Mar 20, 2017
mHealth offers the opportunity to offer scalable and cost-effective mental healthcare. One of the greatest challenges the healthcare systems face is the long-term care of individuals with severe mental disorders such as schizophrenia since the impact this has on individuals, families and societies is huge. Fortunately, some of these issues can be partially solved with the use of mHealth technology. Besides, the advantages of online therapy are many, including a more personalised treatment, patient-empowerment, teaching self-care and helping people who wouldn’t receive treatment otherwise.
Schizophrenia has an estimated point prevalence of 0.4% and a lifetime risk of 1%, which means that 1 in every 100 people will suffer from schizophrenia during their lifetime. It is the 7th most important illness in terms of years lived with disability, accounting for 2.8% of disability caused by all illnesses. For people aged 15 to 44 years, it is the 3rd most important disease, accounting for 4.9% of disability resulting from all illnesses.
During the last few decades, the European Union has made a huge effort to overcome these barriers and to ensure high-quality, longer-term care for people with severe mental disorders. These efforts started in the 60’s with the development of new pharmacological treatments for psychosis, which radically changed the prognosis of severe mental illness. In the 70’s and the 80’s, there was an emergence of new psychosocial interventions and new concepts of mental health care organisations [1].
Nowadays, there is a need to shift the health care model. The transition from traditional large psychiatric institutions to modern comprehensive community-based models of care, including acute patient units at general hospitals [1].
According to a report published by EU, this shift is necessary due to the following reasons:
- Accessibility to mental health care of people with longer-term mental disorders is much better with community-based services than with the traditional psychiatric hospitals
- Community-based services are associated with greater user satisfaction and increased met needs. They also promote better continuity of care making possible to identify and treat more often early relapses
- The community-based services protect the human rights of people with mental disorders and prevent stigmatisation of those people
- Studies comparing community-based services with other models of care consistently show significantly better outcomes on adherence to treatment [1]
However, European healthcare systems need to make lots of alterations if they want to provide accessible, effective, high-quality and long-term care to people suffering from severe mental disorders.
Challenges of the transition to new comprehensive community-based models of care
One of the main reasons why the development of long-term mental health services is insufficient is due to the lack of coordination between the different health services. A close coordination, and even joint funding and management of health and social care services is fundamental to cope with the new challenges European mental health systems are now facing. [1].
According to the report, these are the key principles to organise mental health services:
Accessibility: Essential mental health care should be available locally, including outpatient and inpatient care, as well as rehabilitative care. Local services provide continuity of care in a satisfactory manner.
Comprehensiveness: Mental health services should include all facilities and programmes required to meet the essential care needs of the populations.
Coordination and continuity of care: People suffering from severe mental disorders often find it extremely difficult to gain access to various basic services; therefore, it is crucial that services work in a coordinated manner. This coordination should also include services that are not directly related to health, such as social services and housing services.
Effectiveness: Service development should be guided by evidence of the effectiveness of particular interventions. For example, there is a growing evidence base of effective interventions for many mental disorders, among them depression, schizophrenia and alcohol dependence.
Equity: A person’s access to services of good quality should be based on need. It is quite often that the people who need these type of services the most are the least able to ask for help.
Respect for human rights: Services should respect the autonomy of persons with mental disorders, and encourage such persons to make decisions affecting their lives and treatment [1].
Scalable and cost-effective mental healthcare
The Monsenso mHealth solution does not only offer cost-effective mental healthcare, it can can facilitate five of the six points mentioned in the report to organise mental health services in an optimal way.
Accessibility: With mobile technology and telehealth, care providers can reach patients living in remote locations at a minimal cost. These technologies offer care providers more flexibility to deliver health care while on-the-go or from different locations—expanding the clinic’s service offerings [2].
Coordination and continuity of care: The Monsenso mobile health solution can facilitate and support the care of patients suffering from severe mental illnesses from community-based models. Due to its cloud-based model and unlimited scalability, patient records can be accessed by multiple organisations such as psychiatric institutions, general practitioners, and social services, among others.
Effectiveness and equity: With help of the Monsenso smartphone app, care providers can identify on a daily basis triggers and early warning signs of all patients in the system. With the Monsenso mHealth solution clinicians can prioritize caring for individuals who need immediate attention and continue to monitor individuals who are stable. According to the National Institute of mental health, early intervention is critical to treating mental illness before it can cause tragic results such as serious impairment, unemployment, homelessness, poverty, and suicide [4].
Respect for human rights: The Monsenso smartphone app enables patients to fill in daily self-assessments and write notes about how they feel. The information collected from these assessments is shared with the clinic, allowing individuals to be more involved with their treatment. The Monsenso smartphone app also provides individuals with customised action plans that act as guidelines in case their symptoms appear enabling individuals to take responsibility for their behaviours and actions.
References:
[1] The long-term mental health care for people with severe mental disorders. J.M Caldas de Almeida, H. Killaspy. Prepared under service contract with the Impact Consortium by the European Commission. 2011.
http://ec.europa.eu/health/mental_health/docs/healthcare_mental_disorders_en.pdf
[2] Increasing access to behavioural 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
[3] Directors Blog: SAMHSA and NIMH partner to support early intervention for serious mental illness. P. Hyde and T. Insel. National Institute of Mental Health Blog (2014, June 17)
http://www.nimh.nih.gov/about/director/2014/samhsa-and-nimh-partner-to-support-early-intervention-for-serious-mental-illness.shtml
[4] Evidence based treatment for first episode of psychosis: Components of coordinated specialty care. PHD R. K. Heinssen. RAISE NIMH (2014, April 14).
http://www.nimh.nih.gov/health/topics/schizophrenia/raise/nimh-white-paper-csc-for-fep_147096.pdf
Feb 21, 2017
Using mHealth solutions for clinical trials as data-collection tools, can potentially revolutionise clinical research. Wearable devices and mobile health solutions can offer pharmaceutical companies access to additional patient data to provide a more comprehensive overview of safety and efficacy.
According to a new report by IMS Institute for Healthcare Informatics, there are now more than 165,000 mobile health apps on the market.
A report released in 2015 by Rock Health revealed that:
- 4 out of 5 internet connected adults use some kind of digital health technology
- 52% of consumers strongly agree that they are responsible for their own health
- 40% of people who made an online search for health information acted on the results of their search in some way
- 92% of users agree that they should be the one controlling their health data
- 80% of users would share their health data with their care provider to get better care [1]
The use of mHealth solutions for clinical trials is increasing, and according to industry experts, this trend will dominate the market in the coming years. In a recent SCORR Marketing report, 50% of industry experts surveyed say they use mHealth technology in their clinical trials and protocols, and of those 60% consider mHealth very important or critical to their research. [2]
As of August 29th, a search of clinical trials.gov showed 272 studies that mention the use of mHealth and 186 studies that mention a wearable. [2]
People use their mobile phones every day; it is the first and last thing they see when they wake up in the morning and before they go to bed. This is one of the reasons why the use of smartphones and wearables will continue to increase the use of mHealth solutions in clinical trials and pharmaceutical research.
The patient data obtained from mHealth devices, whether it is sensor or self-reported data, will transform the way patients are being diagnosed, monitored, and treated.
Additionally, the costs of conducting clinical trials are high, and mHealth technology has the necessary means to optimise the resources used and maintain lower costs. Mobile health data provides researchers with access to real-time data and visualisations that enable them to spot situations that otherwise would have been at best an indicator when reported through traditional clinical channels.
Additionally, pharmaceutical companies and researchers can immediately identify if a patient has stopped taking their medication or they present any unusual symptoms in real-time, and take action.
By using mHealth solutions, pharmaceutical companies expect to bring patients closer to the research and obtain better enrolment rates, compliance, and retention.
In addition to receiving information from patients, these devices can also be utilised to send information to the patients such as information about their condition and clinical questionnaires.
In the near future, pharmaceutical companies will be able to gather and visualise even more data in real time using mHealth technology, which will potentially shorten timelines, improve patient satisfaction, and increase future recruitment.
Interested in using mHealth technology for your clinical trial? Click here to learn more.
References:
[1] Rock Health: 80 percent of Internet-connected adults use digital health tools. J. Comstock. MobiHealthNews. (2015, October 19)
http://mobihealthnews.com/47675/rock-health-80-percent-of-internet-connected-adults-use-digital-health-tools
[2] MHealth in Clinical Research. Denise, Myshko. Pharma Voice. (2016, October)
http://www.pharmavoice.com/article/2016-10-mhealth/
Oct 25, 2016
The World Innovation Summit for Health (WISH) released a Report on Mental Health and Well-being for children titled “Healthy Young Minds. Transforming the mental health of children.” The information included on this blog post is taken from the report.
The report revealed that half of all mental health problems emerge before individuals reach 18 years old. However, even in developed countries, only 25% receive any specialised treatment. Mental health problems place massive costs on society, since the total cost of mental illness is 3.5 of GDP in Europe. Besides causing direct health care costs, mental illness in youths also causes educational failure, adolescent crime, teenage pregnancy.
Early intervention is fundamental. Parents, doctors and teachers need to become more open and informed, since mental illness is a common part of life. Schools need to prioritise children’s well-being and “life skills” should be added to the teaching curricula alongside mathematics and literature.
It is estimated that 31% of the world’s population is aged under 18, and 10% of them (which is equivalent to 220 million children) suffer from mental illness as it is illustrated in Figure 1.
The costs of mental illness in children are quite considerable. Children with conduct disorder are four times more likely to commit a crime, take drugs, become teenage parents, depend on welfare, and attempt suicide, as it is illustrated in Table 1.
The costs of mental illness in children are quite considerable. Children with conduct disorder are four times more likely to commit a crime, take drugs, become teenage parents, depend on welfare, and attempt suicide, as it is illustrated in Table 1.
The report estimated that in the UK alone, these children may cost in criminal justice, an amount equal to three years’ average wages.
These figures are severe enough by themselves. However, on top of that, at least 50% of the children who experience mental illness during their early years, will suffer from mental illness as an adult. [7] Their lives are more likely to be impoverished and unhappy, and they are much more likely to commit suicide.
The report mentions that these statistics shouldn’t be so high. Nowadays, there are multiple and effective treatments available for children suffering from mental illness. Besides, there is also an enormous opportunity in schools and communities to make significant changes that can reduce the likelihood of the problem in the first place.
Additionally, technology, and mobile health solutions are a huge advantage! Smartphone applications can contribute to monitor and train youths about mental health.
The WISH report encourages local communities and countries to focus on 10 Action Plans to improve the mental health of children around the world.
- Community action: Every local community should implement a child well-being strategy. This plan should include an assessment of the needs of children and families; and the role of healthcare organisations, schools, and non-government organisations.
- Parity of esteem: Mental health care for children and their parents should be widely available.
- Universality: Health professionals should be trained to identify mental health problems in children, perinatal depression in mothers, and they should also be trained to treat these issues.
- Professionals: Countries should train more professionals in evidence-based treatments, especially psychological therapy.
- Well-being in Schools: The well-being of students should be the priority of every school, including the implementation of a Well-being Code of Conduct to which all teachers, parents, and students must adhere to.
- Measurement: Schools should evaluate all student’s well-being on a continuous basis.
- Add life-skills to the teaching curriculum: Schools should use evidence-based methods to provide explicit instruction in life throughout school life, especially in the early years.
- Teacher Training: All teachers should be trained to notice and promote well-being and mental health.
- Use of smartphone technology: Implement a smartphone-based program to promote mental health and well-being of the children.
- The Sustainable development goals: The sustainable development goals should include physical and mental health.
The Monsenso mHealth solution can help facilitate the achievement six of the ten points included in the WISH Action Plan.
- Use of smartphone technology and well-being at schools – The Monsenso smartphone app can help adolescents express any negative feelings they may be experiencing. This information can help care givers identify problems such as depression, anxiety, eating disorders, ADHD or even more severe diagnosis such as bipolar disorder or borderline.
- Measurement – With help from the Monsenso mHealth platform, school personnel can identify if some students present any Triggers or Early Warning signs. Once symptoms are identified in a group of students, care givers can monitor this group closely to ensure they are receiving the support and attention they need.
- Teacher training – The Monsenso web portal is so easy to use that care givers do not require any special training to use the system. However, since they are not trained as mental healthcare specialists, they will need some training to help them interpret the information provided through the self-assessments.
- Parity of esteem – In most countries, there is a lack of resources and the waiting time to schedule an appointment with a mental healthcare specialist can be up to a year. The Monsenso mHealth solution can help school personnel identify the students who are experiencing symptoms of mental illness. Once a student has been monitored for a determined period and the symptoms continue, school personnel can recommend the family to seek professional help.
- Add life-skills to the teaching curriculum – Since all students would be required to fill out the daily self-assessments to evaluate and monitor their mental health well-being, the class dialogue can be facilitated by the information on the system. Teachers can provide students with real, anonymous examples of a person experiencing symptoms. Additionally, students could be encouraged to talk to a school counsellor if they experience any of the symptoms discussed in class. Students could also be taught how to act if they notice any symptoms on their peers.
If you are interested in running a pilot with the Monsenso mHealth solution at your school, please contact us.
Reference:
Healthy Young Minds. Transforming the mental health of children. Report of the WISH Mental Health and Well-being in Children Forum 2015
