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Is robot therapy the future? | Mental health

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She’s sitting on a purple armchair, nodding slowly as she talks. “When was the last time you felt really happy?” Her voice is low and measured, with the gently broken glottal quality that one might expect of a computer simulation, her ethnicity undefined, her cardigan beige. Ellie, an artificial intelligence therapist created with funding from the US government agency responsible for the development of military technologies, is capable of reading 60 non-verbal cues a second. She wears a watch and a look of blank empathy. On the split screen, her patient repeats her question. “Hmm, when was the last time I felt really happy?” He’s a young white man who appears to find the interaction unremarkable, which I find remarkable. She detects his “low gaze attention” as he answers, and nods, and prods, and mirrors his facial expressions. And I realise I am nodding, too.

The future of therapy arrived faster than planned. Over the past decade the appearance of mental health care has radically changed, evolving from soft conversations held in small rooms, to encompass teletherapy (at a distance), text-based therapy (through messaging apps), chatbots that perform cognitive behavioural therapy, online platforms that match you to a therapist and, soon, AI therapy with a “non-human” therapist like Ellie. In 2020 the pandemic brought about a mental health crisis and these online services were pushed blinking into the light. As Covid gnawed its way through communities, record numbers of children and adults sought NHS help for problems such as anxiety and depression, and private online therapy platforms, such as BetterHelp, saw a spike in users. The future was here, for around £60 a week.

It makes sense doesn’t it? It makes kind, thoughtful sense to democratise therapy, a service previously only widely available to the wealthy, especially at a time of unprecedented suffering. This was the purpose when in 2008 the NHS launched its Improving Access to Psychological Therapies (IAPT) programme – “The most ambitious programme of talking therapies in the world.” It was designed to make therapy more accessible and if you call your GP with anxiety today, you are likely to be referred to an IAPT. If you search for therapy apps on your phone, you can download hundreds of services ranging from adult colouring books and feelings diaries to Woebot, an AI chatbot that uses CBT techniques and Minions GIFs to improve users’ moods. The therapy industry is thriving.

Yet the rise of therapies that no longer require a therapist, or even sometimes another person listening, is a tricky development. Dr Kate Anthony, CEO of the Online Therapy Institute acknowledges the resistance, but maintains: “As professionals and clients, the concept of distance communication for therapy is no longer considered with suspicion. Technology is not a natural fit for the therapeutic experience, but the pandemic proved it to be a good fit where desired or necessary.” She sees the future of therapy as a combination of in-room and online sessions, led by each individual’s needs.

“I’m excited by the current work of Tim Berners-Lee in addressing what he calls ‘the toxic internet’.” Anthony applauds his ambition to advance the web as a public good and a basic right. “I see parallels with good mental health as a basic right, facilitated by technological advances to join up the human race in working towards it.” What does the future of therapy look like, in her opinion? “We need to address digital exclusion urgently to ensure no one is discriminated against in their search for good mental health,” says Anthony. “The world has been concentrating so hard on the bad effects of the pandemic on mental health that we are in danger of missing the good opportunities it offers.” She hopes to see people designing their own “mental health journey in a profession that embraces rather than rejects technology at work. The way the world communicates is electronic and therapy is communication – why are we being so slow as a profession to adapt?”

Leah signed up to BetterHelp during lockdown. She was 41 and was in crisis. Her father had recently died and her relationship with her mother, who had started a new relationship with someone Leah could see was scamming her out of her savings, was strained. Talkspace (which was valued at $1.4bn when it announced plans to go public in January of this year) and BetterHelp (which is based in Silicon Valley) are two of the biggest apps in the mental health space. Clients use the platforms to exchange messages and hold video sessions with licensed therapists at a lower cost than traditional therapy. Such apps advertise on YouTube and Instagram, sometimes with pop art cartoons of crying girls, often in bed. “Swipe left to talk about your broken heart,” reads a cartoon speech bubble on one. “Swipe left to start feeling happier.”

“I wanted to get counselling,” Leah tells me by email, “but I didn’t want to expose myself to Covid. For me the convenience was ideal, and the price was a lot cheaper than conventional counselling.”

I got in touch with a number of users of automated therapy apps and platforms, some of whom found them useful (they appreciated the ease and the affordability – one man told me he felt more comfortable talking online to a therapist and that it had helped him open up) but, inevitably, it was the people who’d had bad experiences who were most keen to talk to me.

After a month of texting, Leah said she felt that the first counsellor she was assigned was unequipped to handle her problems and that she needed a trauma specialist. “But you don’t get to pick your therapist, they pick you and you just have to hope you get someone with good experience.” Leah said she saved screenshots of their texts and sent them to the next therapist she was matched with, having clarified that she specialised in trauma. Half an hour into their first video session some weeks later, the new therapist stopped her. “She said that trauma was not her speciality and recommended I search for another therapist.” Leah said the experience left her feeling worse, having had to revisit her childhood trauma alone. “I felt rejected by the very people who were supposed to help me,” she says.

I asked a BetterHelp spokesperson for a response. “Our system uses millions of data points to suggest a match based on the member’s preferences, as well as demographics, issues and the outcomes of each individual therapist with similar situations. We hope for each match to be perfect, but that won’t always be the case given how personal and nuanced the therapeutic relationship can be.” Over the last eight years, the spokesperson said, “Our network of more than 18,000 licensed, accredited and board- certified therapists have assisted more than 1 million people to face life’s challenges. We facilitate more than 5m messages, chats, voice calls and video sessions on a monthly basis, and we strive to ensure every one of our members receives the best level of care.”

I came fresh to counselling at the beginning of the first lockdown, when therapists were still trying to navigate the new reality, of home, school, clinic and office all existing within the same small house. Discussing birth trauma and parenting on the phone, I could hear the counsellor’s children arguing in the background. A friend of mine was distracted from a guided meditation by her therapist’s WhatsApp alert ringing out every half-minute. But as the pandemic progressed, routines have been established and for many patients the ease and comfort of modern therapy means they have no plans to go back. Which makes me wonder, what might be lost?

Elizabeth Cotton, a former psychotherapist working in the NHS, is an academic based at Cardiff Metropolitan University whose recent research is focused on the “Uberisation of mental health”. She carried out a series of surveys (including three about the impact of Covid on working life in mental health) and has published them under the title The Future of Therapy. We speak on Zoom, of course, and I marvel inwardly at how we have taught ourselves to communicate in this new land, our own faces hovering meanly to the right. “Essentially,” she says, her argument is that “an industrialisation has taken place, a downgrading of therapy, which opens the doors to digital providers, and what is emerging now is the Uberisation of mental health services.”

IAPT, Cotton says, is a good example. The rules of IAPT services are, “that 50% of people will recover, that they will be seen by somebody and will have treatment within a set period of time”. But, she adds: “Now we know that many of these figures are completely fabricated.” In confidential surveys therapists told her how figures can be manipulated – users can be asked to retake questionnaires to show an improvement in mood. If someone is re-referred back into the service they can count as a new patient. An initial assessment can be counted as treatment. And in our capitalist society, successful treatment, it has been argued, serves the state more than the individual, the aim being getting the patient back to work as soon as possible. A big problem comes, Cotton says, if performance data is used to prove online services are more effective than traditional therapy, where similar data simply does not exist.

A couple of years ago, Cotton was at a conference about AI where a speaker who had been involved in setting up the original IAPT scheme was talking about plans for the whole service to eventually become digitalised. “The implication being that they will use more and more AI. And a friend of mine asked the question, ‘So who asked for this?’ And he said: ‘Nobody, but we’re going to do it anyway.’” Cotton sighs, as if slipping underwater. “That’s not to say that young people don’t like using apps and all of those… debates.” She waves away the arguments as if swiping a screen, “but in terms of real distress and what somebody is asking for when they’re asking for therapy, this isn’t it. Except, that’s not the point. The point is to game the numbers: we saw X number of people, they were happier, it only costs this much.” There are still some good services, she wants to stress, great therapists, great managers, good systems, “But the model is designed in a particular way, to downgrade the service. To shorten the interventions, to reduce the number of highly trained clinicians that you need to take on a supervisory role rather than a direct clinical role. To reduce expectations. To reduce what people think is a treatment.”

One concern she has about online therapy platforms is the introduction of what she calls “Therapeutic Tinder” and how that changes a person’s relationship with their therapist. “They’re sold on the basis that you can see a therapist at any point in time and a text conversation becomes an appropriate way of having therapy. And if you don’t like your therapist, you just change them next week. What does that do to the therapeutic alliance, if you’re constantly at risk of being swiped, does that affect your practice?” She has no doubt that it does. “Good therapy means you can absolutely loathe the sight of your therapist. Now the impulse is to be more attractive as a therapist. The pressure is always to go light, rather than go deep.” Whenever innovation promises to provide cheaper access to something millions of people want, big businesses enter and monopolise the market. Which is dangerous when the product is better mental health. If a therapeutic relationship is based on trust and communication, then putting that relationship in the hands of tech companies, an industry rarely applauded for its trustworthiness or safety, threatens its very foundations. The more we talk, the more terrifying her vision of the future of therapy seems.

“There was a mental health crisis summit in 2019,” Cotton says, “and the audience was full of mums, mums of young men who had killed themselves.” She quivers, apologises for crying, gathers herself. These were mothers who were angry, because they believed their children had not received adequate care and then they had lost them. “That’s something I think is really under-articulated – the danger of this model is that the responsibility for recovery ultimately falls back on the individual. When you’re feeling shit about yourself and you feel you failed therapy (because the figures say 50% recovered from it), it becomes your problem. It’s the individualising of social problems. And there are consequences for that. And that’s never addressed. It’s a funny kind of white noise in the profession, a room with hundreds of people who had experienced the devastation of their families, because their kids did not get the right care.”

Our conversation felt like the opposite of counselling. I shut my laptop with a tickly sense of doom. The debate around the future of therapy seemed suddenly to have melted into an ink blot and every time the paper moves another image reveals itself, heart, snake, skull.

The gold standard of therapy remains two people in a room, one talking, the other listening. In Britain right now, that level of care is reserved for the very wealthiest and the very sickest, while those in between have traditionally relied on luck and compromise. The new therapy platforms will undoubtedly offer more people more help than they could previously access – some people will be failed and some might be badly referred, but there will be many more who benefit, whether from CBT or text-based therapy or AI, or finding solace in simply saying their feelings out loud. “I don’t always understand everything you write,” Woebot the AI chatbot offers, “but sometimes the act of sharing is just as good.”

The morning after speaking to Elizabeth Cotton the weather was fine and I shook off the doominess with a walk through the park I’d visited daily throughout the pandemic. Over the lockdowns, I have come to know every tree, repetition and new pandemic eyes learning the boundaries and occasional benefits of our new tense lives. At home I brush my hair for a Zoom meeting and later meet a friend’s new baby on FaceTime, and again I file the lessons we have learned about how to communicate over the months we’ve been unable to sit together in rooms, and talk. The ways in which technology assists and smooths our interactions, but also the new mirrored obstacles it presents. As the future of therapy unfolds, with evolving technology offering greater access to more people, these lessons will continue. The job will be to listen.

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Fivetran nears five times its unicorn valuation as it plans further growth

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The data integration business growing its EMEA HQ in Dublin is set for further expansion following a $5.6bn valuation and key acquisition.

Silicon Valley-headquartered Fivetran has announced $565m in Series D funding alongside a deal to acquire HVR.

This latest funding round sees the automated data integration provider’s value reach $5.6bn just over a year after it first reached unicorn status.

The funding round from new and existing investors included General Catalyst, CEAS Investments and Matrix Partners. Andreessen Horowitz led the round, which also brought in new investors Iconiq Capital, D1 Capital Partners and YC Continuity.

In total, Fivetran has raised $730m to date. And in tandem with its Series D funding round, the company also announced a $700m cash and stock deal to acquire data replication business HVR.

‘Without an always-on, accurate and reliable way to centralise data, global organisations aren’t maximising the use of data or data infrastructure’
– MARTIN CASADO, A16Z

For Fivetran’s mission to help businesses make use of the data they have, in a way that is quicker and requires fewer resources, HVR brings database replication performance along with enterprise-grade security.

“HVR is a recognised leader for enterprise database replication and shares our same vision – to make access to data as simple and reliable as electricity,” said Fivetran CEO George Fraser. “Their product is the perfect complement to our automated data integration technology and will be instrumental for us to help enterprise organisations that want to improve their analytics with a modern data stack.”

Fraser added that the latest injection of funding from investors will enable the company to expand its capabilities and accelerate its global growth.

Fivetran established its EMEA HQ in Dublin in 2018. The following year, fresh investment saw the company plan to double its Irish workforce. Last summer, a $100m funding round saw these expansion plans furthered.

In terms of market opportunity, Andreessen Horowitz general partner Martin Casado says Fivetran is a “critical component” of the modern data stack, which represents “a paradigm shift for global enterprises, with billions of dollars of revenue at stake”.

“Without an always-on, accurate and reliable way to centralise data, global organisations aren’t maximising the use of data or data infrastructure,” said Casado.

The acquisition deal has been approved by the boards of both companies and is expected to close in early October, subject to regular approvals.

Customers from both companies are expected to benefit from each of the business offerings. On the side of Fivetran, this client list includes Autodesk, DocuSign, Forever 21, Lionsgate and Square, while HVR services dozens of Fortune 500 brands.

“Combining HVR and Fivetran will enable a next-generation solution that will better inform business decisions by providing the freshest data available,” said HVR CEO Anthony Brooks-Williams.

“We’re thrilled to be joining forces with Fivetran and look forward to what this incredible opportunity will provide for our growing team, partners and customers.”

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Ring Video Doorbell 4 review: pre-roll is a battery bell gamechanger | Amazon

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The latest iteration of Amazon’s battery-powered Ring doorbell adds a new feature to capture the early details of events most competitors would miss without needing to be plugged in.

The Ring Video Doorbell 4 costs £179 ($199.99/$A329) and can be installed in any home with wifi. It tops Ring’s battery-powered range, which starts at £89.

The look and basic function of the Doorbell 4 is very similar to Ring’s older models. It has a camera with night vision, motion sensors and a large doorbell button.

When someone pushes the button Ring’s signature chime plays and an alert is sent to your phone. You can view a live feed and speak through the doorbell using the app from anywhere with internet. If you don’t answer, the new “quick replies” feature is like an answering machine for your door, recording caller’s messages. And it works as a motion-activated security camera too.

Four seconds of pre-roll

Ring Video Doorbell 4 review
A ring of blue LEDs lights up when the doorbell is pressed showing that it is active and something is happening, such as you answering the door through the camera. Photograph: Samuel Gibbs/The Guardian

Most battery-powered doorbells sleep until motion is detected to save power, which means they typically only capture the second half of an event as it takes time for the camera to wake up and start recording.

Ring’s “pre-roll” system fills in the gap before the motion sensor is tripped. It takes a clip from a looping four-second lower-resolution colour recording that can be operated all the time without draining the battery too much.

It is a gamechanger for battery doorbells, giving you a much better idea of what has happened before the main camera fires up.

Video, motion and replay

Ring Video Doorbell 4 review
The camera has a wide 160-degree horizontal field of view, but only a 84-degree vertical field of view, which means you can’t see packages left on your doorstep. Photograph: Samuel Gibbs/The Guardian

The main 1080p HD video is clear and sharp enough to discern faces and name tags, and recorded HDR (high dynamic range) to better handle the sun shining straight at your door. The infrared night vision is bright and clear, too.

You can adjust the motion sensitivity and define areas you want monitored so that you only get notifications when something happens in the chosen zone, which is particularly useful for avoiding notification overload if your doorbell faces the street.

Ring Protect

Ring Video Doorbell 4 review
All the settings, power modes and alerts are accessed through the app, which has an easy-to-use video recording timeline if you pay for the Ring Protect cloud storage. Photograph: Samuel Gibbs/The Guardian

While standard motion and doorbell notifications, live view and pre-roll are free, you need to subscribe to Ring Protect to get the most out of the doorbell. A free 30-day trial is included so you can see what it does, and plans start at £2.50 a month, but it is essentially cloud recording for your videos as they are not stored locally.

You get up to 30-day event history, messages recorded by visitors from the quick replies feature and still snapshots taken every 14 minutes to fill in the gaps between events.

Ring Protect also enables smart motion alerts, to differentiate between people and other things such as cars, and rich notifications, which show an image of the motion or person within the alert on your phone.

Set up and battery life

Ring Video Doorbell 4 review
The quick-release battery can be swapped out in seconds for charging without having to remove the doorbell from the door. Photograph: Samuel Gibbs/The Guardian

Setting up the doorbell is very easy. It comes with screws and wall plugs, plus a bracket for angling the camera towards your door if needed and cables for attaching it to an existing doorbell wire and chime if you have one.

The doorbell can be held in place by sticky strips if you can’t damage the mounting surface, such as if you’re renting. I used a set of Command-brand foam strips, but Ring sells a £17 “no-drill mount” that achieves something similar.

Once it is mounted you just slot the battery in the bottom, open up the Ring app on your smartphone and scan the QR code on the side of the bell. The app will run through the rest of the setup in about five minutes.

Ring Video Doorbell 4 review
Depending on how close your wifi router is to the door you may need a wifi extender or the £49 Chime Pro (pictured), which as well as acting as a ringer also creates a wifi network specifically for Ring devices. Photograph: Samuel Gibbs/The Guardian

If you don’t have a traditional chime you can buy the wireless £29 Ring Chime or use any existing Amazon Alexa devices in your home to ring instead.

Battery life varies depending on how many features such as snapshot and pre-roll you have on and the number of motion events and live views. With everything active and capturing roughly 45 events a day, the battery lasts about a month. I would buy a second £20 battery as it takes at least five hours to fully charge the battery via microUSB.

Privacy

Ring Video Doorbell 4 review
Ring has had a few privacy concerns over the years, particularly in the US with regard its activities with law enforcement. Photograph: Samuel Gibbs/The Guardian

You can block the recording of certain parts of the camera’s view such as your neighbour’s drive using privacy zones. Ring has recently added options to limit how long recorded videos are stored on a camera-by-camera basis, strengthened account security with two-factor authentication and, in addition to standard encryption, has enabled the activation of end-to-end encryption (E2EE) for videos.

E2EE offers the strongest protection and means only the mobile devices you select can decrypt and watch captured videos. No one else can see the video, not even Ring. But with E2EE turned on some more advanced features such as pre-roll, snapshots, the event timeline, rich notifications and Alexa integration for watching a live feed from an Echo Show cannot be used.

Sustainability

Ring Video Doorbell 4 review
The faceplate and battery can be easily swapped if damaged, while various screws, brackets, parts and add-ons are available direct from Ring.

The Ring Video Doorbell 4 is generally repairable and a range of spare parts, including the rechargeable battery, are available at reasonable cost. Most parts are also interchangeable with older models. The company will support its devices with software updates for least four years from the point it stops selling the device on its site, and continues to support all of the devices it has sold so far.

Ring offers trade-in and recycling schemes through Amazon for its devices, but it did not comment on the use of recycled materials in the Doorbell 4. Ring falls under Amazon’s climate and sustainability pledges.

Observations

Ring Video Doorbell 4 review
The removable faceplate, which is available in several colours to best suit your door, is held in place with a small security screw in the bottom of the battery. Photograph: Samuel Gibbs/The Guardian
  • The response time to live view requests through the app is shorter than previous Ring models, but it can still take a few seconds to answer the door, so Ring has a separate stripped-down Rapid Ring app that is faster to load, which can be used for answering rings alongside the main Ring app.

  • Alexa smart displays can show a live feed on demand or automatically when the doorbell rings.

Price

The Ring Video Doorbell 4 costs £179 ($199.99/$A329) and Ring Protect costs from £2.50 a month.

For comparison, the Ring Video Doorbell (2nd gen) costs £89, the Ring Video Doorbell Pro 2 costs £219, the Google Nest Doorbell costs £179.99 and the Arlo Video Doorbell Wire-Free costs £179.

Verdict

The Ring Video Doorbell 4 is yet another great battery-powered smart doorbell from Amazon.

It intentionally doesn’t look any different from previous versions, so that parts are interchangeable and the older models don’t look dated. But it wakes up faster, the colour pre-roll captures much more of each event and its night vision is really good.

It can be installed almost anywhere but it needs good wifi so you might need a booster. You’ll probably need the extra £29 Chime too, which brings the real cost to £189 as a bundle, plus the £2.50 a month subscription to really make the most out of it as it doesn’t have local video storage.

Note the Ring Android app has an extremely annoying hard-coded pattern of four strong and long vibrations for every motion alert. It cannot be changed, which forced me to disable motion alerts entirely and lost the Doorbell 4 a star. Ring said it is working to fix the problem by the end of the year. This issue does not exist for the Ring iPhone app, however.

Pros: easy to install, clear video, great colour pre-roll, lots of accessories, solid iPhone app, faster, quick replies, snapshots, Alexa device integration, great as a regular doorbell replacement, end-to-end encryption available.

Cons: no local storage means you need Protect subscription for event review, no constant video recording, fairly wide for some door frames, battery needs charging once a month, Chime likely needed.

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-Werror pain persists as Linus Torvalds issues Linux 5.15rc2 • The Register

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Linus Torvalds has revealed that winding back the decision to default to -Werror – and therefore make all warnings into errors – has made for another messy week of work on the Linux kernel.

“So I’ve spent a fair amount of this week trying to sort out all the odd warnings, and I want to particularly thank Guenter Roeck for his work on tracking where the build failures due to -Werror come from,” Torvalds wrote in his weekly missive about the state of kernel development.

“Is it done?” he asked rhetorically. “No. But on the whole I’m feeling fairly good about this all, even if it has meant that I’ve been looking at some really odd and grotty code. Who knew I’d still worry about some odd EISA driver on alpha, after all these years? A slight change of pace ;)”

Torvalds expressed his annoyance that his efforts have seen him enter “fix one odd corner case, three others rear their ugly heads” territory.

But he’s willing to wear the pain. “I remain convinced that it’s all for a good cause, and that we really do want to have a clean build even for the crazy odd cases,” he wrote.

And if he must handle this sort of thing in any week of the kernel production cycle, it might as well be the week of rc2.

“I hope this release will turn more normal soon – but the rc2 week tends to be fairly quiet for me, so the fact that I then ended up looking at reports of odd warnings-turned-errors this week wasn’t too bad,” he wrote.

Late last week, Torvalds also took some time to share what he described as “the true 30th anniversary date” of Linux.

On September 17th he wrote “a random note to let people know that today is actually one of the core 30-year anniversary dates: 0.01 was uploaded Sept 17, 1991.

“Now, that 0.01 release was never publicly announced, and I only emailed a handful of people in private about the upload (and I don’t have old emails from those days), so there’s no real record of that,” he wrote. “The only record of the date is in the Linux-0.01 tar-file itself, I suspect.

“Just thought I’d mention it, since while unannounced, in many ways this is the true 30th anniversary date of the actual code.”

So The Register though it worthy of mention, too. ®

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