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Integrating Metaverse in Psychiatry for
Adolescent Care and Treatment (IMPACT)
Faisal A. Nawaz
1
, Richard Mottershead
2
, Rihab Farooq
1
,
Jaroslaw Hryniewicki
3
, Michael Kaldasch
4
, Ben Jelloul El Idrissi
4
,
Hanaa Tariq
5
and Waleed Ahmed
6
Abstract
The integration of the metaverse in healthcare has been evolving, encompassing various areas such as mental health
interventions, neurological treatments, physical therapy, rehabilitation, medical education, and surgical procedure assist-
ance. For the adolescent population, growing in the digital era and witnessing the interaction of technology with daily life
has made digitalization a second nature. Despite the potential of this technology in advancing adolescent mental health
careandtreatment,thereisanotablegapinresearchanddevelopment. Thus, this commentary article aims to elucidate
the current landscape of emerging technologies for adolescent mental healthcare in the metaverse, identify potential
challenges with its implementation in this growing population, as well as provide recommendations to overcome
these obstacles.
Keywords
Metaverse, digital health, adolescent, psychiatry, mental health
Submission date: 18 June 2024; Acceptance date: 17 October 2024
Introduction
The metaverse refers to a shared immersive digital environ-
ment created by the confluence of physical and virtual
worlds.
1
It is a complex, persistent, and continuous three-
dimensional universe where social and commercial
exchanges are carried out by virtual avatars; facilitated by
the integration of various technologies such as artificial
intelligence (AI), virtual reality (VR), augmented reality
(AR), mixed reality (MR), blockchain, etc.
1,2
In theory,
this refers to a world where users can interact seamlessly
with each other and the digital environment via virtual
avatars which mimic actual interactions in real time.
1
The integration of this innovative technology and its com-
ponents in the healthcare sector has been evolving, encom-
passing various areas such as mental health interventions,
neurological treatments, physical therapy, rehabilitation,
medical education, and surgical procedure assistance.
3–6
For example, a 2023 Korean study found higher levels of
career decision-making self-efficacy among nursing students
after delivery of a metaverse-based career mentoring
program.
7
Beyond these applications, it has also revolutio-
nized our approach to medical research, offering us exciting
prospects in diagnostics, prediction, and testing, as exhibited
by a 2023 systematic review which showed that VR was
effective in diagnosing and treating patients suffering from
psychotic disorders.
8–10
Focusing on adolescent psychiatry, it is crucial to note
that one in seven 10 to 19-year-olds experiences a mental
disorder, constituting 13% of the global burden of disease
1
Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, United Arab
Emirates
2
Faculty of Nursing, College of Health Sciences, University of Sharjah,
Sharjah, United Arab Emirates
3
Voix, Nedlands, WA, Australia
4
Aimedis LLC, Lewes, DE, USA
5
Jinnah Sindh Medical University, Karachi, Pakistan
6
Maudsley Health, Abu Dhabi, United Arab Emirates
Corresponding author:
Hanaa Tariq, Jinnah Sindh Medical University, Karachi 75510, Pakistan.
Email: hanaa.tariq@gmail.com
Creative Commons NonCommercial-NoDerivs CC BY-NC-ND: This article is distributed under the terms of the Creative Commons Attribution-
NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits any use, reproduction and distribution of the work as
published without adaptation or alteration, provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/
en-us/nam/open-access-at-sage).
Commentary
DIGITAL HEALTH
Volume 10: 1–7
© The Author(s) 2024
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/20552076241297055
journals.sagepub.com/home/dhj
in this age group.
11
According to the World Health
Organization, depression, anxiety, and behavioral disorders
such as attention-deficit/hyperactivity disorder (ADHD) are
among the foremost causes of morbidity and disability in
adolescents, with 3.6–4.6% and 1.1–2.8% of youngsters
afflicted by anxiety and depression respectively.
11
While
ADHD is said to affect 2.4–3.1% of this population.
11
Despite the positive shift in attitudes toward mental health
and its growing acceptance, public stigma—which refers
to negative or discriminatory attitudes of people towards
mental illness—remains a significant challenge in this
population.
12
Simultaneously, adolescents exhibit higher digital liter-
acy, making them more adept at engaging with digital
tools and platforms.
13
Growing in the current digital era
and witnessing the interaction of technology with daily
life has made digitalization a second nature. According
to Deloitte’s 2023 digital media trends study, 40% of ado-
lescents in the United States (US) aged 12–27 years have
already used VR technology in one shape or another.
14
Another US survey reported that Generation Z participants
expected to spend an average of 4.7 hours in the metaverse
every day by 2027.
15
While increasing digitalization has
been shown to have its own harmful impacts on adolescent
mental health, such as those associated with cyberbullying
or social comparison via social media, the familiarity of
this population with technology and its positive attitude
towards emerging technologies like the metaverse also
facilitates smoother integration into the mental healthcare
sector.
16–18
Considering the above, the metaverse emerges as a
highly adaptable three-dimensional space that could
redefine our interaction with the internet and the physical
world. It can be customized to provide specific solutions
for advancing adolescent mental healthcare, by aiding
broadly in diagnosis, treatment, and prevention. However,
despite its potential, there is a notable gap in research and
development in integrating the metaverse into adolescent
mental health. A 2022 systematic review of the literature
regarding the metaverse in healthcare found only one
article related to mental health, and no studies concerning
adolescents specifically.
1
Thus, this paper aims to elucidate
the current landscape of emerging technologies for adoles-
cent mental health, identify important challenges in its
implementation, and provide recommendations to over-
come them.
Current innovations
Due to the limited studies available on adolescent mental
healthcare in the metaverse, this section will highlight the
applications of the immersive technologies that comprise
the metaverse for mental healthcare generally, with their
potential to expand to the metaverse for adolescents
specifically.
Data collection and visualization
VR is a valuable tool for collecting specific functional data to
shape therapies and present information in an engaging, visu-
ally appealing manner.
3
For example, the VR-based diagnos-
tic methods developed by Professor Rizzo at University of
Southern California have shown promise in assessing
ADHD.
19,20
One such study involved the use of a head-
mounted VR display to immerse adolescents with and
without ADHD in a simulated classroom environment inte-
grated with neuro-behavior sensors, finding that the VR
classroom showed great clinical potential in the assessment
of ADHD.
19
These methods are extended to ADHD coach-
ing and social-emotional learning for neurodiverse users.
21,22
Telehealth and specific interventions
VR clinics may become a reality as technology, privacy
provisions, and regulatory frameworks mature. Currently,
VR serves as an entry point for accessing well-researched
VR-based interventions for specific conditions such as
phobias, post-traumatic stress disorder (PTSD), affective dis-
orders, addiction, and neurodiversity.
23,24
Virtual reality
exposure therapy (VRET) has shown efficacy in treating spe-
cific phobias and PTSD.
25
VRET involves the use of VR
technology to accurately simulate fear-inducing stimuli and
environments, such as those associated with specific
phobias or traumatic memories.
26
In contrast to in-vivo
exposure therapy, VRET has the advantage of being able
to closely mimic the distressing situation, in a safe and con-
trolled artificial environment.
26
Some surveys have shown
that people may prefer VRET over traditional therapy.
25
Especially in the context of younger patients, therapy with
VR may be preferable because their fascination with this
technology may persuade them to engage in treatment.
26
There is an increasing interest and testing of using the
metaverse as a telehealth platform.
9
Asystematicreview
published in 2021 explored the effectiveness of VR applica-
tions for adolescents in hospital settings and found significant
benefits in reducing pain and anxiety levels. Such applica-
tions were also found to be safe, fun, immersive, and
engaging for adolescent users.
27
Metaverse-based clinics
are being utilized to enhance traditional telehealth for clinical
consultations while introducing more immersive technolo-
gies for coaching and mentoring.
28,29
Figure 1 shows a meta-
verse mental health consultation in progress inside such a
clinic. In its simplest form, the metaverse can serve as a psy-
choeducation and engagement portal. Engaging conversa-
tional AI avatars, such as those developed by Spiegel
et al., can guide young people through managing their uncer-
tainties, potentially preventing future escalations.
30
Cultural adaptability and social connection
Immersive technologies can be adapted to specific cultural
groups, communities, and limitations, making them
2DIGITAL HEALTH
versatile in addressing youth mental health challenges.
31
They can provide global clinical and supportive interven-
tions, overcoming geographical boundaries and effectively
improving access to specialized care.
32
Acceptability and
adoption of VR in this unique population is an integral com-
ponent for creating future immersive experiences. A mixed-
methods study at a cancer hospital involving 90 inpatients
(7–19 years old) and their caregivers’perceptions of the
effectiveness of VR as a therapeutic intervention to
improve psychological well-being showed high user satis-
faction with ease of VR use in both populations, despite
the presence of chronic and severe illness.
33
VR has also
demonstrated potential in combating feelings of displace-
ment and loneliness, enabling young people to break the
isolation pattern and build confidence to re-engage with
the natural world.
34
There is greater potential in utilizing
such immersive communities in the development of
rehabilitation programs for physiotherapy, mental health,
and focus groups for adolescent patients.
35
Implementation challenges
The twenty-first century has seen rapid progress in digital-
ization and the emergence of the metaverse has led to an
accelerated growth in opportunities around how health pro-
viders can interact with clients. In tandem, these opportun-
ities also create inherent challenges as these novel models
of care can create new treatment approaches.
Privacy and security
Safety and supervision of vulnerable groups is a pressing
concern with existing safeguards not yet enveloping meta-
verse use. This includes the critical issue of ensuring that
patient health information is secure and its storage complies
with data protection regulations. With well-researched
digital services such as telehealth or mobile health applica-
tions, certain security measures for protection of patients are
already in place. These include the use of encrypted and
Health Insurance Portability and Accountability Act
(HIPAA)-compliant telehealth platforms, multi-factor
authentication for patients and providers, separating adoles-
cent patient and parent portals, etc.
36,37
In contrast, the
complex, immersive, and interconnected nature of the meta-
verse makes implementing security standards much more
difficult.
38
Stigma
Stigma is a major disabler for seeking mental health support
in this age group, with a significant number of children and
adolescents with mental health difficulties struggling to
seek help.
39
The perspective of youth viewing their
parents as “gatekeepers”to mental health support can in
turn create disabling clinical outcomes due to parental
stigma.
40
The fear of bullying among peers can further
exacerbate the self-stigma experienced by children which
prevents them from reaching out for mental health
support on a face-to-face basis.
Accessibility
Another significant obstacle is that access to the metaverse
may create a digital divide, and therefore inequalities of
care.
41
Although the metaverse can help overcome
common barriers to mental health services for youth—
such as mobility, lack of available services and providers,
and reluctance to engage in treatment—they still require
Figure 1. Mental health consultation in progress inside a metaverse-based clinic.
Nawaz et al. 3
access to digital infrastructure such as electricity, electronic
devices, and a reliable internet connection. This would
exacerbate inequalities in care, particularly among low-
income groups.
2,42
Mejsner et al. explain that AI, VR, AR,
the internet, robotics, and quantum computing undoubtedly
have immersive, intimate, and personalized care applications
useful for adolescent mental health.
41
However, there may be
challenges relating to equality, as understood through the
Social Determinants of Mental Health (SDMH).
43
The
SDMH are the non-medical factors influencing health out-
comes and are associated with conditions in which people
are born, grow, work, and live. The SDMH create an aware-
ness that there is a need for healthcare providers to appreciate
the client’s social context and how it impacts their states of
health and disease relating to mental health.
43,44
Therefore,
the digital inequalities around cost may need immediate
examination by governing health authorities to regulate the
accessibility of the metaverse for adolescents who may not
possess the financial resources to allow access. There is
also a need to educate health workers on the presence of
this possible inequality.
Digital literacy
This point raises the next identified challenge, namely the
competency and confidence of the current mental health
workforce around digital literacy. The authors suggest
that these emerging technologies provide an additional
dimension to contemporary skillsets, and education provi-
ders need to consider an inclusive curriculum design that
demonstrates learning outcomes focusing on the metaverse.
Given this specialized topic area, universities may need to
share resources and expertise to create discursive learning
opportunities for interpersonal learning.
45
Embedding
metaverse health into healthcare training will allow learners
to integrate patient-centered skills into therapeutic engage-
ment with their clients.
Research and funding
Lastly, the authors highlight the challenge of the lack of
research and funding for resources to build metaverse infra-
structure. Donkin et al. argue that action on the SDMH is
required to reduce inequities.
46
This would suggest that
concerning inequalities, this could be realized as an over-
reliance on traditional hospital settings and, therefore, a
need to further research and establish comprehensive
mental health services inclusive of the metaverse through
a commitment to a new digital healthcare strategy.
Recommendations
A multifaceted approach is required to address the chal-
lenges in implementing metaverse-based mental healthcare,
particularly among the child and adolescent population.
Ensuring security and safeguarding
The role of health regulatory bodies is paramount in ensuring
the safety of the users reaching out for accessible mental
healthcare. This has been showcased by having the virtual
presence of the Ministry of Health and Prevention
(MOHAP) from the United Arab Emirates’customer happi-
ness center inside the metaverse.
47
Such virtual authority
hubs have the potential of understanding and tackling
unique challenges that may arise during the patient care
experience. On another level, the role of advanced verification
of user accounts in ensuring safety is critical and can be further
enhanced by connecting user accounts to national identity
numbers, which will allow for ease in integrating unified
medical records. Furthermore, utilizing blockchain technology
is an innovative way to ensure these medical records and sen-
sitive patient health information is stored and shared securely.
1
With its decentralized, immutable, and encrypted nature,
blockchain allows patients to control access to their informa-
tion via smart contracts, while also maintaining transparency
and traceability to ensure accountability and audits.
48
Parental supervision and consent to participating in treat-
ment is of the utmost importance, and will not only provide
a safe but holistic environment for families to be included
in the virtual development space. This can be ensured via
additional security measures for adolescents such as parent-
managed accounts which allow parents to configure supervi-
sion settings and filter content.
49
Verified parent accounts can
be considered to sign digital consent forms before their child
can access or receive mental healthcare inside the metaverse.
To further increase the confidence of parents of children
accessing mental healthcare in the metaverse, educational
courses can be focused on exposure to the metaverse experi-
ence, supported by mental health professionals’counseling
on the risks and benefits of being a part of healthcare in the
metaverse. Simultaneously, in ordertoassistchildrenfacing
challenges with parental consent for mental health treatment,
metaverse-based support groups can be created which would
allow adolescents to connect with peers experiencing similar
issues for advice and guidance. Children could also be given
communication training within the metaverse, designed to aid
them in approaching the subject of mental health treatment
with their caregivers. And finally, the presence of mental
health hotlines where children can securely communicate
with social workers and counselors, who can then facilitate
communication between parents and children, could also be
a valuable tool in navigating the complicated issue of parental
consent. The role of “youth circles”can be explored to guide
younger patients to create communities for self-help and sup-
portive groups, which can be guided by a professional to
allow for regulated information-sharing in a safe space.
50
Increasing digital awareness initiatives
This brings us to a more crucial task of upskilling the
current mental health workforce on metaverse adoption
4DIGITAL HEALTH
through Continued Medical Education (CME) courses, and by
hosting key events related to child mental health advance-
ments using the metaverse platform. One example is a training
session offered by Stanford University on the “Application of
VR and Metaverse Technology in Education for Healthcare
Professionals.”
51
Harvard Medical School also offers a
CME course on Digital Mental Health, aiming to familiarize
healthcare providers with the technologies involved in this
upcoming field.
52
Further educational initiatives are needed
with a particular focus on adolescent mental health in order
to better equip practitioners with an understanding of the
unique challenges faced by this population.
Prioritizing research and funding
On a stakeholder level, this calls for increased funding for
developing the digital infrastructure to allow for cloud-
based linking to healthcare networks. This can facilitate
remote consultations and narrow the digital divide for
access and cost efficiency to seek child and adolescent
mental healthcare. Lastly, research on the benefits of
metaverse-based interventions is vital to understand its
feasibility as an augmentation to traditional approaches,
while empowering the youth to seek support without asso-
ciated stigma.
Conclusion
The innovative tools comprising the metaverse present
promising potential solutions to ongoing issues in adoles-
cent psychiatry. Not only can it aid in diagnosis and treat-
ment, but it also has the potential to assist in prevention
by facilitating social support, reducing stigma, and decreas-
ing isolation among young people. However, the current
healthcare landscape appears unprepared for its implemen-
tation. Further robust studies are necessary to explore the
sustainability and applicability of the metaverse in the ado-
lescent healthcare sector. In order for its benefits to be fully
realized, the obstacles concerning its application must be
addressed through initiatives such as inclusion of
curricula-specific training and education in digital literacy
for healthcare providers, active allocation of institutional
resources and funding towards research and infrastructure;
while ensuring patient security, and parity in accessibility
and quality of care for all.
Acknowledgements:None.
Contributorship: FAN, RM, and RF conceptualized the article
and were involved in reviewing and editing. FAN provided
supervision, editing, and feedback throughout the development
of the manuscript. RM, JH, HT, MK, BJEI, and WA conducted
the literature search and worked on the initial draft. All authors
contributed to writing different sections of the manuscript. All
authors approved the submitted version for publication.
Consent to participate: Not applicable.
Consent for publication: Not applicable.
Data availability statement: Not applicable.
Declaration of conflicting interests: The authors declared no
potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Ethical approval: Not applicable; no human or animal subjects
were involved in this article.
Funding: The authors received no financial support for the
research, authorship, and/or publication of this article.
ORCID iD: Hanaa Tariq https://orcid.org/0009-0004-8375-
7304
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