Mental illness, why bother if all goes well? Because the day it hits you or your loved ones, you may be faced with the harsh reality of “Mental Health in an unequal world”. Close to 1 billion people globally are living with a mental disorder. Yet, countries spend on avg. 2% of their national health budgets on mental health leaving a disproportionate gap between demand for mental health services and supply. Each year, October 10th marks the “World Mental Health Day”. This year the theme is “Mental Health in an Unequal World”.
Originally chosen by the World Federation for Mental Health, the theme Mental Health in an Unequal World” refers to the inequality in access to health services in low- and middle-income countries, where between 75% and 95% of patients with mental disorders have no access to mental health services at all. Despite the universal nature and the magnitude of mental illness, the gap between demand for mental health services and supply remains substantial.
The global pandemic along with the climate crisis and social disarrangement lead the world to a difficult place. To date, the pandemic is impacting people of all ages and backgrounds: Illness, economic impact, job insecurity, and most importantly, physical distancing leading to social isolation and millions of people facing mental health issues.
Close to one billion people have a mental disorder and anyone can be affected.
Depression is a leading cause of disability worldwide and a major contributor to the global burden of disease. Globally, an estimated 5% of adults suffer from depression.
Globally, one in seven 10-19-year-olds suffers from a mental disorder. Half of all such disorders begin by the age of 14, but most go undiagnosed and untreated.
People with severe mental disorders like schizophrenia typically die 10-20 years earlier than the general population.
One in 100 deaths is by suicide. It is the fourth leading cause of death among young people aged 15-29.
The COVID -19 pandemic has had a significant impact on people’s mental health.
The World Federation for Mental Health also addresses the disparity between mental health investment and overall health. On average, countries spend only 2% of their national health budgets on mental health. This has changed little in recent years. Despite the scale of mental illness, the gap between demand for mental health services and supply remains substantial. Unaddressed mental health issues are now a leading global cause of disability and suffering. Yet only 10% receive “adequate” treatment – 75% receive no treatment at all.
The limited global availability of effective mental health treatments and a lack of objective measures of response to treatment, are some of the barriers in advancing patient outcomes. To reduce burden, it is critical to diagnose and monitor mood disorders using widely accessible, less costly, and scalable methods, which can enable a higher degree of specificity in mental health diagnoses and timely detection of clinical deterioration.
Building on the widespread adoption of smartphones, mobile health (mhealth) has gained significant interest as a means for capturing continuous, objectively observable and measurable data of patients’ behaviour and mental state. The data collected on smartphones and sensors represent a new approach aimed at measuring human behaviour and mental health, and thus an opportunity of detecting, assessing, and monitoring psychiatric disorders in a less costly and less burdensome way for the clinician.
The data collected on the smartphone are also referred to as digital biomarkers. These can be collected both passively through inbuilt sensors on the smartphone (physical activity and geolocation, social activity, text messages usage, phone usage, voice and speech pattern or wearables (sleep and activity), and actively via user engagement through self-monitored data/self-assessment data (mood, sleep, stress, medicine adherence).
By collecting this data between physician visits, clinicians can see fluctuations in patients’ mental states, providing a more holistic representation of the patient’s functioning over time. The data hereby offer the opportunity for clinicians to predict relevant outcomes in mood disorders and can thus serve as a tool of triage enabling to provide timely and preventative support to the individuals in critical need.
This approach, also known as digital-enabled psychiatry, has gained considerable interest and been extensively researched over the past decade to offer more people access to high-quality health and social care.
To learn more, visit our Research section here or watch a video on the opportunity of digital-enabled psychiatry from the Week of Health and Innovation conference 2021 in Denmark.
To turn on English subtitles, click on the ‘CC’ at the bottom of the video.
Psychiatrist Kristoffer Södersten from PsykiatriResurs in Sweden shares his experience using the Monsenso mHealth solution.
How does the Monsenso mHealth solution encourage and empower better mental health treatment?
Kristoffer explains how the Monsenso mHealth solution helps him to enhance and inform treatment. Specifically, the solution helps him to gain more relevant information about his patients, such as information that couldn’t have been obtained through the traditional method of verbal sessions. “It’s difficult to retrieve reliable and consistent data from each patient during a verbal consultation with them,” says Kristoffer.
Obtaining the right information is key for psychiatrists and psychologists to provide an accurate diagnosis
“[The accuracy from a diagnosis obtained] from face-to-face consultation depends so much on factors like personal relations, how comfortable the patient is in the conversation, cultural background, etc. Therefore, [due to these factors] it can be very arbitrary about which diagnosis a patient receives. This diagnosis can depend on which clinician he meets, and these other factors.” says Kristoffer. The information gathered from the Monsenso Clinic can help to provide a consistent and clearer view of the patient’s mental health, to better inform a diagnosis.
Kristoffer finds the Monsenso mHealth solution to be particularly helpful in capturing relevant objective data. The solution provides a comprehensive and easily accessible overview of relevant patient data, such as day score, mood score, sleep and medication adherence. Moreover, overview of collected sensor data, such as physical activity, social activity, phone usage and voice features can also be provided. This objective data can help to supplement the subjective data provided during verbal therapy.
“The technology of Monsenso can help us to gather more objective data that – together with the subjective experience – provide a more holistic picture of the patient’s problems, to help provide a more accurate diagnosis and follow-up treatment in a totally different way,” says Kristoffer.
Monsenso mHealth solution is providing a visualization of a historical data, which in some cases can identify why the symptoms appear and help to prevent them.
“You can also use this tool to predict future psychological outcomes, which can help us intervene early and prevent relapse.”
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.
Approximately 20% of the world’s children and adolescents are affected by mental disorders. Mental illnesses and substance abuse are the leading causes of disability worldwide.
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