Abstract
A key ingredient in successful psychological therapies is found in patients' motivation and willingness to engage in and follow through with the therapy program. Engaging children is challenging for various reasons, such as their role in their presentation for treatment and differences in parent and child motivations. This chapter explores the utility of serious games as a potential option that offers an engaging and effective approach to psychiatric treatment for children and adolescents with mental health difficulties. The authors review research projects utilizing the serious games methodology at the Child Guidance Clinic, an outpatient psychiatric clinic for children and adolescents in Singapore, in the management of various mental health concerns. The utility and feasibility of gamified interventions for autism spectrum disorders, attention-deficit hyperactive disorder, anxiety disorders, and anger management issues are discussed, along with practical implications for the application of serious games in mental healthcare.
TopIntroduction
Singapore is a small island city-state in Southeast Asia, about 728 km2 in size (Singapore Land Authority, 2021), with about 5.7 million residents (Department of Statistics, Singapore, 2021). The nation places emphasis on innovation and research to remain competitive (World Trade Organisation, 2012).
Singapore has also done well in providing quality and affordable healthcare (World Bank, 2019, 2021). In recent years, there has been an increasing awareness and focus on mental illness and its associated disease burden on the population. Mental Disorders are the second leading contributor of Years Lived with Disability (YLDs) in Singapore. It also accounts for the majority of YLDs in youths aged between 10 and 34 years old (Ministry of Health Singapore, Epidemiology & Disease Control Division & Institute for Health Metrics and Evaluation, 2019). Mental disorders place a significant financial burden on society, with an estimated average annual excess cost of US$2897.83 per person in Singapore (Abdin et al., 2021). These costs arise from both direct medical costs of seeking professional help and lost productivity due to absenteeism. Unsurprisingly, mental illnesses have greater adverse effects on vulnerable and at-risk groups of people with lower socioeconomic status, who have relatively poorer access to resources such as disposable income, health literacy, and social support systems, as compared to the general population (Lund et al., 2011; Murali & Oyebode, 2004). It is therefore imperative to design new and innovative ways to treat and manage mental illness more cost-effectively.
Mental illness refers to a wide range of conditions that affect a person's mood, cognition, and behavior (American Psychiatric Association, 2013). A significant proportion of mental health disorders has onset in childhood and adolescence. Hence, early intervention is critical for a better prognosis (Goodman et al., 2011). Successful mental health intervention in childhood can initiate important positive cascading effects into adulthood. In Singapore, public healthcare services incorporate technology to improve productivity and enhance access to healthcare (Smart Nation and Digital Government Office, 2021). There has been an increased national focus on utilizing technology to reduce barriers to mental health services (Ministry of Health, Singapore, 2020; Ong, 2017). Hence, serious games can be a potential tool to better engage children and adolescents in enhancing mental health and well-being.
This chapter provides an overview of the current challenges faced by mental health professionals in providing mental health services to children in Singapore, and discusses the utilization of serious games as a potential solution to these challenges. Specifically, this chapter explores the utility of serious games as a means to increase access to treatment and improve treatment engagement amongst children and adolescents presenting with mental health difficulties. The authors describe projects on serious games conducted at an outpatient psychiatric setting and share important findings as well as practical implications for clinicians and researchers looking to adopt serious games in treating the pediatric psychiatry population.
Key Terms in this Chapter
Cognitive Behavioral Therapy: A form of psychological therapy that targets and attempts to change unhelpful patterns of thinking and behavior to relieve psychological problems.
Playability: The degree to which a game is enjoyable and usable.
Usability: A measure of how well a user in a specific context can effectively use a product to achieve a defined goal.
Treatment Engagement: The degree of commitment to the therapeutic process and active participation in one's collaboration with a therapist to work towards recovery. This includes adhering to treatment plans, coming to appointments, and being honest about one's condition.
Disease Burden: The total, cumulative consequences of a defined disease or range of diseases with respect to disabilities in a population.
Treatment Effectiveness: The likelihood that a specific treatment protocol will benefit patients in a specific clinical population when administered in clinical practice.
Treatment Efficacy: The extent to which a specific treatment protocol will bring about desired clinical outcomes in patients under controlled conditions.
Feasibility: The degree to which a proposed product is a practical solution for all involved stakeholders.
Social Communication: The way people use verbal and nonverbal language, gestures, and cues in social situations to express themselves and interpret others' intentions. This includes following unspoken rules of conversation such as turn-taking, adjusting tone of voice when addressing different people, and speaking at an appropriate volume depending on the context.
Feedforward: A control mechanism in which information is collected and used to generate a control signal to counteract measured disturbance in the system. In Cogo™ Land, in-game EEG signals are used to counteract attentional disturbances measured during the calibration phase.