Jan 10, 2017
According to an article published on Harvard Business Review, digital health tools have the potential to provide effective, low-cost ways to prevent and treat chronic illnesses. The article states that these technology-based solutions that have a clinical impact on disease are comparable to the effectiveness of a drug, and they use consumer-grade technology such as mobile devices and big data analytics that can be deployed in real-time and at scale, which is critical for the management of chronic diseases.
From the chronic diseases, mental illnesses account for five of the ten leading causes of disability worldwide [1]. Therefore, prevention as well as the the early identification and treatment of mental illness represents a high priority since it promotes recovery, independence, self-sufficiency, as well as facilitating social activities and employment opportunities [2].
In fact, in the UK alone, depression and anxiety accounted for 11.7 million lost working days last year [3]. Moreover, according to the American Medical Association, stress accounts for 60% of all human illness and disease [4], which means that clinically-tested health apps can help government authorities, corporations and insurance companies reduce their costs by monitoring individuals remotely and intervening at an early stage.
Nowadays, the majority of large employers that offer health benefits also offer a wellness programme in an effort to promote employee health and productivity as well as to reduce health-related costs.
We live in an era where certified and clinically-tested health apps, or mobile health solutions (as they are widely known), are readily available, or are being developed for most chronic diseases.
Most of these digital tools are extremely easy to use, and can be obtained by downloading an application from iOS or Google Play, signing-up, and sharing your information with a coach. The clear advantages of this technology are scalability and low-cost, since an effective health app bundled up with a telehealth can provide affordable support to either 50 or 5 million users.
The Monsenso mHealth solution can be used by insurance companies and large corporations to reduce costs by offering a preventive mental wellness programme. Individuals 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 healthcare professional anytime, anywhere. However, the coach only needs to take action when the web portal indicates that certain individuals present any triggers or warning signs. For example, the coach will be notified when anyone in the system 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 stress-leave or from becoming affected by other physical conditions such as heart disease.
References:
[1] Prevention of Mental Disorders. Effective Interventions and policy options. World Health Organisation in collaboration with the Prevention Research Centre of the Universities of Nimegen and Maastricht. http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf
[2] Early intervention and recovery for young people with early psychosis: consensus statement. J. Bertolote and P. McGorry. British Journal of Psychiatry (2005). http://bjp.rcpsych.org/content/bjprcpsych/187/48/s116.full.pdf
[3] Stress in the City: ‘At first, I thought my depression was a heart attack’. The Telegraph. Peter Stanford. (2017, January 7)
http://www.telegraph.co.uk/men/health/stress-city-first-thought-depression-heart-attack/
[4] How Stress Affects the Body (INFOGRAPHIC). Huffington Post. (2013, January 10)
http://www.huffingtonpost.com/heartmath-llc/how-stress-affects-the-body_b_2422522.html
Simple Digital Technologies Can Reduce Health Care Costs. Harvard Business Review. Alexander L. Fogel, Joseph C. Kvedar. (2016, November 14).
https://hbr.org/2016/11/simple-digital-technologies-can-reduce-health-care-costs
Nov 1, 2016
Smartphones can be used as data-collection tools for mental health. In fact, this blog post is a summary of a research paper titled “Mobile phones as medical devices in mental disorder treatment.” To download the research paper, visit our Resource Library.
One in four Europeans have suffered from at least one mental disorder during their lifetime [2]. In the USA 26.2% of the population, 60 million people, suffer from at least one form of mental disorder [3]. Mental disorders can have a significant, negative impact on sufferers’ lives, as well as on their friends and family. More than 90% of people who commit suicide have a diagnosable mental disorder [4].
Currently, the monitoring of mental disorders relies mainly on self-reporting, developed more than 50 years ago. Hence, the researchers reviewed different systems that utilise mobile phones as data-collection tools for mental health. They evaluated how their core design features and dimensions can be applied in other systems and they looked into the feasibility of using mobile phones to collect data including voice data, motion and location information.
Smartphones as data-collection tools for mental health
From a technology point of view, mobile phones offer a promising hardware platform for various applications. In developed countries almost everybody owns a mobile phone; world-wide this adds up to 4.5 billion users [5].
Smartphones are accounted for 51.8% of mobile phone sales in 2013 worldwide [6]. As of 2014, one third of the currently world-wide used mobile phones are already smartphones [5]. Their cost has dropped dramatically and functionality continues to expand.
Smartphones are also a powerful technical platform. They are powerful in terms of CPU, memory, and battery. They also have extensive communication capabilities with their built-in network interfaces for 3G/4G, Wi-Fi, and Bluetooth; and they are equipped with sensors including accelerometers, GPS, microphone, proximity sensors, etc.
A smartphone is personal and is almost always with a person [7]. This is especially useful when collecting automated data, since the smartphone acts as a wearable device located in the user’s pocket.
Moreover, studies have shown that the quality of the data collected through smartphone-based questionnaires is much higher in comparison to paper-based self-assessments [8]. Paper-based self-assessment requires that patients remember to carry them with them and fill them out, resulting in poor adherence rates, retrospective completion, and memory errors [9]. In contrast, adherence and compliance rates are significantly improved when patients their smartphone since it is always available [8].
Using smartphones for mental health
Many mental disorders are treated through a combination of pharmacotherapy and psychological treatment, such as Cognitive Behavioural Therapy (CBT). The objective of the treatment is to reduce symptoms by ingesting medication and to help patients identify and change their behaviour in a healthy manner.
A smartphone-based solution can provide real-time feedback, it allows individuals to observe their behavioural and disease patterns, and it can also be used as a reminder for medication intake. Moreover, besides having the capability to being used as sensor devices and communication tools. Therefore, remote consultations become feasible; for example, clinicians can communicate with individuals and schedule teleconsultations if needed.
Further, studies have shown that patient adherence rates for smartphone interventions are high. McTavish et al. introduced a smartphone application to support patients with alcohol addiction. 16 weeks after downloading the app, more than 70% of the initial group were still actively using it [10]. Kuhn et al. surveyed perceived helpfulness and satisfaction of post-traumatic stress disorder patients who used a smartphone application as self-management tool for their mental disorder [11]. The results presented were promising but only preliminary.
A recent project called MONARCA focused on bipolar disorder patients and used smartphone sensors as well as additional wearable sensors [12]. The analysis of acceleration data collected with smartphones revealed a correlation between physical activity levels and psychiatric assessment of degree of depression [13].
References:
[1] F.Gravenhorst, A. Muaremi, J. Bardram, A. Grunerbl, O. Mayora, G. Wurzer, M. Frost, V. Osmani, B.Arnrich, P. Lukowicz, G. Troster. Mobile phones as medical devices in mental disorder treatment. 2015.
[2] J. Alonso, M. C. Angermeyer, S. Bernert, R. Bruffaerts,T. Brugha, H. Bryson, G. d. Girolamo, R. d. Graaf, K. Demyttenaere, I. Gasquet, et al. Prevalence of mental disorders in europe: results from the european study of the epidemiology of mental disorders (esemed) project. Acta Psychiatrica Scandinavica, 109(s420):21{27, 2004.
[3] R. C. Kessler, W. T. Chiu, O. Demler, and E. E. Walters. Prevalence, severity, and comorbidity of 12-month dsm-iv disorders in the national comorbidity survey replication. Archives of general psychiatry, 62(6):617{627, 2005.
[4] Y. Conwell and D. Brent. Suicide and aging i: patterns of psychiatric diagnosis. International psychogeriatrics, 7(02):149{164, 1995.
[5] Ericsson AB. Interim ericsson mobility report. February 2014. http://www.ericsson.com/ericsson-mobility-report/.
[6] Gartner. Market share analysis: Mobile phones, worldwide, 2q13, 2013.
[7] A. K. Dey, K. Wac, D. Ferreira, K. Tassini, J.-H. Hong, and J. Ramos. Getting closer: an empirical investigation of the proximity of user to their smart phones. In Proceedings of the ACM International Conference on Ubiquitous computing, UbiComp ’11, pages 163{172, New York, NY, USA, 2011. ACM.
[8] J. E. Bardram, M. Frost, K. Szanto, M. Faurholt-Jepsen, M. Vinberg, and L. V. Kessing. Designing mobile health technology for bipolar disorder: a eld trial of the monarca system. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’13, pages 2627{2636, New York, NY, USA, 2013. ACM.
[9] A. A. Stone, S. Shiman, J. E. Schwartz, J. E. Broderick, and M. R. Huord. Patient non-compliance with paper diaries. BMJ, 324(7347):1193{1194, 5 2002.
[10] F. M. McTavish, M.-Y. Chih, D. Shah, and D. H. Gustafson. How patients recovering from alcoholism use a smartphone intervention. Journal of dual diagnosis, 8(4):294{304, 2012.
[11] E. Kuhn, C. Greene, J. Homan, T. Nguyen, L. Wald, J. Schmidt, K. M. Ramsey, and J. Ruzek. Preliminary evaluation of ptsd coach, a smartphone app for posttraumatic stress symptoms. Military medicine, 179(1):12{18, 2014.
[12] A. Puiatti, S. Mudda, S. Giordano, and O. Mayora. Smartphone-centred wearable sensors network for monitoring patients with bipolar disorder. In Engineering in Medicine and Biology Society, EMBC, 2011 Annual International Conference of the IEEE, pages 3644{3647. IEEE, 2011.
[13] V. Osmani, A. Maxhuni, A. Grunerbl, P. Lukowicz, C. Haring, and O. Mayora. Monitoring activity of patients with bipolar disorder using smart phones. In ACM Proceedings of International Conference on Advances in Mobile Computing and Multimedia (MoMM2013), DOI:10.1145/2536853.2536882, Vienna, Austria, December 2013.
Sep 14, 2016
Approximately 450 million people worldwide suffer from mental disorders. One fifth of teenagers under the age of 18 suffer from developmental, emotional or behavioural problems, and one in eight have a mental disorder. Five of the ten leading causes of disability worldwide are psychiatric conditions, including depression, alcohol abuse, schizophrenia, and obsessive compulsive disorder. [1]
The Institute of Medicine Report has proposed a framework of mental health intervention for mental illness based on the classification and the public health distinctions between primary, secondary and tertiary prevention. [1]
Primary prevention focuses on promoting mental well-being, and decreasing adverse conditions such as child abuse, violence, discrimination, poverty, and lack of education to the general population. It also seeks to target individuals or subgroups of the population whose risk of developing a mental illness is higher due to biological, psychological or social risk factors.
Secondary prevention seeks to reduce the symptoms and decrease the number of episodes through early detection and treatment. [1]
Tertiary prevention includes interventions that reduce disability, enhance rehabilitation, and prevent relapses and recurrences of the illness. [1]
A Dutch study found a 50% reduction in the incidence of major depression among mildly depressed primary care patients who received a stepped-care intervention, compared with the incidence among primary care patients who received treatment as usual. Other studies showed that low-dose antidepressants or problem-solving therapy helped reduce the incidence of major and minor depression in post-stroke patients. [2]
Preventive measures such as mental health promotion and early intervention are the most cost-effective way to tackle mental illness on a global scale. Research reveals that common mental disorders such as depression and anxiety can be prevented. For instance, Cognitive Behavioural Therapy (CBT) has proven to be useful for people who already have mild depressive symptoms.
During the last few years, technology has crossed a new frontier in mental health support and data collection. Mobile health (mHealth technology) provides doctors, researchers and the general population with new ways to monitor a patient’s progress, access self-help tools, and increase understanding of mental wellbeing.
Mobile mental health support can be very simple but effective. For example, the Monsenso mHealth solution which consists of a smartphone app for patients and carers and web portal for clinicians uses self-reported data and the device’s built-in sensors to collect patient information. Based on the self-reported data, the Monsenso smartphone app identifies any triggers or warning signs, and it notifies patients and clinicians that help is needed before a crisis occurs. The Monsenso smartphone app also provides users with self-help tools that are always available in case of an emergency.
Although there are many mental health apps available on both the iTunes and Android app stores, this new technology includes a lot of uncertainty. There isn’t enough information on the quality, security and effectiveness of the different apps available, which can confuse clinicians and users.
The advantages of mental health apps
Experts believe that technology has a lot of potential for users and clinicians. A few of the benefits of mobile care include:
- Convenience:Treatment can take place anytime and anywhere (e.g. at home in the middle of the night or on a bus on the way to work) and may be ideal for those who have trouble with in-person appointments.
- Anonymity:Clients can seek treatment options without involving other people.
- An introduction to care: Technology may be a good first step for those who have avoided mental health care in the past.
- Lower cost: Some apps are free or cost less than traditional care.
- Service to more people: Technology can help mental health providers offer treatment to people in remote areas or to many people in times of sudden need (for example following a natural disaster or terror attack).
- Interest: Some technologies might be more appealing than traditional treatment methods, which may encourage clients to continue therapy.
- 24-hour monitoring: Technology can provide round-the-clock monitoring and self-help tools or interventions.
- Consistency: Technology can offer the same treatment plan to all users.
- Support: Technology can complement traditional therapy by extending an in-person session, reinforcing new skills, and providing support and monitoring. [3]
Trends in smartphone apps for mental health
- Self-management apps
Users enter self-reported data into the app so it can provide feedback. For example, medication reminders, stress-coping strategies or sleep problems. Some apps can also track sensor data and may help users monitor their progress and receive feedback.
- Apps to improve thinking skills and skills training
Apps that help users with improved thinking skills (cognitive remediation) and learn new coping or thinking skills. For example, they provide educational videos about anxiety management or the importance of social support. Additionally, users might pick up some new skills and use the app to practice those skills. This type of app may feel a little bit like a game, and often target people with severe mental illness.
- Supported care
This type of app allows users to interact with a trained health care provider or a peer support group who can offer guidance in case of an emergency.
- Monitoring and data collection
This type of mental health app can collect two types of data. On one hand, it gathers data using the sensors built into smartphones such as movement patterns, social interactions, behaviour at different times of the day, speech patterns and more. On the other hand, it collects self-reported data in the form of a mood diary or electronic questionnaire.
Although mental health apps may not replace mental health professionals, they allow clinicians to provide better support to more people regardless of their geographical location.
References:
[1] Prevention of mental disorders. Effective interventions and policy options. World Health Organisation. http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf
[2] The future looks promising for mental health prevention. Psychiatric News. Joan Arehart-Treichel. 2013 (January 18). http://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2013.10b1
[3] Technology and the future of mental health treatment. National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/technology-and-the-future-of-mental-health-treatment/index.shtml
Aug 23, 2016
This blog post was written by Anne Zieger, CEO at Zieger Healthcare Communications. It was originally published in the Zieger Healthcare Blog and it is © published with the permission of Zieger Healthcare.
Like many Americans, I have a family member with a major mental illness who sometimes needs inpatient hospital care. Because I have been a healthcare researcher and journalist for 25 years, I’m particularly well prepared to help him navigate the system and get him the attention he deserves.
But there’s one issue which crops up again and again, and despite decades of trying I haven’t been able to find any kind of remedy. And as far as I can tell, this policy — which is universal in my region — actually encourages the delivery of substandard care.
As many people are aware, there’s far too few inpatient mental health beds in many regions of the country. My sense is that the problem may be a bit less acute where I live, in metro DC, as my relative can generally find inpatient care when he needs it. But which bed in which hospital? That’s another story.
Like any other service, inpatient mental health treatment can vary substantially from one institution to another. And as a member of a family support group for mental health problems, I get lots of feedback on which psych units are well-staffed, clean, efficient, thorough, kind to patients and good with discharge planning. (Of course, I also have my relative’s feedback and my own impressions to refer to as well.)
However, area hospitals with psych units absolutely, categorically refuse to tell patients or their families whether a bed is available. Yes, they will typically tell a psychiatrist with admitting privileges whether they can take additional patients, but for reasons which are not clear to me, a shrinking number of psychiatrists choose to obtain such privileges. In fact, in many years of trying, my relative hasn’t found a single one who does do direct admissions.
So here’s what happens. Our family realizes that he needs help, so one of us takes him to a hospital where he feels comfortable and safe. That hospital puts him through several hours of “medical clearance,” and only then do they let us know that there are no open beds there. Then they try to convince us to take whatever bed is available anywhere they can find.
In the most recent case, they pressured us to send him to Hospital X, an underfunded, poorly-rated facility which I’d dearly love to see decertified and closed. Since his episode seemed to be tailing off, we decided to take him home and bring him to another good facility the next day, which we did, successfully. But given the coercive nature of the original facility’s approach, it took all of the strength we could muster to do so.
I am certainly aware that with the limited availability of psych beds, every hospital will turn patients away at times. But if the hospitals let patients and/or family members know whether there was even a chance of admission, patients could make informed choices. They could also choose between their preferred hospitals, rather than being side-tracked into those that did not deserve their patronage.
My guess is that such hospitals, whose psych units are often unprofitable, are colluding to make sure that the more effective, humane and resource-rich psych units don’t get all of the traffic. After all, if patients don’t know which units can serve them, it’s easier for facilities to ricochet them across the region and give some of the inpatient days to whichever player is next in line.
But even if there’s no conspiracy involved, the policy of keeping patients out of the loop is unconscionable nonetheless. If patients end up wherever they’re sent, hospitals have no incentive to offer improved services. And that just about defines “anti-competitive.” I dearly hope someone calls these hospitals to account someday.
To view the original blog post click on this link: http://www.ziegerhealthcare.com/2016/08/21/hospital-policies-make-it-tougher-to-get-high-quality-inpatient-mental-health-treatment344/
Aug 18, 2016
mHealth technology is a cost-efficient solution for insurance companies. Technology start-ups are disrupting many existing business models, including the insurance industry. Most of the current trends in the insurance industry have technology as a driver.
By 2020, the global Internet of Things market is expected to reach 1.7 trillion USD, and the number of connected devices is expected to reach 29.5 billion. Due to the low cost of sensors, improved communication methods, and increased data processing power, mHealth solutions are now becoming a cost-efficient solution for insurance companies, therefore, insurers are increasingly leveraging the Internet of Things for various purposes, including identification of customers’ needs and risks.
Mobile health (mHealth) technology and Big Data are also expected to have a significant impact on the insurance industry on both insurers and customers. The most common uses of mHealth technology are: to prevent illnesses, to monitor patients remotely, to support treatment and to serve as self-help tools. Insurers are focusing on mHealth apps to monitor and improve the health of their customers, and to reduce their healthcare spending.
Some of the key determinants of a person’s health include lifestyle, environment, and hereditary traits. Therefore, the data obtained from mHealth apps can be used as a cost-efficient solution for insurance companies that helps them to understand a customer’s risk profile. For example, with all the information collected by a person’s smartphone, insurance companies can predict how likely that person is to be affected by an illness and implement a preventive action.
MHealth technology can help reduce administrative costs of health insurers since all the customers’ data is readily available, which makes policy renewals easier. Besides, insurance companies can also use this data to cross-sell insurance policies to their existing clients.
Since the cost of healthcare is on the rise, insurance companies need to adopt new methods to reduce this, and mHealth solutions allow customers to maintain a healthier lifestyle with lower spending.
Until now, patient adherence to medication has been a big challenge in the healthcare industry. For conditions such as depression, the adherence rate is as low as 50%. This non-adherence increases the healthcare spending of customers.
However, mHealth apps, such such as the Monsenso mHealth solution for mental illness, can help reduce the healthcare spend. These smartphone apps can remind customers to take their daily medication, reinforce the need to follow a medication schedule, educate patients about their illness, and inform patients of the consequences of not taking their medication.
If you want to know more about how can the Monsenso mHealth solution for mental health can help your insurance company save costs, click here.
Reference:
Top 10 Trends in Insurance in 2016. Capgemini Insurance. 2016
https://www.capgemini.com/resources/insurance-top-10-trends-2016
Aug 9, 2016
Using apps for mental health was written by Ross Campbell, Chief Underwriter of Research & Development based in Gen Re London.
It was originally published on the Gen Re blog and it is © published with the permission of General Reinsurance AG 2016.
Improved awareness and recognition of mental health problems and their complexity puts pressure on health systems to increase care. This stimulates exploration of the potential value of software applications (apps) run on mobile devices. The ubiquity of smartphones makes them an ideal tool for apps that can help individuals manage mental health.
Apps create long-term patient health data in a way that episodic clinic consultations cannot. They generate a personal health record fundamentally different from a clinical patient record [1]. Doctors have much to gain from the comprehensive and detailed information gathered by this form of continuous monitoring. Insurers can also benefit from the potential of this technology, especially for claims.
Apps for mental health can monitor physiological cues associated with sleep disturbance, anxiety, depression, phobias and psychosis. For example, depression is associated with a fall in activity levels – less exercise, movement and fewer social interactions. Sensors in smartphones can help spot patterns of altered behaviour that may represent the early warning signs of lowered mood.
Some apps for mental health can even help diagnose problems. Others help people track and manage mood using self-assessment techniques augmented by coaching functionality. Online environments are a gateway to support from more specialist clinical resources. The resources allow patients more control of their mental health management while enabling clinicians to monitor and support them remotely.
Some other apps for mental health can also help with treatment by sending reminders about medication or appointments, regardless of the person’s location. And they can provide distraction from cravings or link with social networks at times of stress. This “nudging” is effective at altering behaviour; for example, integrating text messaging in smoking cessation programmes improved six-month cessation rates by 71% compared to the regular treatment [2].
However, work remains to be done before apps can integrate with insurer’s processes. The confidentiality and use of personal data generated and stored by apps is complicated and needs clarification. The accuracy and sufficiency of information is a potential concern while hardware constraints may limit potential. More evaluation of the impact of digital technology is needed in research and clinical practice. [3]
Meanwhile, insurers could engage with emerging providers of software solutions. Services like these will, over a relatively short time horizon, become highly influential in the lives of people living with mental health problems. Pilot schemes that compare current insurance methods while evaluating new ones would take us one big step forward.
Click on the links to learn more about the Monsenso mHealth solution mental health consisting on a smartphone app for individuals, carers and a web portal for clinicians.
To view the original post click on this link: http://www.genre.com/knowledge/blog/can-apps-set-the-mood-for-managing-mental-health-en.html
- Marley, J. and Farooq, S., (2015) Mobile telephone apps in mental health practice: uses, opportunities and challenges, The British Journal of Psychiatry (2015), 39, 288-290, doi: 10.1192/pb.bp.114.050005.
- Whittaker, R. et al Mobile phone based interventions for smoking cessation. Chochran Database Systematic Review. 2012;11. CD006611. Doi:10.1002/14651858.CD006611.pub3.
- Hayes, JF., Maughan, DL., Grant-Peterkin, H. (2016) Promotion of mental health and prevention of mental disorder in the digital age, The British Journal of Psychiatry (2016) 208, 205–207. doi: 10.1192/bjp.bp.114.161067.
