mHealth -scalable and cost-effective mental healthcare

mHealth -scalable and cost-effective mental healthcare

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.


[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.

[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).

[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)

[4] Evidence based treatment for first episode of psychosis: Components of coordinated specialty care. PHD R. K. Heinssen. RAISE NIMH (2014, April 14).

MHealth, a scalable and cost-efficient solution for mental healthcare

MHealth, a scalable and cost-efficient solution for mental healthcare

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.


[1] Prevention of mental disorders. Effective interventions and policy options. World Health Organisation.

[2] The future looks promising for mental health prevention. Psychiatric News. Joan Arehart-Treichel. 2013 (January 18).

[3] Technology and the future of mental health treatment. National Institute of Mental Health.