Eshanthi Ranasinghe
Interim Lead, Exploration and Future Sensing

A Mental Health Pandemic: Is the World Getting More Addicted, Anxious, and Lonely?

March 19, 2019

By Erica Orange & Jared Weiner, The Future Hunters, and Eshanthi Ranasinghe, Exploration & Future Sensing, Omidyar Network

Mental health issues today have almost become pandemic. Depression and anxiety in particular are increasing rapidly, with much still clinically under- and undiagnosed. This pattern is persistent around the world. The World Economic Forum estimated that direct and indirect costs of mental health amount to over 4 percent of global GDP, more than the cost of cancer, diabetes, and chronic respiratory disease combined. This could cost the global economy up to $16 trillion between 2010 and 2030 if a collective failure to respond is not addressed. 

Some of this global rise could be attributed to spreading norms around treatment; but hypotheses persist that mental health of global populations is increasingly at risk, in part due to a confluence of societal factors, such as: the stress of migration and cultural integration (including among refugee populations); an increasingly polarized world fueled by “us versus them” narratives; lack of available economic and employment opportunities; persistent gender- and race/ethnicity-based inequality, discrimination, and violence; shifting cultural norms and a feeling of “culture under threat”; and the role of tech and social media, fueling everything from tech addiction to loneliness to body image issues. Furthering this trend is the opioid crisis, with signs of it being exported from the US to the rest of the world.

Part A: Mental Health Challenges on the Rise

Patterns Among What is Getting Worse: Depression, Anxiety, and Loneliness

It was estimated by the World Health Organization (WHO) in 2015 that more than 322 million people have depression — about 4 percent of the world’s population, an increase of 18.4 percent between 2005 and 2015. Loneliness is also on the rise. A recent study found that over 9 percent of adults in Japan, 22 percent in the US, and 23 percent in the UK always or often feel lonely or isolated.

While this is more pervasive and rising more quickly among the young, demographic shifts, particularly aging populations in more developed markets, are leading to an increase in social isolation. From 1980 to 2015, the number of seniors in Japan living alone increased more than six-fold, to almost 6 million, resulting in some unusual actions, including lonely seniors, typically women, shoplifting in search of the community and stability of jail. More than half of seniors caught shoplifting live alone; 40 percent either don’t have family or rarely speak with relatives. These people often say they have no one to turn to when they need help.

Technology Plays a Significant Role, Especially as an Amplifier

We know the “usual suspects”, mental health issues resulting directly from technology — addiction, as social media platforms use the same techniques as gambling firms to create psychological dependencies and real imbalance of brain chemicals among teens that resembles depression and anxiety; and smartphone anxiety, including “low-battery anxiety,” “nomophobia”, the fear people can feel when they are out of mobile contact, even FOMO (fear of missing out), which has nearly 23 percent of students in India logging more than eight hours on their smartphones daily. The dependency is strong, and globally pervasive, with nearly all of the 60 percent of Kenyans who own smartphones saying they find it hard to put them down. In China and South Korea, tech rehab camps are now common, and the World Health Organization officially recognizes video game addiction as a mental health disorder.

But there is evidence to suggest that we are just hitting the tip of the iceberg of tech-enabled mental health issues. Constant access to information can cause a kind of collective anxiety and helplessness. Researchers using health-monitoring devices found that entire populations’ sleeping habits, heart rates, and distances walked can swing out of sync after large societal events (e.g., Brexit) — and much of this is heightened by a constant cycle of social media and digital news. 

We also see this manifesting socio-culturally. Smartphones have disintermediated many in-person conversations. We are talking to each other less and having fewer meaningful conversations which can increase feelings of loneliness and anxiety. Not only are more people, particularly digital natives, craving “IRL” (in real life) connection, but studies have shown that people felt better and more connected during times when they only socialized face-to-face

This level of social disconnection can also endanger health. Loneliness has been alleged to have the same impact on life expectancy as smoking 15 cigarettes a day, with a risk factor that rivals excessive drinking or obesity. A lack of social contact can also speed up cognitive decline, heart disease, depression, and suicide. And, smartphones are methodically killing off boredom, which has a very important role in creativity. The seeds of ideas that may come from idle reflection are being replaced by constant distraction. And constant distraction — which causes dopamine to spike when confronted with newness and novelty, addictive but inherently unfulfilling, does not lead to a healthier mental state. Being creative, however, can.

Ultimately, we still have a less-refined understanding of what is happening at the now-pervasive nexus of mental health and technology. And things get complicated when we’re also learning of many ways in which technology can improve mental health outcomes.

Emerging Mental Health Epidemics: The US Opioid Crisis

It’s difficult to talk about mental health without mentioning the US opioid crisis. The US faces a mental health epidemic; nearly 1 in 5 American adults suffering from a form of mental illness. Suicide rates are at an all-time high, 115 people die daily from opioid abuse, and 1 in 8 Americans over 12 years old take an antidepressant every day. The economic burden of depression alone is estimated to be at least $210 billion annually. People abusing opioids also often face the additional burden of depression. And while the opioid crisis is most pronounced in the US, the problem has begun migrating to Europe — which could portend an even greater, eventual global concern. The relationship between opioid abuse and depression is bi-directional, meaning that suffering from one increases the risk of the other. Many prescription opioid abusers may turn to using heroin. This addiction can lead to the feelings of hopelessness, despair, and guilt, and researchers estimate that 48 percent of people dependent on the drug will also experience depression.

Part B: Mental Health Innovations

Entrepreneurs, philanthropists, companies, and individuals have risen to the challenge, creating a range of tools and treatment options that go beyond traditional Western medicine. This includes the rise of “anti-tech tech,” apps and mobile phone-based tools that help users reduce phone use (like this app recently launched in the UK that allows users to earn rewards for not going on their phones; and the MP02, designed for people who want to unplug from the world of apps and constant notifications and use a simple, stripped-down phone). In addition, other types of innovations — “technology Rx” and unusual applications of natural medicine–are being applied to mental health.

Technology Rx: Tech Tools for Mental Health

“Technology Rx” is part of the growing trend of adaptive technology that can personalize healthcare — outside of mobile phone-based apps.

Virtual Reality: VR therapy is being used to address complex anxiety disorders, such as social anxiety, post-traumatic stress, and even paranoid schizophrenia. The Virtual Reality Medical Center in San Diego uses VR therapy as a treatment for reducing pain in patients undergoing procedures. Swedish pharmacy Apotek Hjärtat is prescribing its VR pain relief app, Happy Place, as a supplement to traditional pharmaceuticals.

Gaming: Videogames can also be a tool in serving mental health needs. Akili Interactive Labs is creating a videogame to treat kids with ADHD. “Chill-out” games that focus on relaxation and aim to create a calming space for players are becoming more popular.

Robotic Therapists: Woebot, the bot therapist, does not pretend to be human; it appears as a cartoon robot when it chats with you on Facebook Messenger all while doing psychological work. Researchers found that after two weeks of interacting with the bot, the test subjects had lower incidences of depression and anxiety.

Voice Analysis: Researchers are increasingly enlisting smartphones and machine learning to find vocal patterns that might signal post-traumatic stress disorder or even heart disease. Vocal tests could be useful because they are non-invasive — people are often embarrassed to talk about their mental health, so these conditions frequently go underdiagnosed–and add a level of rigor to measurement that mental health diagnosis has traditionally lacked.

Artificial Intelligence (AI): AI solutions can help psychiatrists and other mental health professionals do their jobs better. They collect and analyze reams of data much more quickly than humans could and then suggest effective ways to treat patients. Ginger.io’s virtual mental health services include video and text-based therapy and coaching sessions. Through analyzing past assessments and real-time data collected using mobile devices, the Ginger.io app can help specialists track patients’ progress, identify times of crisis, and develop individualized care plans.

Brainwave Treatments: While still in its infancy, technology using a patient’s own brainwaves might offer hope against mental health issues such as PTSD and chronic stress, research suggests. NeuroSky technology can detect and interpret brainwaves and has even been used to develop a VR experience to help treat OCD.

New Forums and Ways to (Meaningfully) Connect

With loneliness and stigma both feeding into mental health challenges and preventing treatment, new efforts and organizations are creating community and connection to facilitate treatment.

Online Chat Forums: Reddit may be helping people cope with mental disorders. Researchers learned that frequenting some of the site’s subreddits (e.g., r/depression) improved the mental state of subscribers. Ironically, or perhaps predictably, some of its forums have done just the opposite.

Mental Health Text- and Hotlines: Text messaging is a surprisingly effective way to do crisis counseling and address mental health issues. And it’s the default mode of communication for young people. Three-quarters of US-based Crisis Text Line’s users are under 25 years old and 12 percent are under 13. Sri Lanka’s mental health problems skyrocketed after a three-decade civil war that ended in 2009. The CCC Line phone bank is a free counseling service run by volunteers.

Cathartic Experiences: A Japanese company, Ikemeso Danshi — which roughly translates to “Handsome Weeping Boys” — provides cry-therapy services for men seeking a catharsis they feel unable to express in daily life. Cuddle therapy is also on the rise in the US as people seek out touch from strangers to feel soothed and pacified. With more digital and virtual relationships, rather than interpersonal, these services will likely increase.

Happiness Meters: Alibaba is pursuing a new biometric concept at its Futuremart store: a happiness meter to reward customers for positive attitudes.

Alternative health: Natural health takes on new twists

Return to Happiness: A new wave of “happiness classes” in India focuses on learning through inspirational stories and meditation exercises. This approach emphasizes concentration and self-awareness.

Nature: Ecotherapy refers to a series of nature-based exercises intended to address both mental and physical health. Ecotherapists are a small but growing group of healthcare professionals who are essentially medicalizing nature. Researchers have found that when people did physical activities in natural settings, they experienced less anger, fatigue, and sadness. The Japanese have long engaged in “forest bathing” to promote positive health. Other countries are starting to follow suit with similar efforts (e.g., India, the UK, Hong Kong).

Plant Medicine and Psychedelics: Since the beginning of human history, plants have served many important medicinal and healing purposes. Trends in this area are going beyond medicinal marijuana, to “magic mushrooms”, ayahuasca tea, DMT, and MDMA. Psilocybin, the active chemical in magic mushrooms, may hold promise as a therapeutic approach for several mental health problems. Microdosing LSD has been found to increase mental clarity and treat conditions such as OCD (obsessive compulsive disorder).

Play: Playing physical games is known to positively effect mental health. Children are so over-scheduled in the US that doctors are being told by the American Medical Association to prescribe free play.

Challenges & Questions

Despite the overwhelming need, political leaders and international development agencies frequently overlook the importance of mental health. In Africa, the “treatment gap” — the proportion of people with mental illness who don’t get treatment — ranges from 75 percent in South Africa to more than 90 percent in Ethiopia and Nigeria. Overcoming the silence that comes with mental health is a growing issue in China. In India, 75 percent of millennials said they don’t feel comfortable talking to medical professionals about mental illness because of the stigma attached to mental health problems. In northern countries like the US and UK, mental health services are plentiful but often expensive, inaccessible, and often stigmatized among minorities, immigrants, and young men.

Alternative therapies to combat mental health may become more mainstream. For instance, what would it look like to “prescribe nature”? What would nature-based methods of physical and psychological healing do to productivity? And what could this mean for the creation of sustainable communities — particularly in the developing world? Will more health insurance plans cover ecotherapy like they do cognitive therapy? Or cover prescription-strength video games? Will school psychologists be equipped with VR headsets? Will pet stores or animal shelters become wellness clinics?

Will public parks turn into adult playgrounds? Will robots become our psychiatrists; therapists; confidantes? Will our smart homes, hospital rooms, classrooms, offices, retail spaces, and military arenas of the future be able to respond to individual moods and current mental health states? And while more employers are embedding yoga, meditation, and mindfulness practices into current wellness programs, it will be equally important to examine what technological tools employees are being given to optimize both their performance and their mental health.

Could Technologies Designed to Measure Mental Health Be Used to Manipulate it?

Our environments will increasingly be populated with technologies that anticipate people’s feelings, determine if they are suffering from something like depression, or have mental health issues. One of the important ethical quandaries going forward will be how those technologies could manipulate individuals’ mental health using those data points. A practical example we see today is a Chinese school using facial-recognition to analyze student behavior. The technology records facial expressions, categorizing them into happy, angry, fearful, confused, or upset categories — and the school can tailor its approaches accordingly. We will likely see more applications of this among global populations — in academia, in the workplace, and, in some instances, through direct utilization by governments.

This is Trend #5 of 5 in Omidyar Network’s Exploration and Future Sensing, 2019 Trends to Watch. View the full series here.

Consider Explorations an open space for discussion. We welcome new perspectives — especially those rarely heard, contradictory, relevant, and tangential — and most of all, conversation and partnership to build the future we want, one that includes and empowers us all. To connect and follow new insights we generate, please reach us at [email protected].

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Neelam Kshirsagar Head, Fund Raising & Partnerships at Impact India Foundation

Thank you for focusing on Mental Health. This is a growing concern. Could Omidyar support Process Work Institute of India that trains psychotherapists in Mumbai on Process Oriented Psychology based on the Arnold Mindell model? We would be grateful. Please contact me: 98202 37581. Thank you!

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