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2.8.2 Expanding the Frame from the Individual to the Social

Most algorithmic and data-driven technology in the mental health context appears to be directed at detection and diagnosis,427 which draws the focus to the individual who is identified as requiring expert intervention. This dominant framing has been challenged by some commentators who call for a shift in focus away from the individual, and its associated deficit-based concern with their deviation from presumed norms, toward the social networks and relational nature of distress, mental health, disability and healing.428 Jonah Bossewitch, for example, has elaborated on the way technology can re-direct attention to networked collaboration, which could significantly improve the training and development of providers offering support to those in crisis.429 He writes:

  • Instead of focusing the diagnostic lens on the recipients of services, let’s start by developing better tools to help providers enhance their skills and empathetic understanding. I am imagining contextual help, immersive simulations and distributed role plays, just-in-time learning modules that caregivers could query or have recommended to them based on an automated analysis of the helping interaction. The field could also benefit from more intentional use of networked, interactive media to engage counselors in their clinical supervision and help them collectively to improve. Did that last crisis intervention go well? What could I do differently if I encounter a similar situation again? Do any of my peers have other ideas on how I could have handled that situation better?

For those with lived experience or psychosocial disability, contemporary information communication technologies can have a strong collective dimension that can be used within social movements to create a sense of solidarity, to intervene politically and to provide a sense of belonging for groups that may have traditionally been socially and economically marginalised.430

There are examples of successful online initiatives that appear to boost local forms of mutual support, such as the online peer support network that emerged from the NGO USPKenya (discussed in case study on X). The online support group used a mainstream messenger service and was described as being ‘fully community-based, operat[ing] outside Kenya’s mental health system and [not linked] to any mental health institution.431 The virtual support network involves crisis support for individual members, sharing of information about face-to-face meetups, the generation of fundraising for individual members, and so on.432 Such informal initiatives may not make it into the public spotlight in the same way governments, large NGOs, and industry-funded initiatives do, but they may warrant resources or further research to determine how and why they are working, and how they can be supported.

The call for a focus on relationships over individual autonomy, community over individual rights, and interdependence rather than independence, can be found in much of the literature by people with first-hand experience of mental health initiatives, particularly in low- and middle-income settings.433 This focus is also common in literature concerning

the ethics of care (sometimes referred to as relational feminist ethics)434 and other communitarian-oriented approaches to ethics and justice. A relational focus also aligns with growing research on the impact of social, political, and economic structures on people’s mental health, which extends to querying whether most forms of distress should even be framed in terms of ‘mental health’. As an example, consider Morgan and Kienzler’s statement on the mental health impacts of COVID-19 on populations worldwide

  • To feel anxious and sad, to have trouble sleeping, to be afraid for the future – all are perfectly understandable responses to such a profound rupture in our social worlds. However, framing this distress in terms of mental health – as we have done so far, following the currently dominant narrative – is potentially problematic. This approach, at the very least implicitly, locates distress and mental health problems in individuals and, in effect, severs experiences like sadness and anxiety from the social conditions in which they arise, making them problems of psychology or even of biology.
  • It is this narrative that underpins the predominant responses to date, which centre around calls for an expansion of individual interventions, of mental health services, and, in settings such as schools and workplaces, of myriad therapies such as mental health first aid, various forms of supportive counselling, and mindfulness. This is taken to its extreme in Amazon’s recently reported mindfulness pod, a portable cubicle with space for a single worker to step out of the workplace, isolate themselves, and practice being in the moment as a means to reduce stress. Better, it seems, that workers clear their minds than reflect too much on the excessively long working hours, lack of autonomy, pitiable wages, and the Dickensian working conditions they are forced to endure to further enrich the billionaire, Jeff Bezos. By stripping suffering and distress from their social origins in this way we add insult to injury. We might, then, more usefully think about the distress that arises primarily as a consequence of poverty, precarity, violence, and trauma – including much of the distress stemming from the pandemic, social restrictions, and economic impacts – as a form of social suffering.435

In low- and middle-income countries, the impact will be even more stark. Manuel Capella describes how the Ecuadorian government ‘set up the “telepsychology” phone line with one hand, whilst (in the middle of a pandemic) paying millions of dollars of foreign debt and approving reductions in the public budget with the other’, noting that ‘[s]uch cuts negatively affect the well-being – including the mental health – of the vast majority of the population’.436 In this way, digital practices in mental health have clear potential to reinforce individualistic views of mental health, which invisibilise social determinants and the importance of communities. This might be described as a capitalist instrumental view of mental health (for example, ‘empowering’ people to take matters into their own hands or making damaging work practices more bearable to workers rather than relying on state resources or creating fair and equitable labour conditions).

In contrast, using technology to promote holistic, human growth requires attention to the impacts of socially and economically structured disadvantage. This could even extend to querying the monopolistic, anti-competitive and surveillance-driven nature of major parts of the information economy. Regardless, current pandemic conditions have amplified historic and structural inequalities, making it even more important to consider ways to use computer technology to harness social and economic resources that individuals draw from to cope with and navigate our challenging and changing social worlds.