Mental health in an unequal world. World Mental Health Day 2021

Mental health in an unequal world. World Mental Health Day 2021

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.

References:

https://wfmh.global/2021-world-mental-health-global-awareness-campaign-world-mental-health-day-theme/

https://www.who.int/publications/i/item/9789240031029

https://www.who.int/campaigns/world-mental-health-day/2021

https://www.who.int/key-messages

[1] https://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf

[2] The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011

[3] OECD – 2015

[4] Economist Intelligence Unit – 2015

Transforming healthcare with technology-enabled care

Transforming healthcare with technology-enabled care

Connected health or technology-enabled care (TEC) is the collective term used for telecare, telehealth, telemedicine, mHealth, digital health, and eHealth services. TEC is now seen as a fundamental part of the solution to solve many healthcare challenges.

TEC helps people self-manage their health and wellbeing, alert healthcare professionals in case of any changes in an individual’s condition and support medication adherence.

It also helps clinicians and care providers deliver more efficient and cost-effective care.

Digital technology is advancing exponentially, and its cost is becoming more affordable. The need for more cost-effective healthcare is rising. Now more than ever, healthcare authorities need to adopt new technologies to help meet this demand.

Key trends

An aging population

The population is increasing, and people are living longer. These two factors, in addition to a rise in chronic conditions, present new healthcare challenges.

In the United States, population projection reports that older adults currently make up about 15% of the population, and by the year 2060 is estimated to amount to 23.5%.

There are similar numbers reported for Europe, where the group of 65-year old or older make up 19% of the population and is predicted to amount to 29% of the total population by the year 2080.

Use of mobile devices is increasing amongst all age groups

A 2019 report conducted by Provision Living, a senior living community in the U.S.,  revealed that on average, Baby Boomers (born between 1946 and 1964) and millennials (born between 1981 and 1995) spend on average, five hours a day on their smartphones.

Smartphone adoption among Americans:

  • Aged 50 to 59 is 86%
  • Aged 60 to 69 is 81%
  • Aged 70+ is 62%

Other market drivers

The demand for apps and wearable devices is also being driven by an increased focus on personalised care. Large pharmaceutical companies are now using apps and wearables to gather valuable health-related patient data, support their research, and provide an holistic service to patients.

In 2014, the leading pharmaceutical companies had an increase of 63 % in unique apps compared to 2013. In just one year, the total number of downloads of pharmaceutical apps increased by 197% as shown in Figure 1. These apps deliver education and training, can titrate medication and monitor compliance.

Figure 1. The number of apps published by leading pharmaceutical companies, 2013 and 2014.

There has also been an increase in online patient communities, using social media as a platform to exchange experiences with patients and carers.

Increasing patient trust in health apps

There is strong evidence that patients are now more than ever concerned about self-care, and they are interested in boosting their health and wellbeing. In addition to this, health technology companies are working to improve the quality of apps, increase user confidence and trust, and launch informed decision-making in app selection for health professionals, patients and the public.

Agencies like the US Food and Drug Administration (FDA), or NHS Choices and its NHS Health Apps Library have developed criteria that judge apps for safety and technical proficiency. For example, for apps to be included on the NHS Choices search website, which in early 2015 lists around 150 apps, they must be reviewed by a technical team (testing relevance, legal compliance and data protection), then by a clinical team (to test scientific rigour).

PatientView is an independent organisation that has developed a systematic method of appraising health apps. Until April 2015, there were 363 apps recommended for the Apple platform and 236 for Android, with smaller numbers recommended for use on other platforms.

In 2014, PatientView undertook a survey of 1,130 patient group members to identify what people want from health apps as shown in Figure 2.

Figure 2. What do patients and carers want from health apps?

References:

Connected Health: How Digital technology is transforming health and social care. Deloitte Health.

Forget Generational Stereotypes, Baby Boomers Are Just As Addicted To Smart Phones As Millennials. 

Older Adults Keep Pace on Tech Usage.

An Aging Population, Larger Chronic Disease Burden, and Reliance on Digital Self-Management Tools Require Contributions from Nurse Informaticians.

What Is the difference between a health app and an mhealth solution?

What Is the difference between a health app and an mhealth solution?

Over the past few years, mHealth solutions have begun to solve some of the problems that are ailing healthcare. MHealth is paving the way for better data management, doctor-patient communication, reduced hospital admissionsmedication adherence, and remote patient monitoring. 

MHealth solutions are improving outcomes in measurable, repeatable ways by connecting patients with their doctors.

In 2017 mHealth captured $23 billion in revenues, with an estimated growth rate of 35% annually over the next several years.

What is the difference between a health app and an mHealth solution?

Health apps are application programmes that offer health-related services for smartphones, tablets, PCs, and other communication devices.

The most popular categories of health/wellness apps are: 

  • Sports and fitness activity tracking
  • Diet and nutrition
  • Weight loss coaching
  • Medication tracking
  • Sleep cycle
  • Stress and relaxation
  • Meditation
  • Menstrual period tracking
  • Pregnancy
  • Hospital selection and appointment tracking

Health apps can provide valuable information to users. However, it may be hard to determine the accuracy of the information provided and may not be easy to share this data with the user’s doctor.

MHealth or mobile health refers to the practice of medicine and public health supported by mobile devices such as mobile phones, tablets, personal digital assistants and wireless infrastructure. It encompasses all applications of telecommunications and multimedia technologies for the delivery of healthcare and health information.

Why is mHealth used?

  • Provides education and awareness
  • Assists with diagnostic and treatment support
  • Enables remote data collection
  • Facilitates remote monitoring
  • Enables telemedicine
  • Supports chronic disease management
  • Support medication compliance

Numerous mHealth initiatives across the world have demonstrated the efficacy of using mobile devices to deliver better care in a cost-effective manner.

Many mHealth solutions offer different types of information sharing, such as data collection through patient self-assessments, electronic questionnaires, and sensor data. They can also offer emergency action plans and an encrypted messaging system that allows direct communication with the clinic.

Besides, many mHealth solutions are considered certified medical devices that have a proven record of helping healthcare professionals in the monitoring and treatment of their patients.

Both, health apps and mHealth solutions can both be used on-the-go. However, the main difference is that health apps are for consumers-only and mHealth solutions improve the collaboration between patients and healthcare professionals.

References:

mHealth (Mobile Healthcare) Ecosystem Market: 2017-2030 – $23 Billion Opportunities, Challenges, Strategies & Forecasts.

Health apps definition.

What is mHealth?

 

Can mHealth technology be used to save costs ?

Can mHealth technology be used to save costs ?

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

Digital self-monitoring tools may promote positive behavioural changes, new study suggests

Digital self-monitoring tools may promote positive behavioural changes, new study suggests

Digital self-monitoring tools enables individuals to track meaningful data about themselves. This capability has encouraged healthcare providers to use these tools to personalise and scale treatment in a more cost-efficient way.

A recently published research paper titled “Self-monitoring utilisation patterns among individuals in an incentivized programme for healthy behaviours,” suggest that the use of digital self-monitoring tools could significantly improve a patient’s long-term health engagement.

According to the research paper, the 69% of Americans track regularly at least one indicator of health, including their weight, diet, exercise routine, or symptoms related to chronic disease.  Since there is a wide range of mHealth devices, there is a growing trend among the general population to measure, track, and make changes related to their health based on quantifiable data collected by oneself. Projections show that the number of everyday wearables, devices, and sensors will increase 5-fold by 2019 [1].

Although the effectiveness of these tools varies depending on the manufacturer, it is well-established that effective, digital self-monitoring tools can have profound health benefits. For example, among diabetics, blood glucose monitoring is a major component of disease management and provides individuals the ability to assess glycaemic targets and evaluate response to therapy. Additionally, blood pressure monitoring has been associated with improved short-term blood pressure control and medication adherence, and self-monitoring has also been shown to improve weight loss and short-term activity levels Importantly, monitoring programs, wearable devices, and other non-traditional healthcare resources can potentially facilitate healthy behaviour changes [1].

As non-traditional healthcare channels such as virtual care become more popular, there is a shift to value-based treatment. Together, these aspects have led to an interest in incorporating digital self-monitoring tools into chronic condition management, and the diagnosis of acute episodes. All these are important steps in incorporating digital technologies into routine patient care.

According to the research, after 20 weeks, 28.36% of registered users were still actively engaged in the program. Meanwhile, combined with the duration of program participation, the frequency of program participation over the first 20 weeks demonstrated some interesting trends. First, the average number of activities logged by users was 4.28 during the first week in the program. However, after excluding the roughly one-third of users who ceased recording activities after one week, the average number of activities logged by participating users increased to 7.53 by the second week. After four weeks, this number was 8.01 and remained relatively steady throughout the 20-week period examined [1].

Overall, the study demonstrated that while a large proportion of users stopped participating in the programme early on those that did continue to log activities did so at a fairly consistent level throughout their participation period [1].

Primary findings

Monitoring physiologic parameters, health activities, and health behaviours in a non-medical setting has the potential to enable alternative systems of health management that can be both more individualised and convenient for health consumers.

An understanding of home-based, self-tracking parameters can provide insights into optimising such programs in future health care models.

The results of the study suggest that incentives might work for connected and active participants in achieving healthy activities. The study showed consistent, extended results of how incentivised consumers track health behaviours and health data in a real-world setting with a large population.

 Long-term adherence to healthy behaviour programme and automated self-monitoring tool

According to the study 57% of all users that remained on the study after one month continued to participate for at least twenty weeks. However, it should be taken into consideration that engaging consumers initially and for prolonged lengths are important components of success.

There is still much to learn about long-term participation. However, the digital tools used, should be easy to use and they should incorporate proven behaviour change theories through the use of rewards or incentives. For example, useful tools to improve long-term, self-monitoring are mobile health-tracking technologies since they can collect, transmit, and aggregate health data.

In fact, a study looking for adherence to the protocol through mobile phone apps which compared website or paper diaries for weight loss also proved the advantage of mobile phone apps even when it was not a fully automated process [1].

 Web-based and mobile health self-monitoring is popular in the general population, and could play a critical role in the future of health management and wellness. Self-monitoring has been shown to improve health and management of chronic conditions. [1].

The Monsenso mHealth solution can be used as a digital self-monitoring tool by individuals with a mental illness. With the smartphone app, individuals can track their health and behavioural data, as well as their symptoms and medication compliance. Besides, all this information is also synchronised with the clinical web portal enabling healthcare professionals to offer a more personalised treatment.

Reference:

Self-Monitoring Utilization Patterns Among Individuals in an Incentivized Program for Healthy Behaviours. JMIR Publications. Ju Young Kim, MD, PhD; Nathan E Wineinger, PhD; Michael Taitel, PhD; Jennifer M Radin, MPH, PhD; Osayi Akinbosoye, PhD; Jenny Jiang, MS; Nima Nikzad, PhD; Gregory Orr, MBA; Eric Topol, MD; Steve Steinhubl, MD. 2016. http://www.jmir.org/2016/11/e292#Body