California Tests a Digital ‘Fire Alarm’ for Mental Distress

But the 7 Cups program, which started a year ago, has been delayed by the state, because of an internal state financial review and concerns about some of the company’s network of listeners. According to California officials, some listeners were having inappropriate text-chat conversations with clients, engaging with them and becoming too personal, violating the company’s rules; the issue is being addressed, state officials said.

“We use a series of techniques and programs to identify, quantify, rehabilitate, block, or ban harmful language and/or harmful individuals,” said the company’s founder and C.E.O., Glen Moriarty, by email. He added, “We take matters of confidentiality, privacy, safety and all forms of harassment very seriously.”

As for the Mindstrong app, only Los Angeles County has distributed the technology, to the few dozen people who had keyboards installed last winter. Already, about half of them have stopped using the keyboard function. Some lost interest; others had trouble adapting to the new keyboards (which work better on Android phones than iPhones). A number of users decided they liked the daily diary feature, without the rest.

“The counties are spending money on this program, saying, ‘Here, this is great, we’re giving you a Fitbit,’ and we discovered that many of our people didn’t quite understand it,” said Dawniell A. Zavala, general counsel and associate director of Mental Health America of Northern California, a patient self-advocacy group. “And they didn’t explain the possible downsides of handing over so much personal data.”

Any app maker is likely to need extensive data on thousands of users to begin to adapt its product to the many permutations and combinations of mental disorders, and to the idiosyncratic ways those are expressed in an individual’s daily behavior. And access to patients’ medical records has run into resistance in California.

“We have said no — no access to electronic medical records for Los Angeles County,” Ms. Myrick said.

It is not clear whether other counties are handing over those records and, if so, whether they have obtained patients’ consent.

In an age of hacking and data breaches, tech companies that acquire both medical and monitoring data present real risks to patient confidentiality. “If we’re excited about the potential of data, we should be equally worried about the risks, and those seem to be evolving faster than the scientific benefit,” said Dr. John Torous, director of the division of digital psychiatry at the Beth Israel Deaconess Medical Center in Boston.

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