Much of mobile health technology’s big splashes have involved creating gadgets that track fitness more effectively or make miniaturized versions of heavy hospital and ICU equipment: electrocardiograms, telemedicine video cameras, thermometers, and pulse oximeters.
But what about psychiatric issues? Psychiatric issues often require face-to-face human contact with a psychiatric provider to provide diagnoses and assessments. Technology often does not play a role in mental health encounters.
However, getting patients this face time may not be financially sustainable and scalable, argue researchers from organizations including the World Innovation Summit for Health, Imperial College London, and the Supreme Council of Health in Qatar. They believe that technology should play a more prominent role in psychiatric disorders and believe that Google has already laid out a suitable framework for constructing technological innovations.
Their paper in September 2014’s Health Affairs discusses how psychiatric conditions are anticipated to cost the global economy US$16 trillion from 2011 through 2030 through lost labor and capital output, outpacing that of four other noncommunicable disease states — cardiovascular disease, chronic respiratory disease, cancer, and diabetes — with a combined price tag of US$30 trillion.
And it’s no wonder that mental health is an area where health technology is growing: Stanford’s recent Medicine X emerging health technology conference, for instance, featured a panel focused on technology in psychiatric disorders, the critical role of mental health in whole person care, and depression as a co-morbid condition in chronic illness. The American Psychiatric Association prominently features integrated collaborative care as a model to address these co-morbid conditions. And, the American Telemedicine Association prominently features a mental health track in their annual conference.
“Mobile apps aimed at improving patients’ ability to take care of themselves have the advantage of existing on a device that’s already in patients’ hands at almost any time of day,” writes Jones et al. The authors state that improved patient self-care can help address scarcity and inequality in access to mental health services.
The authors then take Google’s principles, “Ten Things We Know To Be True,” and adapt it towards cases of mental health mobile interventions and apps. For instance, applying the Innovation Principle of “It’s best to do one thing really, really well” means that mental health innovations must focus on improving a single part of the patient-provider care and communication pathway. One research innovation described focused only on the types of messages sent in discharge follow-up text messages following a month-long inpatient psychiatric hospitalization.
And, applying the Mobile Principle of “You don’t need to be at your desk to need an answer” towards mental health apps emphasizes the need to focus on apps that can help patients improve self-care. The “CBT6-CA” CBT app on an iPhone-sized palmtop computer — albeit running MS-DOS — was successful on metrics of panic and anxiety compared to the same length of period with standard face-to-face CBT. The authors conclude that this creates efficiencies of labor, as well as improves access to those who can’t or won’t engage in face-to-face therapy.
They highlight successful mobile cognitive behavioral therapy adjunct apps — such as Viary on iOS and Android, and the CBT6-CA app — along with an overview of challenges that such mobile apps may face like professional resistance by hospital administrators and insurance companies to technological advances in mental health.
Overall, the article succinctly captures the current zeitgeist of mobile health applications for psychiatric disorders, but goes beyond just design issues for patients. Other issues that developers and creators must face: business and organizational issues surrounding adoption of such applications, collaborative issues between policy makers and developers, and higher levels of resistance in higher-income countries versus lower-income countries with fewer professional barriers and systemic hurdles. Considering, however, the clear need for new tools to deliver psychiatric care, these are certainly challenges worth taking on.
“How Google’s ‘Ten Things We Know To Be True’ Could Guide The Development Of Mental Health Mobile Apps” is available in the September 2014 issue of Health Affairs. View the PubMed entry for more information.