Digital technologies are everywhere: from smartphones and tablets to smart TVs and fridges. With the development of every new technology, however, the ‘digital divide’ between those able to access digital communication and information and those without access increases.

Up to 50% of adults with a learning disability occasionally access the internet, and cell phone use is markedly lower and less advanced than for people without learning disabilities. More recent technologies, such as tablets and smartwatches, are likely to be used even less. It can therefore be expected that the uptake of digital health interventions is also not widespread among this population.

In spite of this, current digital health technologies for people with learning disabilities cover a wide range of purposes. From the least to the most advanced, these technologies include:

• Automated alarm systems for behaviour monitoring
• Tele-consultation to access specialist advice using telephone or video link
• Tele-monitoring using wearable devices to track sleep and activity patterns
• Smartphone and tablet applications to support communication with healthcare providers, to report pain, or to improve physical health and fitness
• Computer games to support psychological therapy (see my previous blog on computerised cognitive behavioural therapy using Pesky gNATs: The feel good island)
• Virtual reality to simulate healthcare environments.

Methods

In their paper, Sheehan and Hassiotis examine the digital divide for people with learning disabilities when applied to mental health technologies. They searched for relevant literature on Medline and Google Scholar and used additional Google searches to retrieve information from other sources, such as policy reports and guidelines.

As this is a critical overview paper, it did not evaluate the scientific evidence regarding the efficacy of such interventions but instead examined the potential barriers and benefits associated with digital mental health interventions.

Results

Barriers to digital interventions

The main barriers the authors identified can be grouped into three categories: use and interface, organisation and support, and financial.

Interaction and interface:

• Applications that are mainly text-based and require lots of reading
• Frequent software updates and changes to the layout and interface that require the user having to ‘re-learn’ how to use the device or intervention
• Physical limitations and sensory impairments can make it difficult to access information on small devices

Organisation and support:

• Not having appropriate support to learn new digital skills
• Carers or family members who discourage the use of new technologies, in particular online communication, to shield them from victimisation

Financial barriers:

• The hardware for digital interventions, such as smartphones and tablet computers, are not cheap and only a small proportion of people with learning disabilities are in paid employment.
• Even applications promoted by the NHS to support communication in people with learning disabilities are not available for free (https://apps.beta.nhs.uk/mychoicepad/)

Benefits of digital interventions

When the above barriers can be overcome, digital mental health technologies can bring many benefits. Tele-services are particularly useful when specialist support is geographically dispersed and difficult to access. Meanwhile, wearable devices and behaviour monitors could improve the self-management of physical health. Applications sending daily reminders might improve patients’ adherence to treatment in between appointments.

Additional benefits can be expected in the area of communication. For example, technologies can augment communication skills and the ability to self-report health and mental health symptoms. Digital platforms can also provide social support and promote independence.

The way forward: Implementing digital technologies in mental health support

The authors provide numerous suggestions of how technologies can be used to improve the mental health of people with learning disabilities.

1. Universal design principles could enhance the uptake of digital technologies by people with learning disabilities, and by other users with cognitive, social or communication difficulties. These principles include
   • Equitable use
   • Flexibility in use
   • Simple and intuitive use
   • Perceptible information
   • Tolerance for error
   • Low physical effort
   • Appropriate size and space
   • Work together to optimise the accessibility of a technological intervention
2. Technology training in education, specialist schools and adult services might create a generation of ‘digital natives’ among people with learning disabilities who are capable of using new technologies for a wide range of purposes in their everyday lives.
3. Digital health interventions can provide people with learning disabilities with a variety of means for communicating their needs, distress and desires. Improved communication could be expected to reduce behaviour that challenges and distress arising from unmet or unrecognised needs. Meanwhile, applications to track certain behaviours can provide important information for treatment plans where an individual is not capable of reporting these behaviours themselves.
4. New technologies can be developed to provide digitally supported therapies or blended-care models of therapy (combining technology-delivered and face-to-face support) for the treatment of mental health problems.
5. Digital interventions can be directed at families and carers of people with learning disabilities: providing them with a supportive social network and information to help them in supporting people with learning disability.

Strengths and limitations

The evidence identified in this paper was found through a limited and non-systematic search of the literature. As a result, the authors do not provide a comprehensive list of all digital mental health interventions currently available to people with learning disabilities. It also does not evaluate the effectiveness of any such interventions or allow for replication of the study.

However, the paper does offer an all-round perspective of digital interventions for people with learning disabilities: including the scope of possible digital interventions, practical suggestions for overcoming barriers associated with current interventions, and suggested clinical interventions. Hence, it is an ideal starting point for a more detailed and systematic investigation of these different perspectives.

Conclusion

Inclusion is as important in the digital world as it is in the real world. Sheehan and Hassiotis provide a valuable overview of how new technologies can be used to support people with learning disabilities and the barriers associated with them.

The next steps will be to evaluate the actual efficacy and acceptability of these technologies and to identify strategies to help close both the digital divide and the mental health divide between people with and without learning disabilities.

Links

Primary paper

Sheehan, R., & Hassiotis, A. (2017). Digital mental health and intellectual disabilities : state of the evidence and future directions. Evidence-Based Mental Health, 20(4), 107–111. http://dx.doi.org/10.1136/eb-2017-102759

Other references

Vereenooghe L. (2017) cCBT for people with learning disabilities: Pesky gNATs #MHNR2017. The Learning Disabilities Elf, 15 Sep 2017.

Photo credits

• By EFF-Graphics (Own work) [CC BY 3.0 us], via Wikimedia Commons
• Photo by Edho Pratama on Unsplash