Virtual reality is touted as having the potential to transform how doctors diagnose and treat a number of mental illnesses, and the front lines of this revolution may be forming in China. The country’s troubled psychiatric services are notoriously swamped, a situation signaling that its market is wide open for innovation—and that developers have an opportunity to leapfrog past traditional care models and make China an early adopter of VR psychiatry on a large scale.
VR psychiatric applications include immersing patients in simulations that seem real, exposing their brain—but not their body—to challenging situations and helping them learn to hone their physical and emotional responses. For example, a veteran with post-traumatic stress disorder can visit a virtual version of Iraq or Afghanistan from the safety of a therapist’s office, an alcohol-addicted patient can sit at a virtual bar without drinking, and a person too anxious to fly can “experience” takeoff and landing while staying firmly on the ground. Such treatments can yield fast, dramatic results: in one case a woman with a debilitating fear of heights could calmly ride an escalator after a three-hour course of VR exposure therapy.
Researchers around the world have been testing these technologies—with promising results. Through the end of 2016, peer-reviewed journals had published nearly 300 studies on using VR to treat mental health disorders (although many were small and of mixed quality). And then this March, JAMA Psychiatry published what researchers say is the first ever randomized controlled trial of a therapist-free VR intervention of acrophobia, or fear of heights. It found the technology to be effective, inexpensive and well-received by patients.
Mental Health in Crisis
VR therapy holds broad appeal in many markets for a number of reasons, but China offers particularly fertile ground: an estimated 90 percent of people with mental health disorders have never sought treatment.
This result is partially linked to a shortage of trained professionals. World Health Organization data show China’s concentration of psychiatrists is four times lower than the global average, with only 2.2 per 100,000 people (the U.S. rate is 10.5). This shortage is creating a public health crisis in the nation; some psychiatrists there routinely see more than 100 patients a day, according to Xiaoduo Fan, an associate professor of psychiatry at the University of Massachusetts Medical School and director of the university’s China Mental Health Program. When he observed caregivers at work in China, he saw no privacy and little time spent with each patient. Psychiatrists in China often cannot even spare the time to write prescriptions, relying on an assistant to do so while the doctor moves on to the next person. “I did not believe it until I saw it myself,” Fan says. “The wards are like a flea market—crowded with people.”
Another reason for low treatment rates is cultural. While similar biases exist in many countries, studies have shown people with psychiatric problems endure especially high levels of stigmatization in China. Fan notes that even when psychiatric services are available, people are often reluctant to get help for fear of embarrassment. Families of those with mental illness have been known to hide away their sick relatives for years—reportedly sometimes in cages or empty rooms—rather than seeking treatment, he notes.
Many proponents of mental health VR think it can help address both caregiver shortages and stigma. Because the technology can be fully automated, it can easily scale to meet the needs of many people. And many think VR treatments could break through cultural barriers because they can take place in the privacy of one’s own home via a gamelike interface. Daniel Freeman, an professor of clinical psychology at the University of Oxford who studies VR treatments for mental health, says VR could be “revolutionary in reducing stigma.”
Cognitive Leap, an international VR company that focuses on mental health, specifically concentrates on this issue. The company’s CEO Jack Chen says the limited number of mental health providers in China—combined with a history of viewing some mentally ill people as criminals—exacerbates a situation in which trust is low and stigma is high. Technology, on the other hand, enjoys a greater level of confidence. “The VR system is viewed as very scientific and has zero stigma,” Chen says. “It’s such a pleasant and fun thing to do.”
Tech Swoops In
Even though China has been a hotbed of technological innovation in recent decades, improvements to health care have lagged. Many working in medicine are underpaid, undertrained and regarded with little prestige. Patients remain frustrated by long waits, high costs and impersonal care. In the otherwise tightly controlled country, this frustration can sometimes even boil over into violence: within a single year, 96 percent of hospital staff reported being abused by patients or families, according to a 2014 study.
This general discontent is another factor that leaves health care ripe for a tech disruption that has already begun. China is estimated to have more than 100 artificial-intelligence firms that focus on medical applications. Some concentrate on psychiatric treatment: in addition to Cognitive Leap, companies such as Oxford VR, Shanghai Invision Digital Technology and Shanghai Qing Tech have all launched mental health programs in China, often with support from universities. Lax privacy norms and a massive population make the development of machine learning for health care particularly suited to the country. This fact has led some experts to believe China’s AI medical technology will soon surpass the U.S.’s in terms of sophistication and adoption—if it has not already done so.
If China does innovate its way past its psychiatric care shortage, this would be consistent with its actions in sectors such as retail and finance—where it has adopted novel technologies more quickly than many other countries. This leapfrogging has become synonymous with Chinese enthusiasm for digitization. Credit cards, for example, were largely passed over by consumers—although some people do use plastic, many went from predominantly paying with cash to paying via mobile apps.
Despite the enthusiasm, however, experts warn that technology is no panacea. “VR can only be one part of mental health care and not the whole system,” Freeman says. Even some of the technology’s strongest proponents caution that important safety and ethical guidelines are still lacking. Fan emphasizes that what China ultimately needs most is better training and credentialing for mental health providers and greater investment in community resources. He worries about the privacy concerns involved in relying on tech entrepreneurs. “If we just let the business of technology run, it’s going to be abused,” he says. “A company may make a lot of money, but it’s not going to achieve the desired impact.”
Still, with overwhelming demand for services and distrust of traditional care, digital health is booming in China. In psychiatry in particular, there is a relatively blank canvas for technological innovation—and VR is poised to fill a big chunk of that void. If it does so, China could make significant strides to close its treatment gap. It might even provide a model for other countries with shortages in their mental health care systems, including the U.S.