Mental Health Tools: From Office To Pocket
Mobile apps and telehealth will never replace in-person treatment, but new tech tools can help millions who suffer from mental health conditions. Consider these apps and services.
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More than one-fourth of US adults struggle with mental illness, according to The Kim Foundation. As healthcare experts work to improve awareness and access to mental health professionals, they hope that technologies such as telehealth, social media, and mobile apps will help reduce this statistic and improve the nation's overall psychological health.
The suicide rate for people between ages 35 and 64 grew 30% between 1999 and 2010, up from 13.7 to 17.6 people per 100,000. In 2010, 38,364 people committed suicide -- in comparison, 33,687 died in motor vehicle accidents, according to a 2013 report released by the Centers for Disease Control.
While suicide rates among younger and older people have remained fairly consistent, the study found an increase among middle-aged residents -- a group historically not specifically targeted by mental health experts or suicide prevention specialists. Suicide rates increased 32% among women aged 35 to 64 and 27% for men in the same age group, the CDC reported. Worse, suicide rates increased 48% in people aged 50 to 54, and 49% among those aged 55 to 59.
To support World Suicide Prevention Day on Sept. 10, the World Health Organization has released Preventing Suicide: A Global Imperative, a resource that advocates reducing access to means for suicide, responsible media reporting, and early identification and management of mental and substance abuse disorders. The organization also recommends follow-up care by phone or personal visit as well as community support. As part of the WHO Mental Health Action Plan 2013-2020, member nations have committed to the goal of reducing suicide rates by 10% by 2020.
With today's increased access to general healthcare, primary care physicians are often the first clinicians to see those with mental health conditions, according to Dane Hallberg, CEO of My M3, developer of an app that screens for conditions such as anxiety, depression, and bipolar disorder. "If you don't have mental health, you don't have physical health -- and vice versa," Hallberg pointed out. "Twenty-eight percent of hospital readmission rates are due to a behavioral disorder. It raises the rates for all of us." Based on respondents' answers, the app provides resources such as a suicide hotline number. To ensure confidentiality, Hallberg added, the website does not store users' answers.
Technology -- which some people associate with job loss and other problems, along with feelings of depression and isolation -- can also help combat mental health issues. Many individuals are more likely to answer questions honestly using consumer-oriented apps and websites, according to Dr. Gerald Hurowitz, a psychiatrist and co-creator of What's My M3, which is available to both consumers and healthcare enterprises.
"Having the opportunity to complete the M3 in private and electronically provides a greater sense of anonymity -- and users report that there is a correspondingly greater tendency to provide honest answers to the questionnaire," he said. "Having ready access to a measure of one’s mental health -- via the Internet, smartphone, and one's doctor's office -- is a simple but effective way to protect the public from the scourge of suicide."
Many clinical psychologists believe mobile apps could improve patient care, according to a study by Sigma Research for SelfEcho. In fact, 66% of respondents said obtaining additional patient data via a mobile app would enhance their ability to treat patients, and 73% said a mental health app would help them track patients' progress.
However, while early research indicates some consumer-oriented apps -- primarily those developed with input by mental health professionals -- can help address stress, depression, suicidal thoughts, addiction, and other challenges, most lack scientific evidence about their efficacy, according to a paper published in the Journal of Medical Internet Research. That's why SelfEcho is targeting mental health professionals, not patients, with its Mobile Therapy software. The application is expected to ship later this year, said Shelly Gable, who holds a PhD in social psychology and is part of SelfEcho's leadership team.
"One of the things I've been advocating is this idea of proscriptive versus prescriptive ideas. I would be wary of mental health apps that claim to have an answer or claim to have a one-size-fits-all or if 'you do this you will be better' approach, because mental health is such a complex thing and there are so many facets to treatment," she said. "Our approach is to gather data and deliver [it to] someone who can deliver treatment -- [someone] who has knowledge based on training, but also based on knowing additional information from the client."
Others take a dual approach. Thousands of patients use Ginger.io in consultation with healthcare providers, but users can also download it without input from a clinician. The app, which seeks and tracks changes in patient behavior, integrates big data and workflow to alert clinicians to potential changes that could signal conditions such as depression.
Mental health professionals increasingly leverage telemedicine to deliver services to people who are unable or unwilling to visit doctors' offices. The Department of Veterans Affairs has used telehealth to treat schizophrenics since 2002, Dr. Adam Darkins, chief of telehealth services, told InformationWeek earlier this year. Over the past two years the organization has expanded mental health services within veterans' homes, he said. Many other organizations, public and private, have followed suit, connecting patients with psychiatrists, psychologists, or counselors via secure videoconference lines.
Telemedicine provider Reach Health sees a growing need from mental health clinicians, said CEO Steve McGraw, in an interview. Pointing out that about one in eight emergency room visits involves substance abuse or another mental health issue, he said, "You can't just dismiss the patient because you don't have someone to treat them."
As more consumers gain access to primary care, general practitioners and mental health specialists will be tasked to serve a growing population of patients. Integrated wisely, technologies like telehealth and mobile applications can help support this mission. Read on for some examples.
This free app, available for both Google Android and Apple iOS, lets users anonymously and privately screen themselves for mental conditions such as depression, suicidal feelings, or bipolar disorder. Users can create a support network by adding contact information for friends, counselors, and family; build a safety toolbox of coping strategies and supportive people; and easily access support resources such as the National Suicide Hotline from within the app.
Developed in a partnership between the California Mental Health Services Authority and Link2Health Solutions, My3 is available in English and Spanish. Future versions are expected in additional languages, according to CEO Dane Hallberg.
(Source: My3)
Using continuous data collection, Ginger.io aims to provide clinicians with a more complete picture of what's going on with patients when they are away from the office. Likewise, SelfEcho intends its Mobile Therapy software to be "an extension" of clinicians' offices, investor Jacques Habra told InformationWeek.
"We're going to introduce something that is going to bridge the gap between therapy visits in a very meaningful way. We've learned the average client does not provide very accurate information to their clinician, forgets a lot, or does not have the capacity to share a lot about their emotional well-being," he said. "This will allow the mental health professional to provide faster diagnosis and care."
(Source: Ginger.io)
A growing number of Oklahoma residents are connecting to the state's mental health clinicians via its TeleHealth Network, a move designed to improve overall health while simultaneously saving money. Usage grew 28% in 2013, with almost 34,000 residents using the service, compared with 26,000 in 2012. By comparison, the state saved $3.4 million in 2013 through telemedicine, it told The Oklahoman.
Similarly, North Carolina's Albemarle Hospital Foundation reduced hospital stays by 47% and cut 30-day recidivism rates by 35% when it implemented a telehealth solution. Because of the favorable outcomes, sponsor Duke Network provided an additional year of funding to expand the Telepsychiatry Network. Last year, the North Carolina General Assembly took note and funded the creation of a statewide telepsychiatry program for hospital ERs, to serve between 65 and 85 hospitals.
Centennial Mental Health clinicians, who formerly drove for hours each week seeing patients, colleagues, and managers across the network's coverage area, now use telemedicine for most meetings. Designed with the help of partner CDW, the system includes a secure virtual private network (VPN) intraweb, custom-engineered Polycom videoconferencing platforms, and personal videoconferencing systems, all of which connect to CMH's electronic medical records.
Designed as an educational resource and crisis intervention tool for suicide prevention, the Ask app is based on a practice developed by the Texas Department of State Health Services together with Mental Health America of Texas. Users see warning signs, crisis lines, and lists of best practices to help protect others while preserving their own safety.
Suicide Lifeguard, available for free on Google Play and Apple App Store, offers direct access to the national suicide prevention hotline along with other national and Missouri resources. It also includes specific resources for military personnel, LGBTQ individuals, Spanish speakers, and hearing-impaired users, according to the developer. Designed to support those with a loved one who may be considering suicide, the app includes warning signs, along with advice on how to ask and respond to questions about this subject.
For its part, R U Suicidal? primarily features video of a psychologist talking and asking questions of viewers. Users' answers are not backed up to any server, according to developer PsychApps International, citing patient privacy reasons.
(Source: Suicide Lifeguard)
Tragically, when someone does commit suicide, family and friends are often left wondering why it happened and what they could have done to prevent it. In addition to the grief that comes with the death of a loved one, they also face a litany of regrets, real and imagined. Of course, technology cannot ease grief. But several apps try to reduce at least some of the pain by helping mourners deal with the aftermath of tragedy.
PsychApp International's Did Someone You Know Suicide? for Android and iOS features video of a psychologist talking to users, who can enter in personal information used for customization. To ensure privacy, this data is stored only on the individual's phone, not on any server, according to the developer.
(Source: PsychApps International)
Analysis has long been a key component of mental health care. But today's data analytics tools and access to big data allow clinicians and researchers to make new connections and explore new treatments and preventive measures.
In late 2013, for example, the Florida Council for Community Mental Health and developer Netsmart unveiled an initiative to allow the agency to analyze and aggregate de-identified data from provider members statewide in order to identify costs, productivity, and outcomes in real time. The mental health and addiction services agency and its providers can then detect trends, identify needs, and develop treatment programs based on this information.
"This significant project will help identify the most effective outcomes and measures that can be proposed to the state of Florida to drive accountable care in an emerging pay-for-performance environment," said Bob Sharpe, the Council's president and chief executive officer, in a news release. "It will also help our members aggregate a wide array of complex, dispersed data and use it to enhance the effectiveness of their clinical practices and programs."
Northwestern University's Center for Behavioral Intervention Technologies created Mobilyze, a mobile app designed to improve the user's mood. The software aims to help patients suffering from depression make behavioral changes to reduce or eliminate symptoms and develop a system that learns to identify patients' mental states, allowing Mobilyze to reach out and intervene, David Mohr, PhD, a Northwestern psychologist and creator of the app, wrote in iMedical Apps.
The app requires patient input -- such as scheduling positive activities, noting ways a patient avoids engagement, and developing strategies to overcome negativity -- and uses sensors to augment patient input, Mohr wrote. Developers had considered using wearables but determined this could become an additional area of non-compliance; sensors, located around a patient's home, would be more passive and less likely to be circumvented as part of the patient's treatment plan.
Wearable devices that track activity could give an early warning signal to general practitioners if patients suffer from a depressive bout or mood disorder. A sudden decrease in activity or a change in eating or sleep habits might alert clinicians that a patient is suffering from a physical or mental illness, for example.
This, however, requires busy health professionals to discern this important data from the reams of other information collected by patients' wearable devices. For that reason, it's imperative that developers create dashboards that downplay normal results while highlighting warning signs and alarms. Some pundits predict that Apple's iWatch paired with HealthKit could spur adoption.
The US Department of Veterans Affairs developed PTSD Coach, a free app that's been downloaded more than 100,000 times in 74 nations, according to the agency. In addition to providing general information on PTSD and its treatments, the app offers tools for screening and tracking PTSD, ways to handle stress, and links to organizations that offer support and assistance.
The app is available on both Apple iOS and Google Android platforms.
The US Department of Veterans Affairs developed PTSD Coach, a free app that's been downloaded more than 100,000 times in 74 nations, according to the agency. In addition to providing general information on PTSD and its treatments, the app offers tools for screening and tracking PTSD, ways to handle stress, and links to organizations that offer support and assistance.
The app is available on both Apple iOS and Google Android platforms.
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