Today I had the privilege of speaking at The Chicago School about technology and serious mental illness. We covered apps, wearables, virtual reality (VR), and prescription digital therapeutics. But one question rose to the center of our conversation, and I haven’t stopped thinking about it.
If a psychiatrist “orders” an app that requires therapeutic work, how does that therapy actually happen?
This is not hypothetical. The FDA recently cleared Motivista, the first prescription digital therapeutic for schizophrenia. It is prescribed alongside antipsychotic medication, and it draws on elements of evidence-based psychosocial therapy. In other words, a prescriber writes the order, and what the patient receives looks a lot like the work of a therapist.
Other tools blur the line even further. SlowMo, a digital program for paranoia, works best when it is blended with sessions led by a therapist. Avatar therapy for persistent voices depends on a clinician giving voice to the avatar. VR exposure therapy needs someone to guide it.
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For decades, mental health care has largely run on two tracks. Psychiatrists and nurse practitioners manage medication. Psychologists, counselors, and social workers provide talk therapy. In the best settings, they coordinate. In many others, especially for people with serious mental illness, they barely speak. Families like mine often end up as the go-between.
Technology may not respect that divide.
When a prescription is a piece of software built on therapeutic principles, the prescriber needs to understand what the patient is being asked to do. The therapist needs to know what the app is delivering, so the two do not work at cross purposes. Someone has to notice when engagement drops off, or when the app surfaces something that needs a human response.
So here is my question for you: Will the growing use of apps, wearables, VR, and augmented reality (AR) push prescribers and therapists into a closer partnership? Could technology create a new kind of upheaval in the treatment world, one that finally brings these two tracks together to provide better care?
I am hopeful. The students I met today will help decide the answer. Many will practice in a world where a treatment plan includes a medication, a therapist, and a piece of software, and the people managing each one must talk.
But hope is not a care model. Billing codes, training programs, health record systems, and team structures were all built for the old divide. If we do not redesign them, the technology will simply land in the gap between the two tracks, and patients and families will be left to fill it, as we always have.
I would love to hear from prescribers, therapists, and families. Where have you seen this working? Where is it breaking down?
Nicole Drapeau Gillen is a mother, advocate, and author who translates the fast-moving landscape of technology in serious mental illness (SMI) care into guidance families and clinicians can use. Thrust into caregiving for a loved one with SMI, with no direction on how to help, she turned that experience into a mission, writing two books and building an ongoing effort to bring families and clinicians into the conversation.
Her first book, Schizophrenia and Related Disorders: A Handbook for Caregivers, is a reference for every stage of caregiving, endorsed by Dr. E. Fuller Torrey as a must-read for SMI caregivers. Her second, Connected Care: A Practical Guide to Technology for Serious Mental Illness, maps apps, artificial intelligence tools, telepsychiatry, and brain-based treatments for a field moving faster than anyone can track. Dr. Akira Sawa, director of the Johns Hopkins Schizophrenia Center, has said the book “directly addresses” significant gaps.
