Serious Mental Illness: Using Technology to Achieve Better Patient Care and Outcomes

Few groups are as impacted by healthcare disparities than the mentally ill.  People who suffer from mental illness categorically suffer from General Mental Health and Substance Abuse (GHMSA) or serious mental illness (SMI).

The SMI population is comprised of patients who are diagnosed with Major Depressive Disorder, Bipolar I, Bipolar II, Schizophrenia, Obsessive Compulsive Disorder, Panic Disorder, Post traumatic Stress Disorder and Borderline Personality Disorder. [i]  These disorders can afflict anyone regardless of age, gender, socioeconomic status, race, ethnicity or education.  “Approximately 60% of the 10.3 million people with serious mental illness get care in public facilities, 90% as outpatients.”[ii] “Although the mentally ill have high accident and suicide rates, about 3 out of 5 die from mostly preventable diseases.”[iii]

While there are many potential barriers to adoption,  the potential rewards for a technology accessible by the SMI population are great.  And today’s adolescents are “wired” for online communication. “Roughly one in every five young adults between 18 and 25 has a mental illness, says Melissa Pinto-Foltz, a postdoctoral scholar and instructor at the Frances Payne Bolton School of Nursing at Case Western Reserve University.  “Seventy percent of them don’t receive treatment.  Of these that do receive treatment, they have trouble managing the illness and often drop out of treatment early.”  As Ms. Pinot-Foltz set out to solve this problem, she worked with a group to create a computer program called, “Electronic Self-Management Resource Training to Reduce Health Disparities (e-SMART-HD). Her group’s specific goal was to assist young adults who struggle with mental illness to “manage their mental illness independently,…stay on medications, and keep medical appointments in order to optimize mental health.”[iv]  She is not the only proponent of using information technology tools to help mentally ill patients manage their disease state.

Mobile applications have been deployed and are being implemented that help to treat not just the “worried well” but the SMI population.  Applications currently being developed or in use include:

  • Mobile Therapy: An application developed by Intel that chart energy levels, sleep patterns, activities, diet and more.  The application, beta tested in 2010 proved beneficial to patients, whether suffering from schizophrenia, depression, bipolar disorder or another mental health diagnosis[v],[vi].
  • Live OCD Free[vii]: Exposure and Response Prevention for obsessive-compulsive disorder
  • CBT MobileWork: Tracks and rewards cognitive behavioral therapy homework for patients with Major Depressive Disorder[viii]
  • Mind’s Eye[ix]: A “mood monitoring and well-being tool” assisting adolescents in managing their mental illness.
  • DocReady: Prepares a person suffering from chronic mental illness to discuss their care with their primary care doctor.
  • MoodyMe: Tracks mood and allows users to upload photos.
  • LiveHappy: Offers activities that boost mood through specifically “prescribed activities” to improve mood, develop goals, and jot down gratitude.
  • DepressionCheck: a 3-minute screening tool for anxiety and depression
  • Bipolar Disorder Connect: A gateway into a community of people living with BP.
  • PTSD Coach: Developed by the VA’s National Center for Post-Traumatic Stress Disorder, includes self-assessment, relaxation, and anger management tools.
  • Tactical Breather: Guides people through breathing exercises to control stress response

And, as Kate Anthony et al, discusses in her book, the Use of Technology in Mental Health:  Applications, Ethics and Practice, even websites, blogs, wikis, and podcasts can be used by professionals to educate lay audiences and colleagues.  They can use connectivity to find community, work out scenarios, and experiment with new behaviors and approaches by using tools like Second Life.  “The internet offers a greater sense of equality and reduces the stigma traditionally associated with mental health disorders.”[x]  So, even though, “Providers tend to be skeptical of patient-entered data,”[xi], University of Pennsylvania researcher Dimitri Perivoliotis, who treats patients with schizophrenia, says, mobile technology, “gives me an additional source of rich information of what the patient’s life is like between sessions.”

Given the potentially low literacy levels associated with some of the SMI population, the graphical user interface (GUI) needs to be carefully designed.  Using the Flesch-Kincaid Grade Level assessment or the Flesch Reading Ease scale, and providing mentally ill patients with the equipment, as well as training in its use, a customized GUI could help achieve the objective of improving the health of this challenging population. by addressing the challenges associated with the population will not only achieve meaningful-use criteria but, most importantly, improve health outcomes for the mentally ill.

Endnotes

[i] NAMI website

[ii] USA Today article

[iii] USA Today Article

[iv] E-Smart Technologies May Help Young Adults Self-Manage Mental Illness

[v] Developing Patient-Centered Interventions for e-Health Applications:  Lessons Learned

[vi] Mental Health Apps:  Like a ‘Therapist In Your Pocket’

[vii] Smartphone apps become ‘surrogate therapists’, CNN.com

[viii] CBT Mobile Work:  Initial Usability Results of a Mobile Device to Promote CBT Homework Adherence, Callahan, J.

[ix] “How new digital technology is helping young people cope with mental illness”, The Independence blog

[x] The Use of Technology in Mental Health:  Applications, Ethics and Practice

[xi] A Field Guide to Online Personal Health Records