Watch Peter Hagelund’s documentary series, ‘Jeg savner min sygdom’ on living with bipolar disorder type 2 here.
Click here to read this story in Danish.
Four years ago, I was diagnosed with bipolar disorder type 2.
For my whole life I had known that something was different about me. I had always struggled with depression and anxiety, and what eventually turned out to be hypomania. When I was 22 I had my first big depression episode and had to start taking anti depressant medications. However, it would take me six more years before I was officially diagnosed with bipolar disorder type 2.
The tricky thing about having the diagnosis of bipolar type 2 is that you are not experiencing the typical manic episode where you are over-energetic and nearly psychotic. Instead, you’re hypomanic, which means that you’re socially well functioning. You’re not psychotic. You actually feel really good. So the problem is that you don’t end up going to your psychiatrist saying that you feel too good. At least I didn’t.
The reason why my psychiatrist found out I was bipolar was because he couldn’t get me out of my depressions. At first, my psychiatrist diagnosed me with depression and ADD. But these diagnoses didn’t fit. When I didn’t have the right diagnosis, I still had my large mood swings, and a lot of anxiety. When I was diagnosed with the ‘right’ diagnosis, of bipolar disorder type 2, it actually felt really nice. A lot of things made sense. Suddenly I could see why I had felt how I had for most of my life.
I really believe that Monsenso could have helped my psychiatrist diagnose my disorder earlier, because the app helps me to keep track of my mood and really helps me to become more aware of how I feel. Due to the app, every single day I have to pause and take a moment to think about how I’ve actually been doing before putting my answers in the app. After doing this, when I go to my psychiatrist we can together see how I’ve actually been. The good thing with the app is that my answer to how I’ve been is not only based on my memory but how I actually answered that day. Logging all of this information has helped my treatment. My psychiatrist and I can better plan how to avoid my future depressive or hypomanic episodes, because we can clearly identify when I am having mood swings.
In August, my documentary about being bipolar aired on national danish television. The reactions have been overwhelming. So many people have messaged me, thanking me for talking about the disease. I had originally made the documentary so that people would not be ashamed about having the disease. I think I have succeed.
My hope for the future is that people will be diagnosed earlier with the disease than me. Of course, that will take a lot of other factors, however I truly believe Monsenso is one of the things that can help. My hope is that other psychiatrists and patients alike will start using the app.
The ROI on mobile health apps is critical to ensure the feasibility and long-term success of digital initiatives implemented by a healthcare institution. On a previous blog post titled “Patient engagement – How important are mHealth tools?” we pointed out the importance for healthcare institutions to embrace mHealth technology if they want to meet consumers’ requirements.
A recent survey revealed that:
- 80% of internet connected adults use some form of digital health technology
- 52% of consumers strongly agree 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 
Furthermore, a report from a Swedish market research firm forecasts that by 2021, there will be 50.2 million patients monitored remotely, of which 22.9 million will be monitored remotely using their own smartphone. 
By boasting the consumers’ use of certified, clinically and technically validated mobile health apps, organisations could potentially have huge cost-savings in four particular areas.
- Addressing chronic illnesses: providing mobile health apps to people with chronic diseases such as heart disease, diabetes, and mental illness, can be a great way continuously monitor the symptoms and spot any relapses.
- Avoiding non-urgent use of the ER: the use of mobile health apps enable continuous monitoring and early Therefore the trips to the emergency rooms can be prevented by scheduling preventive consultations based on the data collected by the health app
- Reducing preventable readmissions: A study conducted by the Mayo Clinic showed that there was a 40% decrease in readmission for patients with heart disease who used a specific health app. The RADMIS research project, which is being conducted in Denmark using the Monsenso mhealth solution, aims to reduce hospital readmissions of psychiatric patients by 50%
- Improving prescription adherence: A review in the Annals of Internal Medicine estimates that a lack of medication adherence causes nearly 125,000 deaths, 10% of hospitalisations and costs the US economy between $100 to $289 billion per year . Mobile health apps can be used to help improve adherence rates.
As more healthcare institutions embrace mHealth initiatives, it is important to take into consideration certain aspects to secure an optimal return on investment and ensure long-term success.
Prioritise strategically and secure C-suite support:
Aligning mobile health initiatives with an organisation’s business goals helps achieve ROI on mHealth solutions and better outcomes in the long run, and it also helps obtain the support of the organisation’s decision-makers. When an organisation’s mHealth initiatives are aligned with the overall strategy, this will also contribute to ensuring that the technology is rolled out on a large scale, instead of being implemented as small independent projects with a limited impact.
Furthermore, when selecting and implementing an mHealth initiative, it is critical to involve both employees (because they will be using the system daily) and management, since it is up to the latter to ensure all employees understand the process involved in the roll-out, allocate budget and/or time for special training, and make the necessary changes to the organisational processes.
Healthcare institutions that take a strategic approach by scaling internal resources across their organisations are more likely to make use of the transformational aspects of the technology. Instead of limiting mobile projects to a particular department, mobile health initiatives should be integrated throughout the entire organisation and become embraced as part of the organisation’s culture.
Utilise a mix of customised and off-the-shelf solutions:
Recognising when to select customised solutions and when to opt for existing mobile health solutions will help an organisation operate strategically and focus on business transformation.
According to a study by the IBM Institute for Business Value “More than 1,000 C-suite and mobile executives globally found that 62% of executives surveyed said their most successful mobile projects pay for themselves in less than 12 months – a considerably faster rate than the two-to-three years it takes for other technology projects. ”
 Rock Health: 80 percent of internet-connected adults use digital health tools. J. Comstock. MobiHealthNews. (2015, October 19)
 MHealth and Home Monitoring. Berg Insight. 2015.
 The cost of medication non-adherence. NACD. (2017, April 20)
 IBM Study: Four Ways to Achieve Maximum ROI in Enterprise Mobility. IBM News. (2017, April 22)
The advantages of online therapy are several, from closing the gap between a shortage of qualified mental health professionals in an area, to reaching out people who live in rural areas, far away from a clinic. Additionally, online therapy can also reach people who have very busy schedules and can’t spare the commute, or those are not too comfortable with face to face appointments.
That being said, online therapy increases the opportunity to reach out to people that you wouldn’t be able to reach otherwise.
More personalised treatment
Telehealth and mHealth solutions are a tools that can be used to personalise the treatment of individuals with a mental illness. Based on the individual, you can select the tools and features a person could find useful, such as pushing clinical questionnaires on their smartphones, answering electronic self-assessments, accesing psychoeducation, scheduling video sessions or teaching them self-care.
Furthermore, since the use of eHealth itself can help individuals to access psycho-education online, this means more time spent on face-to-face or online sessions.
Mental health professionals offer their patients therapy and counselling, however, without the person’s motivation to get better and hard work therapy may not be enough. Digital tools are designed to keep individuals motivated and have a more active role in their treatment, which tends to produce better results.
Nevertheless, digital tools are not only about motivating, they also help with patient empowerment since they track a person’s behaviour over time, so they can take credit for their progress over time.
Therapists offer the best therapy and guidance they can, unfortunately they cannot always be there to help; therefore, individuals need to learn to face their problems alone. By providing these individuals with an mHealth solution, they have access to valuable information that can be useful if their symptoms appear, and write down any comments on how they felt, so clinicians and individuals can review the situation together.
Helps people who otherwise wouldn’t receive any treatment
Many people who need mental health treatment have to wait endlessly to get an appointment, if they manage to get any treatment at all, however, the demand for mental health services is on the rise.
This problem cannot be easily solved, and even though online psychoeducation, smartphone-based Cognitive Behavioural Therapy (CBT), or smartphone-based Dialectical Behavioural Therapy (DBT) may not be as efficient as therapy with a mental health specialist, it might be a great alternative for individuals to get started on a self-care plan while they meet with a specialist, and for some people, this may even be the only alternative.
As Dr. Margaret Chan, Director-General of the World Health Organization, recently said “We must find ways to make sure that access to mental health services becomes a reality for all men, women and children, wherever they live.”
The top cause of insurance claims is mental illness. According to a new study conducted in the UK, two-thirds of British adults said they have experienced mental ill-health at some point in their lives. The survey revealed that on average 70% of people between the ages of 18 and 54 have experienced a mental health problem. In all, 65% of all the people surveyed, said they had experienced some form of mental health problem. 
Britain’s high stress, long-hours work culture has led to a higher level of people out of work with mental health problems than any other country in the developed world. 
Furthermore, a different study has shown that approximately 53% of NHS patients displayed clinical symptoms of depression and anxiety within a year after completing psychological treatments. Over half of these were found to have suffered a relapse event, with up to 79% of events occurring within the first six months after treatment.
The economic cost
According to an OECD report, people unable to work because of mental health issues cost the UK economy £70 billion each year with 40% of all people claiming disability benefits is due to psychological issues.
Top cause of insurance claims
The top cause of insurance claims are mental health issues, which have remained at the top of the list since 1999, far above other claims such as back injury or stroke.
According to an analysis by the Institute for Fiscal Studies, nearly half of all people claiming disability benefit are doing so because they have a mental illness rather than a physical condition. 
The analysis reveals that the proportion of disability claims which are related to mental illness has risen from 27 per cent to 41 per cent since 1999. 
In fact, six in ten claims by those aged between 25 and 34 are now related to mental illness, up from half in 1999. 
In a recent interview, Vanessa Sallows, Benefits and Governance Director at Legal & General’s Group Protection, said: “Mental health continues to be the main reason for absences on our group income protection. 
mHealth technology is here to help
Smartphones and wearables
In the UK alone, there are over 40 million smartphone users over 3 million people utilise some type of wearable device.
Mobile health technology
mHealth technology uses connected devices to help prevent illness, improve compliance and get people back to health.
mHealth technology puts customers at the centre, where they want to be, and helps them to live the lives they want.
The Monsenso mHealth solution for mental health can be used by insurance companies to offer a preventive, mental wellness programme.
Policyholders can use the Monsenso smartphone app to enter their daily levels of stress, anxiety, irritability, physical activity and number of hours they slept. This information is gathered and stored electronically so it can be accessed by a coach or telehealth consultant, anytime, anywhere.
In this way, the coach or telehealth consultant can remotely monitor policyholders and follow up with those users who present any triggers or warning signs. For example, the the coach or telehealth consultant will be notified when a policyholder indicates a high level of stress, anxiety and irritability for more than five consecutive days or when someone sleeps less than six hours for more than three consecutive days. These two actions would be considered indicators that the individual needs to be contacted for a “wellness check” and implement the necessary measures to prevent the person from going on long-term leave, or become affected by other physical conditions such as heart disease.
 Two-thirds of Britons have had mental health problems. The Guardian. Haroon Siddiqi. (2017, May 8)
 British workers among the most stressed in the world. The Telegraph. Georgia Graham. (2014, Feb 14)
 More than half of NHS patients display symptoms of relapse after depression treatments, study finds. News Medical Life Science. (2017 May 3)
 Legal & General group protection payouts rise. FT Adviser. Simoney Kyriakou. (2017, May 2).
 Nearly half disability benefit claimants have a mental illness. The Telegraph. (2015, May 21)
According to a recent statement by the new American Heart Association (AHA), major depressive disorder and bipolar disorder should be recognized as moderate risk factors for atherosclerosis and early cardiovascular disease. 
In 2011, the National Heart, Lung and Blood Institute identified four conditions (chronic inflammatory disease, human immunodeficiency virus, Kawasaki disease, and nephritic syndrome) that lead youths to a mild risk of developing cardiovascular disease before they reach 30. 
The statement released a few days ago, reveals that depression and bipolar disorder meet the same criteria as these conditions. Moreover, these two behavioural disorders are more widespread than the previous mentioned conditions combined.
These studies showed evidence of a link between paediatric depression and bipolar disorder with premature cardiovascular mortality. Cardiovascular risk factors for these teens include obesity, insulin resistance and diabetes, dyslipidemia, and hypertension. According to the statement, depression and bipolar disorder are the first- and fourth-most disabling conditions, among adolescents worldwide.
After the report had been unveiled, researchers from schools around the U.S. and Canada looked at existing studies on mood disorders in people under the age of 30. Researchers looked specifically into youths suffering from depression or bipolar disorder with cardiovascular markers such as high pressure and cholesterol. They found a significant connection between having depression or bipolar disorder and increased odds of high blood pressure, high cholesterol, obesity (especially belly fat), type 2 diabetes, and hardening of the arteries. 
This discovery denotes that healthcare providers should track physical activity levels and food intake as well as metabolic monitoring is crucial for these young patients as a preventive measure.
However, to monitor cardiovascular markers, physical activity and food intake, of thousands of young patients who also suffer from mental illness is not an easy task. Although, there are hundreds of smartphone applications tracking physical activity and counting calories, these apps are personal, and clinicians do not have access to an individual’s data. Nevertheless, with the Monsenso mobile health (mHealth) solution, this cumbersome task becomes easy and achievable.
The Monsenso mHealth solution enables clinicians to access a patient’s data on a daily basis. Every day, youths would be reminded to fill in a self-assessment with important information that could include the number of hours they slept, the amount of unhealthy food they have eaten, and if they realized any physical activity throughout their day. Additionally, the smartphone can also collect physical activity and mobility data, based on the smartphone’s inbuilt accelerometer and GPS locator.
The Monsenso mHealth solution, especially designed to monitor behavioural data of patients suffering from mental illness, can in this way help clinicians monitor any unhealthy habits of patients with risk of developing cardiovascular disease.
Further, with the customisable action plans, each youth could follow “contingency plans” if they experience some symptoms related to their mental illness or if they have engaged in unhealthy activities. For example, a special trigger could set up if a youth has indulged in unhealthy food for several days in a row, or has had a low level of physical activity. The action plan listed for this trigger could then encourage individuals to engage in physical activities and and to try to avoid sugar and fat during the upcoming week.
 Browser,D Medscape. Depression, Bipolar Disorder in Teens are CVD Risk Factors: AHA (2015, August 10) http://www.medscape.com/viewarticle/849312
 American Heart Association. Young people with mood disorders have increased risk of developing early cardiovascular disease (2015, August 11)
 Walton, A Forbes. Teens with depression, bipolar disorder, should be screened for heart disease, experts say. (2015, August 11) http://www.forbes.com/sites/alicegwalton/2015/08/11/depressed-teens-may-be-at-higher-risk-for-heart-disease/
Goldstein BI, Carnethon MR, Matthews KA, et al. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease. Circulation 2015.
The World Innovation Summit for Health (WISH) recently released a Report on Mental Health and Well-being for children titled “Healthy Young Minds. Transforming the mental health of children.”
This infographic represents some of the facts displayed in the report.