|Leveraging Technology in Military Mental Health
|Human Factors and Medicine|
Biomarkers, BrainNeurostimulation, Genomics, Leveraging Technology, Machine Learning, Military Mental Health, NeuroBiofeedback, Neuroimaging, SimulationSerious Gaming, Webbased Mental Health
Leveraging technology represents the greatest opportunity for advancing mental health in over a century. Across the NATO alliance all partners are contending with a significant mental health burden and leveraging technology will be part of a concentrated effort to mitigate its impact. Advances in fields such as data analytics, robotics, imaging and biomarkers, simulation, machine learning and genomics have been leveraged in various medical specialties, most notably in oncology, cardiology, radiology, surgery. Mental health is lagging behind in the application of these advances. Leveraged technologies will augment or replace conventional approaches across all domains of military mental health (assessment, treatment, education, training, and identification of risk). Taking advantage of these technologies will contribute to greater force readiness and enhance assessment and treatment of the ill and injured.
Current military mental health approaches reflect mental health in the broader community. However, given their unique populations and mandate, militaries are perfectly poised to leverage technology. Unlike civilian communities militaries have a mission-oriented responsibility to optimize a broad range of aspects of a member’s life, including health, employment, housing and family/community. It is the unique role of the militaries that makes it possible to effectively invest in leveraged technology.
The Exploratory Team (ET-137) concluded that the myriad of technologies and potential mental health applications are too expansive to be covered in a single RTG. As such the recommendation is to focus an RTG on technologies for military relevant mental health problems such as PTSD, Depression, Substance Use Disorders and Suicidality.
The relevance of this proposed RTG is the collective sharing of efforts in the domain of implementing new technologies in mental health. The impact will be a decreased mental health burden on our militaries through the adaptation of these emerging technologies. This could lead to the standardization of various technologies within NATO.
This RTG will address priorities in other NATO S&T areas including Big Data & Long Data Processing and Analysis, and Sensor Integration & Networks. This RTG will also coordinate with relevant on-going activities: ET-135 Precision/Personalized Mental Health and Performance, and HFM-RTG-260 Wearable Sensors. In addition, this RTG will also address the 2016 NATO S&T Priority ‘Advances Human Performance and Health’ in the following areas: Human Resiliency, Medical Solutions for Health Optimization and Enhanced Cognitive Performance.
The outcome of this RTG will be identification of technological advances that can have a direct impact on assessment, treatment, education, training, and identification of risk. This will enhance force readiness through optimized performance, risk mitigation, return to duty, and more efficient health care utilization.
The main objective is to identify and validate technologies that will advance mental health within military populations thus reducing the burden.
The proposed RTG will review existing technologies with regards to their applicability and suitability in the military mental health setting. The list below outlines some of these technologies, but others could be studied as the field continues to evolve. Each technology will be reviewed with respect to prevention, diagnosis, treatment and prediction of military mental health disorders.
Big Data/Machine Learning: Most militaries have incredible amounts of data in Electronic Health Record (EHR) systems, as well as personnel and other administrative data. These approaches will provide a depth of analysis that has not been possible before. This allows for risk stratification, algorithm creation, treatment predictions, and training need identification, all of which may inform policy. Augmentation of datasets with alternative data streams from sources such as wearable devices and social media can further enhance opportunities to leverage this technology.
Neuroimaging/Biomarkers: Increased exploration of biomarkers (e.g. hormones, cytokines) and neuroimaging techniques (e.g. magnetoencephalography (MEG)) has greatly enhanced the understanding of the biological underpinnings of mental health disorders. Computational analyses of these objective markers allows for discovery of biosignatures that can inform clinical care of military relevant mental health problems.
Mobile and Online Interventions: Several new applications have emerged that allow online assessment as well as treatment (e.g. web-based CBT, telemental health). There are no geographic or temporal limitations to these approaches which is crucial for militaries that deploy troops throughout the world. These approaches are provider multipliers in a setting where personnel resources are limited.
Genomics: Genomic analyses have facilitated better understanding of the molecular biology of PTSD, Depression, Substance Use Disorders and Suicidality. This understanding may result in more refined approaches. Most notably pharmacogenomics has evolved to the point where medication management can be fairly specifically directed based on discrete testing.
Simulation and ‘Serious Gaming’: Militaries are already familiar with Simulation and Serious Gaming. New approaches can extend this technology, create more immersive environments and incorporate live (e.g. wearables, neuro/biofeedback) interactive modes of training. Serious Gaming tailored to military contexts can enhance resilience and simulation can augment treatment response (e.g. Virtual Reality for PTSD).
Neurostimulation: Biological therapies beyond medication have existed for many years. This field is rapidly advancing despite a controversial history. Effective treatments such as repetitive Transcranial Magnetic Stimulation (rTMS), Deep Brain Stimulation (DBS), Vagal Nerve Stimulation (VNS), transcranial Direct Current Stimulation (tDCS), and Electroconvulsive Therapy (ECT) stimulate regions of the brain in order to alleviate suffering. These approaches can be individualized to target affected regions of the brain and are generally very well tolerated in military relevant mental health disorders.