Sacha McBain, Ph.D.
Assistant Professor and
Associate Director of the Center for Trauma Prevention, Recovery, and Innovation
University of Arkansas for Medical Sciences
THESE ARE STRESSFUL times, and some of it comes from technology itself: hours and hours on Zoom, overflowing email in-boxes, always on the job, thanks to our many miracle devices. To try to get a handle on what we’re all feeling these days, we sat down with UAMS clinical psychologist Sacha McBain, whose expertise is in traumatic stress and working with patients to prevent post-traumatic stress disorder (PTSD). We specifically asked how technology plays into her work.
Fortunately or unfortunately, it seems like you picked the perfect career for the world we’re living in now.
Yes. Let’s just say it depends on the day as to whether it feels fortunate or unfortunate.
I don’t study the effects of technology on mental health specifically, but I’ve done studies around how we can leverage technology to improve access to mental health services.
That’s the positive side of the equation. How does that work and how has your field changed through tech?
It’s changed it a lot, I think. The VA, especially, has always been a leader in developing technology to improve access to care for veterans, so it has been happening and growing slowly. During the pandemic, there was just this explosion of the need for telemental health services that our healthcare systems had to respond to really quickly in order to ensure that existing patients were getting the mental health care they needed and that we were able to provide services to those seeking services for the first time as a result of pandemic-related stressors.
So, pandemic response had to leverage an existing, slowly growing infrastructure and increase it exponentially. What has happened as a result in the mental health field is that technology has helped to increase access to services for certain subsets of the population. But, just like anything else in our society, we’ve seen that there continue to be disparities in who can access technology and telemental health services. The people who have the deepest, most ingrained barriers to accessing mental health services likely also have significant barriers to accessing stable Wi-Fi, or a phone that has compatibility. The increasing acceptability of telemental health services by healthcare systems, and—importantly—insurance companies, has overall increased access to mental health services. This is especially true for people who maybe already were able to access in-person mental health services and likely has increased access for some who haven’t had access before. However, there’s still a subset of the population, such as rural residents or those living in
poverty, for whom it hasn’t really improved access due to larger structural barriers.
What’s being done about this disparity?
One of the compelling conversations that I’ve been hearing, though it doesn’t really fully answer your question, is about Internet access at this point in our world being a fundamental right and not a privilege. In 2016, the UN General Assembly passed a resolution declaring Internet access as a human right. The pandemic has highlighted how a lack of access to the Internet has had devastating impacts on access to information, to education, health care, and employment. I think that’s the foundation of how we get on the same page in this day and age—agreeing that being able to stably access the Internet is a right that people should have, versus something that’s still very much contained within a business model, at least in the United States. Our biggest hurdle is how we reconceptualize what it means to have access to technology, and the Internet specifically. And then how we build the infrastructure and make sure that people have accessible options in terms of technology.
What’s your normal day like, and how does technology enter into it?
I’m trained as a clinical psychologist. My expertise is in traumatic stress and prevention and early intervention for post-traumatic stress disorder (PTSD). In other words, how we help facilitate recovery after trauma rather than waiting years after they’ve experienced a traumatic event and have been struggling with an untreated mental health diagnosis like PTSD. To do that, I built a trauma surgery psychology consult service that is embedded within the UAMS Trauma Service. I provide integrated care alongside the interdisciplinary team and provide intervention and support to patients who are at high risk of experiencing post-injury mental health concerns while they are hospitalized.
One way we use technology on the floors right now, because of the pandemic-related visitor restrictions, is by providing a patient with an iPad to do a FaceTime call with a family member who can’t come up to visit them. It gives them a portal to the outside world. Also, when people are in the hospital, there are so many stress-producing life issues that need to be managed that they can’t do if they’ve, say, been in a wreck and lost their phone or their wallet—especially if they don’t have a loved one who can do it on their behalf. There are studies out of the University of Washington showing that simply giving patients a laptop to use while they’re in the hospital helps reduce stress and promote recovery, in tandem with more formal psychosocial interventions. Practically, providing access to WI-FI-enabled devices allows hospitalized patients to address stressors that can create more problems and stress down the road. They can get on the computer and put a freeze on their credit card or pay that bill that’s going to be overdue because they’re in the hospital. And we know that reducing those types of psychosocial stressors helps with facilitating natural recovery after an injury, because it’s like you’re not caught up and worried about, “Am I going to have electricity when I leave here?”
So technology can certainly be a portal into that. I would love to see hospitals utilize such tools better, leveraging technology to support positive coping. When someone is hospitalized, their identity can sometimes be reduced to “patient.” Technology provides an opportunity for people to stay connected to their lives outside of the hospital by allowing communication with their social network, limiting worry through positive distraction, and empowering them to have an active role in managing responsibilities and tasks that can often be put on hold
It would help the treatment team, too. Currently our care managers and social workers are strapped. On top of everything else they do, they’re having to make calls and track down numbers and track down things that patients could do—and want to do—if they had the technology to do more of that on their own, or with support, rather than feeling really disempowered and like they have no autonomy to do anything to improve their conditions.
How do you use technology once patients are discharged from the hospital?
Once they get back out into the community, this is a population that can be hard to reach. I’m working on a pilot project now examining the use of a mental health screening platform designed to monitor people’s mental health once they leave the hospital. I’ve found that people are really interested in that. They like the idea of follow-up—but the reality is that there are so many barriers: Do they have the same phone number they had when they were in hospital? Do they trust the technology and the institution it is coming from? Will they answer the phone when we follow up? The follow-up is really low. It’s just a difficult system for people to navigate when they’re dealing with the aftermath of a serious injury. It comes back to the idea that some patients will greatly benefit from technology-based follow up, while others are up against so many psychosocial stressors that they don’t have the emotional capacity to navigate another system, even one that might be helpful in the long-term. So the question is, How do we bridge the gap between patients’ desire to have access to technology-based follow-up contact and their actual ability to then access appropriate services? Many participants in the pilot are saying they want the tech-based screening to facilitate their access to in-person services.
You mean as opposed to being out there by themselves?
Right. So one of the things we ask them to do is to complete a questionnaire. And what they want is, if they answer those questions and say yes, they’re having symptoms or reactions that are concerning, they want that data to then be given to a person and for that person to follow up with them. They don’t want to answer those questions and then be pushed to a website. People want that human connection.
Is that hard for medical teams when everybody’s so pressed?
Yes, especially now when our mental health treatment waitlists are beyond what they’ve ever been.
It seems to be the way of the world now. So many services or companies make it difficult for you to actually talk to anybody.
Absolutely. I had to rent a car recently and I never got a confirmation email, so I tried to call the rental car location. The automated call system pushed me through all of these different automated options. When I finally got to what I thought was going to be the right place, I was told I would have to pay 10 percent of my rental fee in order to talk to a person.
You are kidding me.
No. So imagine the people who’re paying that money to get through that gate, and how frustrated and angry they’re going to be and how they’re going to treat that human that they actually end up talking to. Think about mental health and the people tasked with answering those calls.
Seems like a missed opportunity to make customers’ lives easier through technology, rather than harder and more expensive. Speaking of stress and anger and mental health, so much is happening in this country right now—shootings and raged driving and belligerence on airplanes. From your perspective, what’s going on?
When we think about community violence and escalations in aggressive behavior, we know that what protects against violence is stability in our living conditions, aka the social determinants of health: access to stable employment and housing, and equitable access to psychosocial resources, etcetera. COVID has drastically changed that. The increasing instability and polarization of our society has created immense psychological pressure. So I think it’s important to think about it first and foremost at a system level, because where we get into trouble is in the sensationalizing of individual factors. We must think about systems first and foremost, and all the socioeconomic impacts to truly have a chance at ending the current violence epidemic.
At the individual level, though, I think people are so cognitively overwhelmed and tapped out and people’s emotional and cognitive resources are really depleted right now. And we don’t live in a society that really reinforces rest and taking breaks; the expectation is that you push harder through difficult times. That just leads to increased irritability and increased stress. People are just at the boiling point.
It feels like we’re living in a very bad movie.
Yes, and I want to change the channel! Over the past couple of years, technology has given many of us invaluable opportunities to stay connected to our loved ones, to broaden our awareness and perspective of the world, to continue our education, to stay entertained, to access health care—really to keep us living some version of our lives when everything seemed to be grinding to a halt. Technology can and does make our lives better… if we can just keep in mind all of the lessons from our favorite classic dystopian Sci-Fi films and novels.