but a lot, get them to the point where they can actually know who to report to evolve more parts of the department of defense. ah, so it's more of a formalizing of the process. they're going to have a budget, they're going to involve the intelligence community as are now just, they're going to be the airborne object identification and management synchronization group. ah, type of quick check of the top stories here on al jazeera, at least 31 refugees and migrants trying to reach britain, have drowned an english channel near calais after their boat sank. is the worst disaster on the crossing since you and officials started keeping records 7 years ago. this disaster underscores how dangerous it is to cross the channel in this way. and he also shows how vital it is that we now step up our efforts to break the business model of the gangsters who are sending people to see

in this way. i say to our partners across the channel. now is the time for us all of to step up to work together to do everything a we can to break these gangs who are literally getting away with murder. 3 white men in the u. s. have been found guilty of murdering a 25 year old black man who was out joking. a mod, aubrey was chased down and shot dead in a george a neighbourhood. last year. all 3 been claimed by african self defense, the old faith life and prisoner. an overnight curfew is holding on the french caribbean island of guadalupe off the days of violent protests against cobra. 1900 restrictions. it stirred long standing grievances of poverty and inequality. the protest civils i spread to the neighboring island of martinique, health officials in the us are concerned about another potential surge and kind of in 1900 case is not as millions of americans travel to the fangs getting holiday this week. travels expected to be near pre pandemic level,

despite most safe seeing rising case numbers. that's one more writing in the capital of the solomon islands. despite the government imposing a 36 hour locked down, demonstrators are demanding the prime minister, not safe sort of vari resign. they say the island has been neglected by the government. the son of libya, the former leader market offi, has been bought from running in next month. presidential election. libya is electro commission, says cipher lee. lemme get off. he is ineligible because he's been convicted of a crime. and leaders of 3 german political parties have agreed to form a coalition government following 2 months of talks. left shelter is now set to take over a chancellor early next month. well, those are the headlines and he continues now to 0 up the stream stage and watching bye for now. when the news breaks, when people need to be hot and the story needs to be told, ah,

with exclusive interviews and in depth reports, the protesters are saying the president is out of molasses packer that he's hurting their interests and that's why they remain on the streets al jazeera has teams on the ground, they are demanding an immediate restoration off the civilian government to when you move would, when documentaries, and live knees with . do you regularly deal with racial aggressions, inappropriate, or demeaning comments or just nasty? looks because you're black. well, i am here to help my name is being i'm an artificial intelligence created by artist rashad, newsome to help the black community deal with the trauma you experience when you're mistreated because of your race. so that's being helped me kick off today's episode

off the stream. we are looking at digital mental health care. that was one example digital mental health care looking at the benefits and the potential dangers. if you get your mental health support from on line, what would you like to ask? i guess what concerns questions do you have? youtube is right here for you. it's a difficult conversation to talk about mental, how i promise you it will be a safe space. i guess will be very kind to you that say hi to the guests. hannah nicole some yes, so nice to see you had a please introduce yourself to our international audience. tell them who you are, what you do. hi. thank you so much for having me. my name is hen, as even i teach at u. c. berkeley and i have just screwed in the book, the distance cure a history of tell of therapy for mit press. good to have you. hello, nicole. introduce yourself to our international audience. hello, i'm nicole martinez, martin. i am an assistant professor at stanford center for bio medical ethics. i

and my research recently has been on others of digital mental health tools and a i r i and thank you very much for helping. oh, thank you for making the time and i learned some. yes. so good to have you here. introduce yourself. try international audience. so great to be here. thank you. i'm so me that they, i'm a psychiatrist and an author and i teach narrative medicine at mount sinai. do you remember some? yeah, the 1st time you saw digital therapy or line therapy, cuz your psychiatrist went, when did you remember a, do you remember when you saw that? i do. so it was actually during my own psychiatry residency training when people would come into the clinic and they would tell me, hey, i know i'm seeing you in the office, but i'm also using these other tools to help me between our appointments. and i found that to be such a fascinating and new thing to to be able to see that on hold right in front of me . ah, i did it, take us back to the very beginning of tele therapy. what were the 1st examples of

telephone repay thanks so much for that and starting with segment for it. and the mention of psychoanalysis people have had tim make use of all kinds of technology. all kinds of media to meet each other where they are and to receive care. and so every single you know, decade has had its own technology, has its own ways of doing mental health care at distance all the way through to the contemporary space of tele therapies. on apps and the pandemic because we seem to be having this huge boom in apps anyway, but their mental health apps. why do you think i is? i think i'm the one hand it's because there is this need i got there at are you know something around, you know, 55 percent of people in the u. s. for example, who have mental health issues, but who are not able to receive care and the tech industry or, you know,

the ability to use that tech to fill that need. you know, certainly is understandable and it's an area of great interest. i'm going to play me i what was it? not that the who does as like i said, oh no i would just yeah, i would like to add to to what was said, which i, i think was such a great explanation for that that i think also during the past couple of years we've had this increase need for a connection and a lot of lots of connection in so many ways. and so sometimes what these apps can do is also restore that in some way. i think i had a go ahead. i'm going to so can guess you just go ahead. i also think that there is an additional thing here, which is that they're heavily marketed as effective as safe as a good, easy alternative and as cheap or even one. sometimes that's not the case and it's been really successfully done. so what i'm going to bring in here is josh acoya, he's the founder and c e o of

a specific kind of online therapy session. he explains why he did it and what the need is in his part of the well, his joshua, the trigger was the bun demick. i'm the anxiety of been escalated what it brought. our reason is that andre 1000000 africans, i've been estimated to leave with depression. they have limited access to medicaid . i cannot even afford. yeah, but it will kit is inspired world to offer easy and affordable access to less as there is for africans anyway in the world. and google actually means strengthens right. you me, i mean, to reassure us about center city to do life no matter what's on our up because speech therapies you can of screening tests and you can keep it voice diary. what our challenge so far, beauty, this is a, we are facing decades of culture, our stigma. somebody that sounds like perfection, right? you're on a, in a part of the well, but you don't have access to

a therapy to even have a, a mental challenge is frowned upon. so why can't an out fill in that gap? is this the future, you know, i, i think that speaks to such an important and widespread thing that's going on where it's really hard to get help for a mental health. and there can be so many ideas, depending on the culture, on the communities where we were raised in the ideas around mental health itself to, to make that appointment. and then to even see if there's a provider and we can make that appointment with so apps and other sources of technology can fill in that gap because i think one thing we've seen again and again, and we continue to see is that there is such a need for mental health care, and it's so hard to find that mental health care all across the world kind of thoughts. well, yeah, i mean, just to add on that before the current corona virus pandemic, the w h o already stated that we were indeed in a pan down mac of both anxiety and depression worldwide. and so the question is,

what kinds of care can be furnished remotely and how they actually address those gaps? rather than this kind of creep of more and more proliferation of digital mental health, where it's not necessarily addressing those gaps. and that's a complicated conversation. i'm, i'm just, i think, yeah, because i am at yeah, i was gonna say what, what i would add to that is that definitely the pandemic i showed you know, this if celebration into the use of tele, mental health and mental health apps. and, but it also showed was, you know, those kinds of gaps that hannah was talking about, that you can't just, you know, sort of drop these tools in, ah, and expect them to fill a need when there are already a systemic issues such as, you know, how does care get reimbursed, you know, depending on how you are, that many people now have smartphones, but there may be additional infrastructure needed in order to use the apps effectively, as well as if you do have a therapist who's using the apps. either

a lot of questions about best practices, you know, what, who are these actually best for i, you know, can they be used for people who have more severe mental health needs as opposed to being best directed towards people with maybe more moderate needs. and so i know that the, this really raised a number of these questions quite sharply when there was this accelerated push, then to a digital mental health. nicole, when does this, i am medical and ethical conversation happen. is it after all the apps are out that no problems or is it before i get out that well that, that's, that's a great question. i'm that, you know, certainly there have been a number of people raising these ethical issues is for several years, you know, since, since absolutely have, you know, really been raised as a way of addressing these mental health needs. but i, i think that in the pandemic what it, what it showed was that while the concerns were raised, that

a number of them still hadn't been address. certainly data and privacy remain. no good for any questions about these mental health outs. and what uses might be made of data, especially that people may not be aware of. i'm so for example, an app can collect location data and a number of health inferences can be drawn from that data. and so then there's concerns about, you know, whether there's transparency about that, whether people are aware that they may be trading that data for their mental health care. and these concerns have been raised for a while. and i think part of the trouble is, is that certain areas like regulation that might be useful for addressing them that they're, there really are just a number of other sort of barriers for, for that. hannah, i want you to help me out with some concerns. has some y'all come right back to you . we some concerns here that we should really raise and some of our needs on youtube. also raising, i want to start with an, a i act called whoa bought,

i'm not miss, we're not pronouncing the, the are okay. well as in what ways me, so going to start with a little a little promo for that. and then i'm going to take you to alex sandrine, who is raising some concerns about mental health care on apps. whoa bought 1st meat. well, buy a friendly little bot who's ready to listen. 24, sorry. what bots been trying to cognitive behavior therapy? air approach to mental health that is all about identifying distortions and you're thinking what about doesn't do therapy, but he can be your guide to help you figure out things on your own. every day he asks how your day is going, how you're feeling, and what you're up to. he built an emotional model of you over time and can help you see patterns in your mode. as he learns about to help you to things like useful

strategies and practical tools that have been shown to work. most of the technologies are classified as long as tools and has, are considered low risk, like government agencies, with yankee, n u. s. meaning that developers don't have a duty of care towards their users. who are these high rise specific guidance on there are seen safety policies and whether data is shared or 3rd parties or the solutions are chief in scalable government. health care providers can be that the owners of treatment on users and saws rather than looking into the fashion of preventative services. policy makers, should really look into on demanding more and long term review of ease solutions and assa. objective measures in place for the monitoring is gone, all users, every single one of i guess, a nodding, it's getting to articulate the knows how to use stuff. well, i think there's a lot here, and one thing that we haven't yet addressed is also do they work? right? so there are all of these questions about say they work then. okay, is this

a fair trade off in the process of receiving mental health care? but as was just raised, re, i wo bob is providing a very specific kind of care. it's not therapy. so 1st of all, it's a sort of mental health tool with a cute robot avatar bite. what's behind that? so in the whole, what's called digital mental health space, there thousands of applications which is already hard enough to navigate and then only one percent of them have their claims backed by evidence. so that's the 1st question and then what is being collected? how is it used? is it being leaked and so on that are other panels can also address some yeah, i will say that one concern that's come up again and again for people whom i've seen is that exact question? what information of mine is going to be shared? how is it going to be used to? because not only is that a concern, it's also hard to figure out the answers to those questions. i don't think even the

research behind knowing who's sharing what is very clear to obtain. so that's very, very tough. and i think that we're already asking people to give vulnerable information and put themselves in this position where they're sharing things that may be very hard to talk about. and then there's this big idea around where that information is going. you call before i come to you, i'm going to put something that you choose is talking about right now. call for instance says, what's to say these apps won't spy on off with mental health issues. that's a problem with apps anyway. we give them our information, but if we need mental health support, that makes us even more vulnerable, doesn't it? a certain nicole so at. so i'm going to say no, that certainly does. and, you know, i want to again emphasize that there's 2 layers to that. there is the, the information about your mental health about, you know, your behaviors that you're sharing as part of therapy. there's also the other types

of data that can be collected through these apps where, you know, they can be analyzed and inferences drawn from that. and, you know, that's part of where i was talking about regulation earlier. is that, you know, i think to take a step back is that a lot of ethical obligations like confidentiality, like, you know, having that duty of care that comes from the relationship. that is, you know, between a caregiver and a patient. and that's where, when you drop these tools into that, you don't necessarily have the framework that seems established sense of the relational obligations from which, than, you know, confidentiality, privacy, those duty of care of, you know, what you do when this person is at crisis. and, and that's really, you know, sort of where we've been pushed very quickly from the pandemic. and the issue of,

you know, what next steps need to be taken? privacy is obviously a big issue with that. regulation in many places is, is certainly part of what's needed. because of, you know, the sort of lack of established obligations, whether it's companies, you know, whether in some cases of the algorithms themselves. but in establishing you know, what those duties of care are, who has those ethical obligations, india sort of new, new types of relationships that are established using these tools. we talk about concerns, but have you seen actual examples of this happening? like we do, we worst case scenarios as well. so let's see there's in finland. this came up in a wired magazine article last year that in finland there was a big data hack of a therapy app that did not have sufficient data protection. and there were many

instances, you know, in that case, of people being blackmailed with their information. there's also, you know, been a study like a researcher named heartfelt, you know, and the u. s. let us study looking at whether, you know, with mental health apps, whether they were actually following their own data protection guidelines. they put out there. and they found out that a significant proportion of the apps were not, in fact, actually doing what they said they were doing and were actually sharing people's personal information with 3rd party apps. and so, you know, definitely there's these examples out there. i want to bring in another voice track conversation. this is linda michael's. he says, i colleges and co founder of the psychotherapy action network. it made me wonder about how therapies think about this digital progression in that profession. how are they handling it? his linda?

it's always been hard for people to find therapist to take their insurance with the panoramic and more people seeking help. it's harder than ever. also, insurance companies are in business to make money. so they're introducing things that cost less, such as apps, online, self helped tools, and even coaching, which is completely unlicensed and unregulated. so again, when more and more people are seeking how insurance companies are steering them towards license coaches or telling them basically just to figure it out and help themselves, we can and must do better. people need access to therapist data, insight and relationship and therapist need to be paid fairly. oh, think okay. she's that somebody you help me out with the economy. do you have a therapist in your pocket on your phone? oh, can you right? is that do you out of a job and then hanna regulations, you help me out with regulations as some east on. sure. so in terms of having that

therapist to me, you can contact all the time. i think the cornerstone of therapy is that relationship someone has with their therapist. and so how, however often someone is meeting with that therapist that's forming the framework of their care. and it's very, very hard to have that similar type of framework without having that human connection and to add to what linda was saying so eloquently. i think that trust is so important and it can take so much time to build that trust with someone. and of course we're talking about the most vulnerable things someone may be experiencing. and so having that trust and not knowing if you can have that trust can be really tricky places for someone to go when they're going to a service to help them with very tough parts of their lives. i absolutely agree with that and it was, you know, and with what linda was saying and at that last piece as well, not just regulation but also the fact of scale is really the central thing here. and so we are living in a moment where the word therapy is losing its meaning,

we're wellness is coming over the top of therapy. and so this entire space is it's very difficult to know what one's getting a, is it a person mediated by an i a phone? that's one thing. is it an app that is using some kind of his self help tool? that's another, is it a game? and all of these other ways of doing care skirt regulation almost entirely, and that just leaves it up to the consumer who is a patient who needs care in the 1st place, which is we're have her unfair and incredibly difficult. i am going to use you hannah and nicole somewhere as a resource because we've got so many youtube comments and questions, i can get you to respond very quickly to them. so music says i left a mental health chat app because the walls have been drawn up without use an input . the moderates is treated as like children, and vulnerable uses were excluded from minor things. it was

a bruising experience. nicole thoughts. so, you know, you, you certainly see that, that goes partly on to what you know, hannah was saying in terms of, you know, you may be going to these apps with a variety of needs and we're using this word therapy. you know very broadly ethan, you know, therapists are often trained and, and specialized and particular types of conditions. ah, you know, they may have, you know, different different areas of expertise. and so that can be very important. and that often isn't necessarily accounted for, you know, in the environment as well as no oversight in terms of, you know, the, the type of chat that, you know, this question comes from where there mean it, you know, oversight that, that really looks at whether it's a wild west and i handled a question a call it so why with the app is that all right, satellite laurence from brewer says which mobile therapy app would you recommend?

how do you know which app to use? let's land on that 2nd half. that question. some yeah, how do you know which app to use? so that can be very tricky and i think it depends on what your concerns are and what you would like to get out of the app. now i see the apps primarily as a supplement to that healthcare. so i would say starting with, what is it that your concerns? are you having racing thoughts? are you having low mode? are you needing someone to just be in contact with? and i would start there and then try to find apps based on those needs. because there's so many acts out there that claim to do a lot. i'm going to do one more from youtube and this comes from joshua koya. if you remember him at the beginning, he had that at the he designed because in his region they just didn't have therapists and, and there was a lot of stigma guys. so joshua, thank you for watching the show as well. appreciate you. i'm going to put this one to you, hannah. prior to establishing his own at. he tried some telepath tell it gives me tele, tele therapy apps that they were globally recognized. but he couldn't really connect

culturally with the therapist, because he had a very different background. hannah, so i think that that's a, you know, unfortunately going to be an increase in common experience when it, especially in the a i space. the idea is a universal patient. and unless you match both what's happening mentally and culturally and socially that universal patient, that is a script that the counter script is running off of. it's not really going to work. and so when we opened with being app, which we did, right, that's a really different approach, right? it's not all about scaling up for corporate profit. and i think that's the kind of space to look at is away from the corporate tell therapy app that claims to be able to help everyone. it's an impossibility. got one more voice to add to our conversation. so much knowledge alicia, i really appreciate you get this one is from yasmin bought, who is just saying, ah,

the future, the future is what we're experiencing right now. he is yasmin years ago, over 80000 individuals, there was only one psychologist present today for 99000 patients. there's still only one psych all his present at this read as i causes you're not going to be able to solve the problem with artificial intelligence. scan e, i is already 80 percent a grade and disease detection was a 37 percent higher than human being or aside causes. e, i takes only 3 minutes in masking. you are the therapist with the psychologist would take 60 minutes a i a 75 percent cheaper than regular solutions. e i is available and more than down languages which has the ability to cover for really people across the world. it's reliable, it's cheaper, it has no gender. it has no religion. it has no buyers. it's the future. oh yes. when right at the end there's so much debate about yasmine, so wait, right? no. why is it that for you so much?

yeah. ah, right. he's got he got us thinking, but i'm only going to give you guys one sentence. the future of digital mental health pay is what finished the sentence. some ya is a part of helping mental health be treated with the same complexity and nuance as physical health. aha, nicole finish the sentence is, is using it as a tool as a part of an existing system, and that needs to be restructured for more equity and access to the future of digital online mental health care. it's what ada, it's increasing all the problems of current mental health care, but at scale, and we have to be careful about redressing them only via the attack. oh my goodness . you guess i've spent so much good time with you so much good information. i wanna audience to find out where you are online, have a look at my laptop. this is hannah and nico

and some yeah, i highly recommend you check them out online. thanks for watching. i will see you next time. take care everybody. ah. december on and just either guitar hose, the fever, i recall a momentous event for the region and a glimpse of what's in store for the 2022 wildcat. people in power, invest the gates, the use and abuse of power across the globe. a world exclusive interview with joint nobel peace, laurie recognized the safeguarding freedom of expression as a pre condition for democracy and lasting peace from shore. documentaries, too in depth explain their portal. showcase is the best voucher zero's digital content. as the year rolls to a close,

we look back at the events that have shaped the news and look ahead to next year. december on a jesse europe in colombia, transforming urban waste into building block use is to for a same for the west blast of the war. we can finish day, i was in charge of fishing america and me just send you any single pole critical farms and living buildings. anything you do on land, on the ground, it doesn't make sense to do that. apply on a building. now can, we might have not just decorative, but can we make it biologically productive. earth rise? describe as cutting edge solution for sustainable cities. on al jazeera, we town the untold stone ridge. ah, we speak when others done. ah, we cover all sides. no matter where it takes us a fan, sir. yeah, i am power and passion. we tell your stories. we are your voice,

your news, your net al jazeera ah 2. ready dozens of people drowned off to a migrant boat sinks in english channel. it's the worst single loss of life on the crossing from france. this disaster underscores how dangerous it is to cross the channel in this way. ah, hello, i'm darn jordan. this is al jazeera la you from dough are also coming up 3 whiteman, i found guilty of murdering amount operate a black man that was shot dead, one out jogging in the us state of georgia, valez pro.