How the Web Could Help People with Mental Illnesses Get to Work

No, it's not Craigslist. It's technology, gamification, and telehealth.

Credit: Kenny Louie, Wikimedia Commons

Web-based games can help people living with severe mental illness return to work, a study has found.

Combining brain-training exercises on the internet with supported employment programs can drastically improve the chances of these patients finding and maintaining jobs, according to the report by Australia’s Westmead Institute for Medical Research.

“There’s a whole group of games that are often oversold to people who have normal cognition and are just anxious about whether their short-term memory is functioning like it used to be,” said lead researcher and clinical psychiatrist Dr. Anthony Harris. “But this study shows they can be useful for people with cognitive problems as a result of severe mental illness to regain some of their thinking skills.”

That, in turn, can boost patients’ employability, the study found. On average, participants using the web-based therapies worked 3 times the number of hours and earned almost $2,000 more than the control group over a 6-month trial.

The study used cognitive remediation therapy, or CRT, which includes games similar to the popular brain-training app Lumosity. They are engineered to improve attention and concentration, response speed, and short-term memory. CRT targets cognitive deficits that individuals may have as a result of their illness. “The gamification makes it a lot easier for people to stick with exercises that can otherwise be quite dry,” Harris said.

In the US, about 80% of people living with a severe mental illness are unemployed, according to a 2014 report by the National Alliance on Mental Illness, the nation’s largest grassroots mental health organization. The same report also found that roughly 60% of the 7.1 million people receiving public mental health services nationwide want to work, but less than 2% receive supported employment opportunities provided by states.

Unemployment for patients living with a severe mental illness is bad for the individual, bad for the community because of a dependence on social services, and bad for the workforce because of wasted manpower, Harris added. “It’s a triple whammy.”

Being in full-time work is one of the best means to recovery, but a negative feedback loop exists between long-term unemployment and severe mental illness: The poverty and marginalization associated with joblessness can cause further alienation and exacerbate the symptoms of severe mental illness. “You can be presented with regular failure, it can stop you from engaging in social networks, resulting in loss of contact with the working world, loss of status, loss of friends,” Harris said.

Harris said games can be particularly attractive to young patients, who tend to dislike therapy. The symptoms of schizophrenia usually start between ages 16 and 30, according to the National Institute for Mental Health.

“Young people especially don’t want to be seen to be unwell, to have a mental illness and don’t want to be caught going to therapy groups, which aren’t seen as particularly cool.” The web-based therapies are “a way of using the work of software developers, who are oftentimes all too good at getting people hooked into their games, in a positive way.”

According to the U.S. Centers for Disease Control and Prevention, only 1 in 4 individuals with a psychological condition believe that others are caring and sympathetic to people with mental illness. That stigma can not only prevent patients from getting hired, but it can also stop people from seeking the help they need.

“People are concerned to say that they are depressed or feeling suicidal, and the tabloid press reporting on issues like schizophrenia are usually horrendous,” Harris said. But cognitive remediation therapy on the internet could create a way for patients to seek assistance in the comfort of their own home or discreetly while at work. The growing popularity of telehealth reflects a need to provide specialized health services at a distance, according to Harris. That’s already been happening in psychiatry for some time, he said.

Because the cost of web-based treatment is small compared to, say, in-person therapy groups it would be straightforward and inexpensive to roll out. Then it could reach sparsely populated rural areas where access to treatment tends to be more limited, the report said.

For the best results, the games should be matched with supported employment opportunities. Harris said that is essential. “The cognitive remediation therapies alone only have a small effect,” he noted, “but it’s much better if it’s combined with other psychosocial interventions, like disability support programs.”

The trial was conducted with a sample size of 86 people with a range of severe mental illness—including schizophrenia, bipolar disorder, and psychotic depression—from across New South Wales, Australia.