're saying is you see technology is really filling that access gap. And it sounds like you're optimistic about what that potentially means, for care for individuals.
Dr. Michael Lindsey: I think you're absolutely right. Great summary, Jason, because I do worry, in most of my career, I have examined the disparities and mental illness, and the receipt of mental health treatment. And so because of that, Jason, I have had to think about these sorts of innovations and alternate ways by which we can bridge that gap.
And so, as I think about innovation, for me, that is at the top of the list, how can we create technologies that bridge the gap? And I think for me, as I reflect on 2049 and where we'll be at that time, that's really prominent for me in terms of my consideration of things, but the reality also is that there is a whole environment and a landscape that fuels if you will, or contributes to how one functions in terms of their mental health. And so I do think that as we figure out ways to increase access to care, broadly speaking, we figure out how to ensure that we're training the next generation of healthcare professionals in terms of innovations and that sort of thing.
I think that all the pieces that I've laid out in terms of how technology will be a driver will have to be parallel with these trends that we're seeing in healthcare and how we train professionals. And so you'll find then that for me, for example, I'm trained as a social worker and I have been trained across the spectrum of psychosocial interventions that relate to various diagnostic outcomes. But even as a social worker, I'm starting to think about innovations and so we're using mobile technology in our work. We're thinking about how AI and predictive analytics can help us to be crisper if you will, in terms of how we identify need.
And increasingly this notion of what I'm getting at is, this notion of interdisciplinary science and how we generate the science, the questions we ask, is going to fuel the innovation that we'll see. And so, in those ways that I remain hopeful and we'll have to figure out how to prepare that next generation.
Jason Helgerson: So maybe Michael, we could dive a little bit more into that year, 2049, the role of the human being and the provision of care. We've had these conversations around, eventually artificial intelligence replacing human beings in terms of diagnosis, and the potential of that opening up physicians to be more focused on explaining to patients what their options are and helping them make informed choices and hopefully bringing empathy back into the provision of healthcare where it's often been lost in the past.
But what do you think that technology potentially means in terms of redefining the role of human beings as caregivers? As those providing services, not just in the designing the algorithms or developing the new pharmacological solutions, do you see a role for humans in actual treatment? And if so, can you describe for us what that role looks like?
Dr. Michael Lindsey: You know, Jason, that is a really great question. And to be honest with you, I think that it's one that we should be thinking about in parallel fashion. And so, as we think about innovations, we should be thinking about what the human condition or the human interaction will be.
So I don't know. I mean, it's a really great question. And actually this may be a good thing now that I think about it, will we be pushed toward prevention in ways that are meaningful, that perhaps it interrupts the trajectory toward more severe illness. And so I think in terms of the human role in all of this, what might be then the case, is that individuals will be providing education, not only about how best to interact with these more technological devices, if you will, but it would be also important to provide education about the mental health issue. And then I think further upstream, we'll be trying to figure out ways to prevent folks from going further downstream into a cycle of severe illness. And so we don't do that enough now, Jason, and I think that a preventative focus might be the lens by which the healthcare professional can ensure that they have a relevant position in the overall discourse of how we provide healthcare.
Jason Helgerson: I had a conversation, not that long ago with someone, in the United Kingdom, that's very much of the similar mindset that we spend a lot of time quote, unquote treating mental illness and we don't really spend a lot of time building up mental fitness. We talk about physical fitness and the importance of maintaining or improving physical fitness, but there aren't that many programs, platforms, initiatives around building mental fitness. And so you see that the role of mental health professionals in the future will be moving more into that space and, thinking of new strategies, new programs, new initiatives, in order to improve that, so we're not always sort of focused on when problems arise.
Dr. Michael Lindsey: I totally think that future providers of mental health services will be focused on prevention because, think about it, if you approach it from an entrepreneurial perspective, you often, as an entrepreneur, think about what is the next frontier? What is the space in which there's an opportunity for me to develop something that is niche, but that is going to be bountiful in terms of the rewards? And so if you think about it from even that perspective, entrepreneurially, there is a lot of space in the prevention aspect of how we administer or deliver health care because as you mentioned, our focus has almost been exclusive on intervention. We've waited for the problems to emerge.
Now, we've done so because when you think about how to best allocate resources the focus has been, let's allocate those resources based on what is emergent, what is happening in the now. And so, I do think then that there is a lot of ample space and opportunity on that prevention side. And we're starting to slowly see this in terms of mobile technology. So right now, if I’m struggling with stress at work or wherever the stress is coming from, I can go to my phone and hit my favorite mindfulness app and do some deep breathing and focused meditation that will alleviate my symptoms. So then how do we expand that? How do we think about that kind of prevention programming in ways that are accessible, but also have great evidence for preventing more intense illness or needs. And so, I do think there's a lot of ample space for that.
Jason Helgerson: So Michael, I think some of our listeners may be wondering, and oftentimes we talk about technology and health or technology in general, concerns that technology can create inequalities, that there is potential for not enough access that people, particularly vulnerable communities, the communities you care so much about, won't have access to the latest technologies and the health disparities that exist today could potentially get worse.
But how would you respond to that concern? Is that something that concerns you and with regards to the vision you see forward and what do you think society needs to do to sort of prevent those unintended consequences from what it's otherwise what you described is a very positive view of the future?
Dr. Michael Lindsey: It is my extreme worry, Jason, that such innovations will miss out on opportunities to meet the needs of marginalized groups. It's an extreme worry. The way that I think we can offset my worry, let's take AI for example, and machine learning, predictive analytics, we know that if not managed well, that type of technology can have unintended consequences for marginalized groups.
So you take facial recognition software, for example, that might capture voluminous number of faces, but began to then pick out people of color and might unfortunately render people of color and more sort of serious labeling kinds of position. Now, that technology though, can be developed from an ethical foundation. And so I think in parallel fashion, as we're developing the technologies, we need to be thinking about how we are going to ensure that marginalized populations have access to the technology? And then further, how are we going to ensure that whatever we develop, doesn’t leave marginalized populations out?
And so I think we have to be quite intentional about marginalized populations being representative in the research that we do. And we know that in biomedical research already, that is an issue. How do we ensure that marginalized populations, people of color, are participating and randomized control trials, as far as biomedical research is concerned?
And so I think we have to keep the foot on the gas pedal, if you will, in terms of asking that question, ensuring that we're developing ways for marginalized populations to be a part of the research, and then to ensure that whatever we develop has scalability, it’s like you can't be so caught up in the innovation that you forget, who is going to be using this? Who has access to this? And look at, for example, in the contemporary context, how vaccination for COVID is rolling out. I saw a New York Times article recently that, you have limousines pulling up into marginalized communities, people jumping out of those limousines, getting in line for vaccinations. We have to be careful and considerate of the populations who might be in most need. And who, might be left out and have an agenda that is focused on inclusion just as much as it is focused on innovation.
Jason Helgerson: Absolutely. And so, Michael, I've got one last question of thinking about this vision of yours for 2049. How does that vision, if it actually does come to be, how will it make the world a better place?
Dr. Michael Lindsey: Well, right now, as people are struggling with mental health challenges and they have accessed, let's say psychotherapy, they have the combined approach of being involved in talk therapy that is evidence-based, but they have the combination of the psychotropic medication that is alleviating the symptoms so that they might be able to benefit from talk therapy. But yet, it is uneven in terms of whether or not what we're doing now really works. Do we know that it works with, for example, blacks as great as it works with white populations? Those are the enduring questions that we're asking.
What I'm hopeful for in terms of 2049, is that we know what works. We have brought technology to bear on these issues in such a way, as we have clear cut answers on what works best and that folks who need those supports have access to it. I think to the extent that we can continue to work in parallel fashion, as I mentioned in terms of innovating, but also including, then we'll have the answers to those enduring questions, and we'll be doing things that work, that we won't be shooting arrows in the dark, if you will, in terms of how to best alleviate one's mental illness. We’ll be clear about it. And for that the world will be better.
Jason Helgerson: Absolutely. I couldn't agree with you more, Michael. I think that behavioral health, mental health, is certainly an area where we need more research. We need to apply science in a more rigorous and more effective way. So thank you very much, Michael, for coming on the show today.
And that was Dr. Michael Lindsay's vision for healthcare in the year 2049. As always, thank you for listening to health 2049. If you enjoyed what you heard please subscribe to us and share this podcast with a friend. Thank you! And see you next time.
