Apr 10, 2017
The Monsenso digital self-monitoring tool was tested in a pilot study by individuals with Borderline Personality Disorder in a Public-Private Innovation Partnership between The Zealand Healthcare Region and Monsenso.
The Zealand Healthcare Region, which provides medical services to more than 820,000 citizens, was looking for a smartphone-based application to replace the existing paper-based self-assessments and clinical questionnaires. The application was used in a pilot study to support the treatment of 30 patients with Borderline Personality Disorder receiving Dialectical Behavioural Therapy (DBT) and it ran from January 2016 to January 2017.
Objectives
The main goals of the pilot study were to identify and track the triggers and early warning signs of individuals with BPD using the digital self-monitoring tool, and to evaluate the project from a Mini Medical Technology Assessment (MTV) perspective, in relation to performance, future impact on patient outcomes and financial implications.
Challenges
- To provide patients and healthcare providers with an effective digital self-monitoring tool that is able to identify and track triggers and early warning signs
- To optimise the treatment of BPD and to reinforce the recovery process by improving patients’ access to information about their illness
- To configure, further develop, and install the Monsenso digital self-monitoring tool so that it can be tested in day-to-day operations in the psychiatry unit in Region Zealand
The Monsenso digital self-monitoring tool
The Monsenso mHealth solution is configured to meet the needs and track the symptoms of patients with borderline. It is based on a double-loop treatment model that connects patients and healthcare providers. The Monsenso digital self-monitoring tool gives patients the opportunity to enter and visualise self-reported data and early warning signs. At the same time, the system provides healthcare providers with access to prognosis, statistics, pattern analysis, risk, and tracking of early warning signs. The solution consists of a smartphone application for patients, and a web portal for healthcare providers. The web portal allows care providers to access all the data collected by the patients’ smartphones, and facilitates data analysis. Each clinic has access to an overview of the patients for whom they are responsible. This allows healthcare providers to monitor patients closely in order to quickly identify when the patients’ conditions are changing and document the process patients go through during their treatment.
Results
Since the 30 patients rapidly embraced the app, when the pilot was completed, they had no wish to return to the paper-based self-assessments. Therefore, The Zealand Healthcare Region chose to extend the agreement with Monsenso for an additional year, even though the project had not been fully evaluated.
The final evaluation, which will be conducted by the Psychiatric Unit of Research of Region Zealand in Slagelse and the Consolidated Unit of Production, Research and Innovation is set to be concluded in early 2017.
The final evaluation includes a round of interviews with patients and staff, who have been testing the Monsenso solution.
Click here to watch a video displaying patient testimonials.
Click on the links below to learn more about Monsenso’s usage in the treatment of Borderline Personality Disorder:
Apr 5, 2017
Telehealth for mental healthcare makes a lot of sense since mental health care is generally harder to access than other health services, due to a shortage of qualified mental health providers and coverage limits.
A report released by the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) titled “Increasing access to behavioural health care through technology” suggests that to be able to reach a larger amount of people, organisations should consider the use of telehealth for mental healthcare.
Teleahealth for mental healthcare
The report mentions that broadly speaking, telehealth for mental health can take two forms:
- A caregiver such as a nurse or social worker can use telehealth technology to conduct a distance-based consultation with a mental health specialist to discuss how to handle a patient’s mental health needs
- A patient can participate in a videoconference session with a mental health specialist
The value telehealth for mental healthcare, was identified by HRSA safety net providers in terms of potential cost savings, efficiency, and expanded access to services. In general the HRSA report mentions the five main benefits of using telehealth tools for mental healthcare:
Improved care delivery
- Provide a more efficient patient care when they combine patient data with best practices in order to make care decisions. For example, in mental health, clinicians can review data and identify early warning signs for behavioral health concerns
- Facilitate the access, use and sharing of data and it supports the health system’s move toward collaborative and integrated approaches by strengthening relationships within a team and across agencies
- The patient-centered medical home (PCMH) model of care recognizes the value of care coordination supported by wireless technology
- Clinics can gain expanded access to experts, like mental health specialists, residing outside the local community. Telehealth can also ease the task of convening consultation sessions between primary care clinicians and behavioral health specialists
Expanded staff capacity
- Offer care providers more flexibility to deliver health care while on-the-go or from different locations—expanding the clinic’s service offerings
- Facilitates the hire of part-time, specialized staff who work remotely for multiple clinics
- Telehealth for mental health can be added to existing clinic operations. Thus, putting a team together is a matter of figuring how to make it work within the context of existing staff and budgets
Enhanced training opportunities
- Conduct trainings for staff when sessions are devoted to sharing of insights and best practices. These trainings can elevate expertise within an agency and across multiple providers
Cost savings
- Reduces the cost of care delivery. For example, if a patient suffers a relapse, telehealth enables a care providers to deliver counseling and intervention services quickly through teleconferencing sessions
Patient acceptance and engagement
- Works around patient fears over accessing services at a certain clinic or neighborhood. Health center patients are frequently reported to be either unable or unwilling to seek services outside of their communities
- Patient acceptance rates for telehealth in mental health are generally high. One HRSA grantee was surprised over one of their early adopters: a psychiatric patient with a paranoid belief that TV was speaking to him. Surely, telehealth would not work with him. However, the patient successfully participated in a session, and, at one point, looked over to his sister with a grin and said: “see, the television does talk to me.”
- Patient portals are meeting a demand since people are increasingly turning to search engines to learn about their health concerns prior to accessing care. When patients go online, providers need to be there. Some portals provide patients with access to their health data so that they can take an active role in their treatment
The Monsenso mHealth solution
The Monsenso mHealth solution for mental healthcare supports the use of telehealth technology in the remote treatment of patients suffering from mental illness. Moreover, the report released by the HRSA mentions five main benefits that the use of telehealth brings to mental health care, and the Monsenso mHealth offers all these benefits.
Improved care delivery
With help of the patient’s smartphone, the Monsenso mHealth platform utilizes advanced technology to collect and analyze data on a patient’s behavior. This collection and analysis of data gives the clinician a deep insight into the relationships between the patient’s behavior and the illness.
Expanded staff capacity
The Monsenso mHealth solution enables clinicians to focus on patients who need immediate attention by notifying clinicians automatically if there are any patients who present any triggers or early warning signs.
Enhanced training opportunities
The information on the clinical web portal can be accessed and shared by multiple clinicians even if they are not based in the same geographical location.
Cost savings
The smartphone application enables patients to fill out self-assessments on a daily basis letting the clinicians know how they feel. This information as well as the information collected through the smartphone’s sensors can help clinicians intervene at an early stage, before the patient needs hospitalization.
Patient acceptance and engagement
The patient-oriented clinical evaluations by Monsenso have shown that the compliance rate is very high (87% to 93%), the solution is very useful and extremely usable by patients and clinicians, it helps patients to manage their illness better, and it helps clinicians offer a better treatment
Reference:
[1] Increasing access to behavioral health care through technology. The U.S. Department of Health and Human Services Health Resources and Services Administration (2013, February). http://www.hrsa.gov/publichealth/guidelines/behavioralhealth/behavioralhealthcareaccess.pdf
Mar 27, 2017
Self-care for mental health means that individuals should develop a healthier lifestyle by paying careful attention to their diet, exercise, and sleeping habits. A person’s lifestyle can have a significant impact on how their mind and body respond to a mental health treatment plan.
Managing Stress
Stress can be defined as the brain’s response to any demand. Many situations can trigger this reaction, including change. It is important to learn to recognise the symptoms of stress which may include: difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy. [1]
The following activities may help individuals cope with stress:
- Set priorities. Decide what must get done and what can wait, learn to say no when it’s necessary
- Avoid dwelling on problems
- Schedule regular times for relaxing activities
- Explore stress coping programmes, such as meditation, yoga, or tai chi [1]
Exercise
Exercise is one of the most efficient ways to improve a person’s mental health. Studies show that exercise can treat mild to moderate depression as effectively as antidepressant medication. Besides, it is a natural and effective anti-anxiety treatment. It relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins. [2]
A person can experience the physical and mental health benefits of exercise with just 30-minutes of moderate exercise a few times a week, and in some cases, two 15-minute or even three 10-minute exercise sessions can also work. [2]
Nutrition
Eating high-quality foods that contain lots of vitamins, minerals, and antioxidants nourishes the brain and protects it from oxidative stress — the “waste” (free radicals) produced when the body uses oxygen, which can damage cells. [3]
On the contrary, diets high in refined sugars are harmful to the brain. In addition to worsening your body’s regulation of insulin, these diests also promote inflammation and oxidative stress. Multiple studies have found a correlation between a diet high in refined sugars and impaired brain function — and even a worsening of mood disorders symptoms. [3]
Tips for healthy eating:
- Prepare your own meals
- Eat with moderation
- Reduce sugar intake
- Eat a mix of lean protein, whole grains and colourful fruits and vegetables on a daily basis
Sleep
There is a close relationship between sleep and mental health. Over an extended period, a severe sleep problem could make an existing mental health issue worse.
- Establish a routine by going to bed and waking up at roughly the same time every day
- Feel comfortable. Ensure the temperature, light, and noises levels are right
- Stop any stimulating activities, such as working or doing exercise, and avoid looking at screens (phone, a computer, tablet, or TV) for one hour before going to bed
- Don’t try to force sleep. If it’s difficult to sleep, get up, go to another room and try to relax
- Avoid large meals, drinking too much water and stimulants such as alcohol, caffeine and nicotine during the evening [4]
The Monsenso smartphone app for mental health
The Monsenso smartphone app for mental health is an excellent tool to support self-care. It can help individuals with a mental illness to self-monitor by filling in daily self-assessment on their smartphones that indicate their level of stress, physical activity, anxiety, the number of hours they slept, and if they took their medication. It also tracks sensor activity such as physical activity, mobility and phone usage.
The smartphone app can be configured to notify users and their primary health care provider if they present any triggers and warning signs, which means that the system identifies some of the person’s behaviours that are likely to cause a relapse. If this is the case, the smartphone app also provides users with customised action plans that can be used when their symptoms appear so they can take action. By using the Monsenso smartphone app every day, individuals can monitor their progress over time and learn to avoid the behaviours that trigger their symptoms.
In addition to this, all the information captured by the individual’s smartphone is synchronised with the user’s primary healthcare provider in real-time; therefore, when a person is called for a consultation, the dialogue is facilitated by the information in the system. To learn more about the benefits of the Monsenso app for Individuals click here. If you want to learn more about the benefits for clinicians, click here.
References:
[1] Fact Sheet on Stress. National Institute of Mental Health
[2] The mental health benefits of exercise. HelpGuide.org
[3] Nutritional psychiatry: your brain on food. Harvard Health Publications. Eva Selhub. 16 November 2015.
[4] How to cope with sleep problems. Mind.org
Mar 26, 2017
The MDiary Study is a part of the ENTER project (previously called E-Mental), which is being done in collaboration with The Mental Health Services in the Region of Southern Denmark (MHS), the South Denmark University, Aalborg University, and Context Consulting.
Borderline Personality Disorder (BPD)
Borderline is a serious and debilitating mental disorder characterised by difficulties with regulating emotions, which leads to unstable and self-destructive behaviours and relationships.
The prevalence of BPD is 1%-5%. Borderline increases the risk for suicide by 4-fold, while patients with comorbid Borderline and a tendency to self-harm have a further 2-fold attenuated risk. BDP is difficult to treat, and even more difficult when co-occurring with other disorders.
Dialectical Behaviour Therapy (DBT) is the best validated treatment for Borderline, showing medium to large effect sizes as compared to treatment as usual. Dialectical Behaviour Therapy uses self-monitoring as the mainstay of treatment, which helps patients regulate their emotions by means of emotional regulating skills, and reduce problem behaviour.
Self-monitoring has traditionally been done by means of daily paper diaries. The latest developments in smartphone applications have generated alternatives for ecological momentary assessments of problematic behaviour with the additional functionality of prompting patients to practice skills targeting emotion regulation.
Monsenso’s involvement in the the mDIARY Study for patients with Borderline Personality Disorder
Monsenso is responsible for improving and developing additional modules in the Monsenso mHealth solution. The objective of the study is to prove that the Monsenso DBT (Dialectical Behavioural Therapy) solution is a reliable and clinically valid way to collect patient data, helping individuals with Borderline learn these skills at home, speeding up their recovery.
1. Skills tracking
In the current configuration used for DBT treatment, skill used throughout the day can be selected in the daily self-assessment. This does not take into account if the patients have actually learned the skills, meaning a lot of skills will appear in the list that the patient might not already know. In order to personalise the skills list, and in order to help the clinicians and patients to track progress, the skills should be configurable in the sense that the patient is able to indicate whether they have not learned a skill, are in the process of learning a skill, or know it and can use it meaningfully. This implies, the the patients should be able to, on their phone in the configuration section of the self-assessment, to have a list of skills appear, where they can indicate whether a skill is ’Not known’, ’In the process of learning’, or ’I know it, and can use it meaningfully’.
2. Skills training / Psychoeducation
In DBT treatment, skills are an essential part, and patients often have a paper folder, with descriptions of each skill. In the current version, the “Action Plans”’ in the system have been used for this purpose, but it makes it not very easy to overview and need more ways of presenting content, like videos or sound files. The layout is like a dictionary, where patients can find information regarding their disorder, usual treatment regime, prevalence, but alto typical issues and preventive actions that could be taken.
3. Emotion rating (BEARS)
One parameter in the self-assessment should be named “Emotions” in which joy, anger, attachment, sadness, safety, anxiety, pride and shame can be be rated on a scale of 0-4:
0 – Not at all
1 – A Little
2 – Some
3 – A lot
4 – Extreme
It is important that they are all rated in the same screen, as the patient need to see these together.
4. Therapy progress / Detailed overview
The overview screen will be re-designed and focus around “Therapy progress,” highlighting the progress over time. The key factor for the use of the system should be the patients’ development and progress over an extended period. The scope of the solution is to include graphs of the clinical questionnaires in the overview screen, which includes summary scores of DERS, BSL, and HTQ questionnaires. Likewise the attendance percentage should be shown, together with the Hierarchy level rated by the clinician.
To learn more read:
Mar 26, 2017
SmartCare by Smartphones was developed in collaboration with the Unit for Psychiatric Research, a group of young patients and their caregivers from the Infirmary for adolescents with schizophrenia in North Jutland.
Schizophrenia
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling and include hallucinations (hearing or seeing things that don’t exist), delusions (unusual beliefs not based on reality), muddled thoughts (based on hallucinations or delusions) and changes in behaviour.
Monsenso’s involvement in SmartCare by Smartphones
The SmartCare by Smartphones project developed a mobile health (mHealth) solution called “MindFrame,” which is powered by Monsenso, that supports the treatment of individuals with schizophrenia. It consists of a smartphone application for patients and a web portal for clinicians. MindFrame was developed as a framework that offers a unique impression of the correlation between the illness and daily life. Together, healthcare providers and patients can customise the application’s settings so that it corresponds to the person’s actual challenges and supports his particular needs.
MindFrame also provides individuals with customised action plans within the application ensuring that self-help tools are readily available, even when the person is feeling well. Participants are required to fill out a self-assessment on their smartphone; these assessments will reveal the state of the individual’s mental health. The data collected on the self-assessment will be subsequently displayed on the smartphone app as a graph over the course of 14 days.
The clinician can also access the patient’s self-assessments through the clinical web portal enabling him to identify any patterns and make possible connections between certain behaviours and the symptoms they may trigger. With the data from the self-assessments, the system can also identify triggers and early warning signs notifying both, the patient, and the clinician.
To learn more:
