The ethics of digital mental health applications

Wykes, T., Lipshitz, J., & Schueller, S. M. (2019). Towards the Design of Ethical Standards Related to Digital Mental Health and all Its Applications. Current Treatment Options in Psychiatry, 6(3), 232–242.

Summarized by Ariel Ervin

Notes of Interest: 

  • Although technology can make mental health services more accessible and effective, researchers, clinicians, and healthcare organizations still have ethical concerns about utilizing digital mental health.
  • This article aims to discuss important ethical issues in order to encourage future technological developments, potential formal and informal regulations, as well as ethical standards.
    • The authors pay specific attention to the following key ethical issues: risk-benefit ratios, privacy, and data security, ethical development of digital mental health tools, ethical research processes, and informed consent.
    • Recommendations for digital mental health stakeholders are provided.
  • It is vital for clinicians, researchers, and health organizations to acknowledge their responsibilities in developing ethical frameworks and begin to shape frameworks for ethical development and implementation.

Introduction (Reprinted from the Abstract) 

Purpose of the review

Digital health technologies offer tremendous potential in increasing access to services and augmenting existing services. Utilizing these technologies, however, poses new ethical considerations for clinicians, researchers, and healthcare organizations. These issues have been particularly apparent recently with several public instances of misuse of digitally available personal data. Responsibility for ethics is distributed among creators, end users, and purveyors which has meant that this aspect of digital technology production and use tends to be thought of as someone else’s problem.

Recent findings

In this overview, we discuss key ethical issues and dilemmas in order to drive ethical implementation, future technology development, and potential formal and informal regulation. Key considerations discussed include risk-benefit ratios, privacy and data security, ethical development of digital mental health tools, ethical research processes, and informed consent. Concrete recommendations are made for different stakeholders in digital mental health.


Digital mental health tools come with ethical considerations for the public, patients, clinicians, and health services to feel confident in their use. It will be essential for all groups to recognize their responsibilities and begin to shape frameworks for ethical development and implementation.

Implications (Reprinted from the Discussion)

The very fact that this is a fast-developing area suggests that we do not know what the problems are going to be in the future. But we can specify in advance what we expect digital technology to do in healthcare so that their design options are transparent. A number of issues need to be considered by everyone in the digital technology field and, in particular, for the fast-growing field of digital mental health care and services.

  • 1.Social and cultural issues may be subtle and affect how technology is used in different social strata and different countries. We must be sure that developments or use of digital technology does not accentuate existing digital divides [1, 19, 29].
  • 2.Data manipulation which includes the use of personally identifiable data, but most often is about algorithms for Big Data can affect the service, the intervention, or the interactions between them. For instance, a non-transparent application of an algorithm might have unintended (or intended) effects on the provision of services by providing more face-to-face time with those likely to recover quickly rather than harder cases which will absorb more clinic time. This would have the intended consequence of allowing a service to meet targets for efficiency and may even suggest that it was more effective, but neither would be true.
  • 3.Complexity occurs because there are multiple producers and users who may never be in contact, and on top of this, there are new uses for old technology that may never have been envisaged by the original producer. This distributes responsibility through a network with no clear understanding of what each node is responsible for. It is like Homer Simpson’s manifesto when he ran as Commissioner for the Sanitation Department, “Can someone else do it?” The assumption that it is someone else’s job has the potential for allowing important problems to fall through the net.

In sum, the interdisciplinary nature of the field of digital mental health introduces challenges of colliding ethical traditions and responsibilities. We identified and discussed some of these issues and emphasize the need for stakeholders to work together to address these issues. We do not pretend that this will be simple, but we believe that much more can be done now to ensure that ethical guidelines are followed.

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