was killed if 1st they ought to fail. okay, and we live in fear on this is worse than during the war. back then we could at least defend ourselves. after 5 years, i thought we would have a place to live a little land and basic security. we feel disillusioned yet we endure darker. but despite during, during commitment success for them and the country remains elusive, in a lasting peace is not guaranteed. allison them give to al jazeera cal dawn or coca . ah, hello there. this is al jazeera and these are the headlines. estrella says it's sending troops to the solomon islands to help restore order as it faces a 2nd day of rising. the protest is what the prime minister to resign saying. the government has neglected them. sarah clark has more from brisbin in australia. australia has decided to send troops other, but announced that 20 troops at

a small number bits, and they are hitting to from townsville in queensland. and where i am at 220 hour as we speak and we got another group of but school year. so heading there on friday . and this is simply to monitor the situation and do what the prime minister said is to try and restore stability and security on the ground. and a prime minister said he, what says the strain trips out to help the police are? he's also now he's spoken to the prime minister of pg as was popping, he's getting so suddenly it's a volatile situation. the un secretary general is calling for an immediate and a fighting in ethiopia. the u. s. is urging diplomacy and to cease fire. but on the ground, the ethiopian government is recruiting volunteers to join the war against to grind rebels. germany's carnivorous dest hall has officially passed a $100000.00 hospitals are rapidly filling up across the country. gemini announced tougher restrictions last week to try to cope with the outbreak. meanwhile, an overnight cathy who is holding on the french caribbean island of guadalupe after

days there violent protests against private 19 restrictions. instead, longstanding grievances over poverty and inequality. that's a nation rates there remain low with less than half the population having received corona virus jobs. and now health officials in the u. s. saw consent. there could be another surge in cove in 19 infections there. that's as millions of americans travel for the thanksgiving holiday. this week. air travel is expected to reach levels close to those before the pandemic. at least $27.00 refugees and migrants have drowned off the coast of france after their boat capsized. they were trying to reach, can reach the u. k. it's the worst disaster in recent years for migrants attempting the dangerous crossing. while those, the headlines next, it's the stream. the coded 19 pandemic has led to a spike in child trafficking across india,

$1.00 to $1.00 east meets those fighting to save hon children on al jazeera. ah, how do you regularly deal with racial aggressions? inappropriate ordered meaning 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 museum 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 of 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 online,

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 get hannah nicole some yes, so nice to see you had a please introduce yourself to an 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 written the book, the distance cure a history of tele therapy for mit press. good to have you. hello, nicole. introduce yourself to our international audience. hello, i'm nicole martinos 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. all right, and thank you very much for helping. oh thank you for making a time and hello sonya. 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 online 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 the hold right in front of me. ah ha, take us back to the very beginning of tele therapy. what were the 1st examples of tele therapy? 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 a tele therapies on apps and the pandemic. nicole, we seem to be having this huge beam in apps anyway, but their mental health apps. why do you think? i yes. 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, 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, of great interest. i'm going to play me i what was it not that that with us 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. busy 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's 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 welt. his joshua, the trigger was abundant mc. i'm the anxiety of been escalated. what it brought.

our reason is doug aldridge, 1000000 africans, i've been estimated to leave with depression. they have limited access to medicaid . i cannot even afford. yeah. billable kit is inspired, weld to offer easy and affordable. our says to lessons. there is 4 africans anywhere in the world. and google actually means strengthens right. e, i mean to reassure us of our center city to do live no matter what's on our up. because picture therapies you can of screaming test i'm you can keep it voice diary . what i challenge so far. butte in this is a we are facing the kids of cultural stigma. tony, 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 think, i think that speaks to such an important and widespread thing that's going on where

it's really hard to get help for 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. hina thought on. 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 pandemic 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 just, i think. yeah,

because i'm 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, uh, 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 a medical and ethical conversation happen? is it after all the app throughout that no problems or is it before i get out that well that, that's, that's a great question that, you know, certainly there have been a number of people raising these ethical issues is for several years, you know, since since absa have, you know, really been raised as a way of addressing these mental health needs? but 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 addressed. certainly data and privacy remain no good for any questions about these mental health apps 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 about when it's 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. whoa, as in what ways me know. so going to start with a little a little promo for that. and then i'm going to take you to alex sauntering,

who is raising some concerns about mental health care on apps. whoa bought 1st meat. whoa, by a friendly little bot who's ready to listen. 24, sorry. well, bats been trained and cognitive behavior therapy or approach to mental health that is all about identifying distortions and you're thinking, well, but 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 you, he'll do 2 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 a government agency system. yet the n u. s. meaning that developers don't have a ged of characters or users. human,

these high rise specific guidance on there are seen safety policies and whether data is shared or 3rd parties are the solution. lar, chief and scalable government, healthcare providers can be the artist of treatment on users and saws. rather than looking into the expansion of preventative services. policy makers should really look into on demanding more long term review of ease solutions and objective measures be put in place for the monitoring of the users. every single one of i guess on nothing is 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 application 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 panelists can also address some yeah, i will say that one concern that 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? 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 a 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 called 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 just 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 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 in the a 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 weekly worst case scenarios as well? so let's see if 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 i, you know, in that case of people being blackmailed with their information. there's also, you know, been a study like a researcher named tuck fail, you know, and the us 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 wanna 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 grand damage 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 inside 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 or in your pocket on your phone or can you write is that do you out of a job and then hannah, regulations, you help me out with regulations as some east on. sure. so in terms of having that therapists 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 are, 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 have that trust can be really tricky places for someone to go when they're going to a service to help them with the very top 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 or 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 helped 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's a patient who needs care in the 1st place, which is ever 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'm going to 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 the input . the moderates is treated as like children, and vulnerable uses were excluded from minor things. it was a bruising experience. nicole votes. 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. and then you know, the 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 is like the wild west of ag handled a question, a college. so why waste the app is? are i satellite laurence from brewer says which mobile therapy app would you recommend? how do you know which app to use? let's lendl 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 health care. so i would say starting with, what is it, that's your concern. 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 apps out there that claim to do a lot. i'm going to do one more from youtube and this comes from joshua koya. you remember him at the beginning? he had that at the he designed because in his region they just didn't have therapists 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, 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 at 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 money from yasmin bought. who is just saying ha, the future. the future is what we're experiencing right now is yasmin years ago, over 80000 individuals, there was only one cycles as present today for 99000 patients is still only one cycle. his present at this read as i causes we'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 psychologist e, i takes only 3 minutes in masking. you are the therapist with a psychologist would take 60 minutes a i a 75 percent cheaper than regular solutions. e, i is available in more than dental languages, which has the ability to cover for believe people across the world. it's reliable, it's cheaper, it hasn't gender, it has no religion, it has no buyers in the future. oh, yes. when right at the end, there's so much debate about yasmine, so wait, right? no. why is it so much? yeah. 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 yeah. is

a part of helping mental health be treated with the same complexity and nuance as physical health. aha, nicole finished 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 we're addressing them only via the attack. oh my goodness, you guess i've spent so much good time with you so much good information. i want our 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.

graves of the unnamed evidence that schools designed to strict indigenous people in the u. s. of their culture also claimed the lives of their children abuse. corporal punishment forced to child labor loss of identity. loss of language in loneliness. the discipline was from, if the kids were killed, there isn't any native personal life today that hasn't had someone that went to boarding school in their family. very truth on a jesse, you know, this is al jazeera, it's november the 15th day, one of a new era and television. you, if you have known that, that was the scale of bloodshed would you have still gone from moments ago to miss also landed about a 100 meters away from us. we're on the front line, but it's on the road. we saw the union army flag hoisted high in the city.

many people here have told me that the war will not end until they secret duffy and his son brought to justice. gonna get 90 seconds for this on. so we're being told that this it on is very, really coming our way buying brides is lack of respect for women and lack of any value that the home. and i was just only here, guy by the police on purpose. there's at least $20000.00 for him. to refugees who live here. i'm on l 20. i got to commend you. you're not trying to push people to believe in this or believe in that the. i'm a say hey, has completely changed you with the board al jazeera offices in garza, our hires in that building. but summer has come down. the other before in human

history has the months for steam environment the arctic didn't such peril. ah. had a couple of beautiful and al jazeera has obtained a satellite imagery that reveals the u. a is supplying weapons to the ethiopian government for their fires against to brian rebels. ah, there i'm is darcy. this is al jazeera life and doha also coming up violence for a 2nd day. and the solomon islands, as anger grows against what protest to say or fail the government promises.