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Should We Monitor the Mentally Ill With Wearables?

Researchers think smart clothing will help reintegrate patients to society, but the plan poses moral dangers.
Screengrab: Youtube

A high-security psychiatric hospital lies tucked away among the belching refinery smokestacks and squat, run-down buildings in the north end of Montreal. Austere arrangements of plain concrete in classic Brutalist style characterize its exterior, but in its bowels, researchers are pushing the boundaries of technology to treat violent, mentally unstable individuals.

They first started working with virtual reality to do things like stimulate and study sexual offenders in a safe environment. Now, they're looking to wearables.

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Today, researchers presenting at a conference held at the Philippe-Pinel Institute unveiled their plan to use smart clothing loaded with sensors to monitor the physiological signals of patients in stressful situations, and help them to manage their emotions, remotely and in real time, outside of the controlled environment within the hospital walls. The goal is to help patients reintegrate into society after treatment.

Recording biometric data such as breathing patterns, heartbeats, and physical activity, and matching it up to known psychological profiles will help people who find it difficult or impossible to recognize their emotional triggers do just that, Jean-Pierre Guay, the criminologist leading the project, told me.

If a patient is giving off physiological signs of stress that might trigger a violent outburst, a caregiver could message him and recommend a course of action to manage his feelings; basically, the goal is to create a data-driven feedback loop between patients and their doctors.

"You and I regulate our emotions quite well, I guess, but some of these people can be very angry and depressive," Guay told me. "If you get that data, you can send alerts and say, 'Based on what we know about you, you are probably feeling this. Do you feel okay with that? Should you regulate that emotional state? Here are some tricks to regulate emotional responses.'"

The key component of the system is Hexoskin, a slim black camisole embedded with numerous sensors and a tiny external device that collects all the information and transmits it in real-time to a remote device. Last year, the Canadian Space Agency began testing a variant of the Hexoskin, called the Astroskin, in Antarctica. It will one day be used to remotely monitor astronauts' vitals. Now, the Hexoskin appears to be the next frontier for reintegrating former psychiatric patients into society.

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A trial run for Hexoskin in psychiatric treatment is already being planned, Guay told me. He plans to give a group of youth with a history of violent behaviour a Hexoskin to wear three days a week for a month. While all that biometric data is being gathered, the patients will complete surveys and record their experiences—what happened, and how it made them feel—as well as undergo tests at the Philippe-Pinel Institute.

One of Hexoskin's textile sensors. Photo: Author

After it's all said and done, Guay said, researchers will have an idea for if the Hexoskin can be used to treat the mentally ill. That is, if the data it produces can reliably be used to predict how people will feel.

But there are serious ethical concerns at play in this work. Patients will be giving researchers data of an intensely personal nature for the express purpose of using it to regulate their behaviour. The power dynamic would be a serious, and potentially dangerous, one. A previously planned study was nixed because it didn't make it past the ethical review board, Guay said.

These concerns are somewhat universal to wearables. Who has access to your data, and what can they use it for? Should it be used to alter behaviour, especially when the person giving the data up doesn't necessarily get to see it, or understand what it could indicate to the person receiving it?

"Bad things can be done with this stuff; it's not going to solve all our problems, and it will create new ones," Guay said. "It can be considered quite invasive in some ways. What happens when you have sex with your girlfriend? Will we see that? Will it be comfortable for them, or will they shy away from certain situations? We don't want to stigmatize these people or add to their burden."

Guay said that some of these concerns will be addressed with consent forms and a kill switch to stop the shirt from sending data to doctors. Besides, these issues will only be brought to bear if the technology is proven in tests, before patients start wearing Hexoskin in the real world. According to Guay, "It might not work."