#EMentalHealth: Digital interventions blended with traditional care.

 

…what is E Mental Health?

images

E Mental Health has been around for the last 50 years, perhaps more, in a rudimentary fashion using two-way radio and landline telephones. The idea of consulting with, and supporting, patients (and their families) using communication technology is well established. We have been using telephone services in mental health for many years, but in recent times, E Mental Health has snowballed to include a wide range of electronic and digital technologies enabling mental health promotion, early intervention and longer-term treatments in both stand-alone and blended care formats.

Increasingly, it is seen as a viable and cost effective strategy to integrate or blend care within a comprehensive suite of mental health service delivery options, making it possible to help more people at a time and place of convenience to them (Wilson R. L. & Usher, 2015). A wide range of digital interventions are emerging, however not all of them has been validated for safety and efficacy in clinical trials. Never-the-less, it is known that positive engagement in mental health interventions (especially where behaviour change is required) is improved where technology-based strategies are included in either standalone or blended therapies (Alkhaldi et al., 2016). Digital interventions can be described as “programs that provide information and support – emotional, decisional and/or behavioural – for physical and/or mental health problems via a digital platform” (Alkhaldi et al., 2016; Bailey et al., 2010).

E Mental Health is expanding into new and exciting areas of practice, and for clinicians and health researchers, this is a particularly dynamic time. The general community are engaged and ready to use E Mental Health innovation (Fox & Duggan, 2012). More than that… people now expect to find useful mental health information, support and even treatment in digital formats (Fraser, Randell, DeSilva, & Parker, 2016). People expect to access E Mental Health in a range of forms as simply and quickly as pulling their smart phones out of their pockets. Increasingly, a ground swell exists for self-care E Mental Health and this is gaining widespread popularity (Alkhaldi et al., 2016). Many people prefer to receive, information, guidance and even treatment in the privacy, and comfort of their own homes where they remain connected to their place and daily practical life competencies that underpin their optimal wellbeing (Bissell, 2013).

The 21st Century E Mental Health reality is that health care professionals can deploy a virtual mental health clinic in the pocket, handbag, or backpack of the majority of people in the developed world, and for many people in developing countries also (Brusse, Gardner, McAullay, & Dowden, 2014; Wilson, Ranse, Cashin, & McNamara, 2013). The global opportunity that is available by using the personal Internet connected smart devices of individuals everywhere has enormous potential and capacity to promote mental health, and to reduce the burden of global mental illness (ICT Data and Statistics Division Telecommunication Development Bureau Geneva Switzerland International Telecommunications Union., 2012; Proudfoot, 2013). These are exciting times.

3 main categories for E Mental Health services:

  • Voice/Text/SMS
  • Video
  • Web 1 & 2.

voice & text…

            examples…

  • Two-way radio UHF services where mobile or cell phone coverage is poor (for example, Royal Flying Doctors Service in remote regions of Australia).
  • Call centre-based services to triage and arrange intake or referral to individuals seeking entry to mental health care services (for example NSW Health free call numbers in Australia) (Elsom, Sands, Roper, Hoppner, & Gerdtz, 2013).
  • Call centre-based services to crisis mental health help lines (for example Australian services such as: Lifeline, Suicide Call Back Service, Kids Help Line). Similar services are available in most countries where free public mental health care services/insurance also exist.
  • Most countries have an emergency service free call telephone number such as 000 in Australia, 911 in USA, 112 in Europe and 999 (or 112) in the UK.
  • Mobile/cell phone SMS or text-based services (“Nancy Lublin: Texting that saves lives,” 2012).

images (2)

video…

            examples…

  • Telepsychiatry – frequently refered to as video links between health services where the consumer or patient and/or carer is in one location, while the specialist mental health clinician/s are in a separate location. A synchronised time is arranged to make a private video consultation link-up. This allows people to receive specialist care without the need to travel to a far away appointment in a distant location (for example Queensland Health (Queensland Health., 2013; Statewide telehealth services., 2013) and )
  • More recently Skype has provided a platform that enables flexible video based consultation and added an element of convenience and simplified technology.

web 1 & web 2…

            examples…

  • Email usage and web browser literacy is now generally considered to be a basic life skill for adults, where an integration of web literacy develops as people are able to explore, build and connect relevant information that is useful to them and for solving a range of problems from a self help perspective. For example: Browser search engines such as Google and associated free email host services such as gmail have provided a virtual and digital context where people are more able to search for health information aligned with their health needs and specific health question.
  • Web 1 has provided a platform for health care professionals to develop static information and education resources for the general public (for example: beyond blue, black dog), and also website based intervention tools. For example Cognitive Behavioural Therapy (“myCompass. Introductory video,” 2010) and Mindfulness Based Therapy.
  • E Mental Health electronic patient records such as the European E health action plans and in Australia (Australian Commission on Safety and Quality in Healthcare., 2016).
  • Call centre-based services have been able to add value to their telephone services, by providing extra general information on website connected to their services so that they can support callers further. (For example: Lifeline)
  • Web 2 has expanded the options available even further by integrating all other options with a synchronous real time, and asynchronous convenient times, social media enhanced interactive experience that is particularly convenient to the general population, and it is this element of E Mental Health that offers particular promise as new service and interventions are developed.
  • Smart devices, and especially smart phones, facilitate the opportunity to utilise apps to enhance the mental health service portfolio, with many apps currently available as information or treatment services.
  • Personal electronic accessories such as fitness monitoring devices (eg fitbit or the apple watch) that sync activity levels, such as heart rate, calorie consumption, with smart device diary tools to monitor health characteristics and behavioural change. Fitbit has demonstrated effectiveness as a monitoring tool to enhance engagement in self-care and promoting health and wellbeing generally. The integration of these personal monitors into health care is gradually occurring.
  • Gamification in E Mental Health, enhancing engagement in mental health self-care, and gaming-based interventions is an area of particular growth. Gamification introduces a fun and engaging way to interact with health promotion, digital intervention and to foster behavioural change with the added incentives and motivation of providing rewards for efforts. Some gamification is simple and brief such as gif files that prompt and guide breathing to assist in reducing the experience of panic or anxiety.
  • More advanced gamification is used to connect with various populations, for example, young people. Integrating gamification software strategies into mental health promotion and strategies will target at risk populations.
  • Social media is a useful platform for teaching the public, student health professionals and less engaged experienced clinicians about mental health information and clinical skill development. We know that many health professions students prefer to gain their discipline information for social media such as Facebook (Usher et al., 2014). We also know that a growing number of health professionals are using social media to create virtual communities for research, practice, knowledge exchange and mentoring purposes.

blended capacity…

The common usage of personal smart phones and access to computers and other smart devices has driven a level of integration so that we are now in an era where voice, video and web-based resources are available, and often in a blended format so that all three can be use simultaneously and either in synchronous or asynchronous formats. This provides service users and service providers with a level of flexibility and convenience not seen previously.

images (5)

commercial & social enterprise influence in the E Mental Health arena…

Plenty of innovation in the field of E Mental Health is occurring at a rapid pace, with commercial and social enterprises quick to respond to the global appetite to address mental health problems generally. There are many apps and websites to choose from – some with costs, others free to access. This dynamic has both risks and benefits associated with it.

benefits…

  • A general population wide awareness and expectation about accessing mental health information and support in an electronic environment.
  • Populations skilled and literate in the use of electronic devices and digital technologies such as apps, web site navigation, email and social media.

risks and limitations…

  • The trustworthiness, reliability, dependability and credibility of many E Mental Health activities in the commercial and social zones are not known because E Mental Health research and development occur at a slower pace than the commercial and social environment, and with a rigorous process to demonstrate efficacy and patient safety. Thus, health service providers and clinicians are reluctant to engage in E Mental Health initiatives with out best practice rigour to support their practice.
  • Clinical trials take a significant amount of time, planning, design and testing to underpin evidence to support safe practice. In the context of the rapid pace of change in the E environment generally, this poses a challenge.
  • Not all clinicians are keen adopters of social media generally. Thus a digital literacy and skills base has not dominated the health environment generally to date. The mental health workforce is aging in the international sphere, and as younger and digitally literate workforce enter the mental health professions they will bring with them the ease and comfort of existing and operating in the various web environments (Wilson et al., 2013).

opportunities for safe E Mental Health development…

E Mental Health holds great promise for mental health care now, and into the future. There are some gaps at present, and there is a significant need for ongoing research to develop practice-ready tools to contribute to a blended care delivery system (Fraser et al., 2016). Blended care includes elements of face-to-face and online or electronic components of clinical mental health care.

Mental health clinicians and researchers need to develop and refine their skills in the use of e health care technologies – especially in regard to web-based tools, apps and social media (Wilson et al., 2013). Encouragingly, students in the health professions indicate that they are likely to have a strong grasp of electronic health care and information transfer because they bring pre-existing web-savvy skills to their pre-qualification studies (Usher et al., 2014).

Governments and funding bodies increasingly anticipate the incorporation of strategic E Mental Health care into health service delivery systems, because it aligns with economic business plans and population distribution plans (Department of Health., 2015; E-mental health strategy for Australia, 2012; European Commission, 2012).

images (1)

in summary…

  • E Mental Health is not new, but it is expanding at a rapid pace, driven by consumer demand and heath service financial constraints to deliver more services with limited budgets
  • Three main avenues exist for E Mental health: Voice/ text; video; and Web 1 & 2.
  • Opportunities exist to build safe E Mental Health into the future as research and development collaborate with willing practitioners to create a evidence base to support best practice in the E Mental Health field.

References

Alkhaldi, G., Hamilton, F. L., Lau, R., Webster, R., Michie, S., & Murray, E. (2016). The effectiveness of prompts to promote engagement with digital interventions: a systematic review. Journal of Medical Internet Research, 18(1), e6. doi:10.2196/jmir.4790

Australian Commission on Safety and Quality in Healthcare. (2016). Safety in E Health.   Retrieved from http://www.safetyandquality.gov.au/our-work/safety-in-e-health/

Bailey, J., Murray, E., Rait, G., Mercer, C., Morris, R., Peacock, R., . . . Nazareth, I. (2010). Interactive computer-based interventions for sexual health promotion. Cochrane Database of Systematic Reviews, 9(CD006483). doi:10.1002/14651858.CD006483.pub2.

Bissell, D. (2013). Virtual infrastructures of habit; the changing intensities of habit through gracefulness, restlessness and clumsiness. Cultural Geographies, 0(0), 1-20.

Brusse, C., Gardner, K., McAullay, D., & Dowden, M. (2014). Social Media and Mobile Apps for Health Promotion in Australian Indigenous Populations: Scoping Review. J Med Internet Res, 16(12), e280. doi:10.2196/jmir.3614

Department of Health. (2015). e-Health.   Retrieved from http://www.ehealth.gov.au/internet/ehealth/publishing.nsf/content/home

E-mental health strategy for Australia. (2012). Canberra: Commonwealth of Australia Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/D67E137E77F0CE90CA257A2F0007736A/$File/emstrat.pdf.

Elsom, S., Sands, N., Roper, C., Hoppner, C., & Gerdtz, M. (2013). Telephone survey of service-user experiences of a telephone-based mental health triage service. International Journal of Mental Health Nursing, 22, 437-443.

European Commission. (2012). eHealth Action Plan 2012-2020 – Innovative healthcare for the 21st century. Retrieved from Brussels: file:///Users/rhondawilson/Downloads/eHealthActionPlan2012-2020.pdf

Fox, S., & Duggan, M. (2012). Mobile Health 2012: Half of smartphone owners use their devices to get health information and one-fifth of smartphone owners have health apps Retrieved from California Health Care Foundation: E Mental Health.docx

Fraser, S., Randell, A., DeSilva, S., & Parker, A. (2016). Research Bulletin: E-mental health: the future of youth mental health? Retrieved from Orygen Youth Health: https://orygen.org.au/Our-Research/Research-Areas/Online-Interventions-and-Innovation/Orygen-Research-Bulletin-E-Mental-Health.aspx

ICT Data and Statistics Division Telecommunication Development Bureau Geneva Switzerland International Telecommunications Union. (2012). Mobile cellular subscriptions per 100 inhabitants, 2001-2011 (Excel Spreadsheet) Retrieved from http://www.itu.int/ITU-D/ict/statistics/material/excel/2011/Mobile_cellular_01-11.xls.

. from Telecommunication Development Bureau Geneva, Switzerland: International Telecommunications Union. http://www.itu.int/ITU-D/ict/statistics/material/excel/2011/Mobile_cellular_01-11.xls.

 

. myCompass. Introductory video. (2010). In B. D. I. m. program (Producer). Australia: Black Dog Institute.

Nancy Lublin: Texting that saves lives. (2012, April 2012). TED talks. Ideas worth spreading. Retrieved from http://www.ted.com/talks/nancy_lublin_texting_that_saves_lives.html

Proudfoot, J. (2013). The future is in our hands: The role of mobile phones in the prevention and management of mental disorders. Australian and New Zealand Journal of Psychiatry, 47(2), 111-113.

Queensland Health. (Producer). (2013, 7 March 2013). Telehealth. Retrieved from https://www.facebook.com/notes/queensland-health/telehealth/379845328790222

Statewide telehealth services. (Writer). (2013). Extending the reach of clinical health services throughout Queensland . In Q. health (Producer). Australia: Queensland health.

Usher, K., Woods, C., Casella, E., Glass, N., Wilson R. L., Mayner, L., . . . P., I. (2014). Australian health professions student use of social media. Collegian, 21(2), 95-101. doi:10.1016/j.colegn.2014.02.004

Wilson R. L., & Usher, K. (2015). Rural nurses: A convenient co-location strategy for rural mental health care of young people. Journal of Clinical Nursing, 1-11. doi:DOI: 10.1111/jocn.12882

Wilson, R. L., Ranse, J., Cashin, A., & McNamara, P. (2013). Nurses and Twitter: The good, the bad, and the reluctant. Collegian(0). doi:http://dx.doi.org/10.1016/j.colegn.2013.09.003

 

Advertisements

2 comments

  1. Sara J Smith

    This blog’s major point is that this era is a particularly dynamic time for E Mental Health. Another point was that in the modern day, there are several electronic resources widely available to people in the developed world including voice calls, text, video, websites, apps, and other alternatives. There are reasons to believe once there are rigorous clinical trials on the efficacy of E Mental Health that it will have a great international impact. This is because what usually happens in each connection of healthcare providers with patients is more affordable and improved patient outcomes. I believe one positive aspect that is overlooked in this blog is the ease of which patients’ privacy is maintained because of the convenience of the patient remaining in their own home.
    Sara J Smith

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s