“The pandemic has changed the trajectory of psychiatry,” says Frank Chen, chief medical officer at Houston Adult Psychiatry in Texas. Before the pandemic, many patients resisted using apps and other digital tools, he says. But since the beginning of the COVID-19 pandemic, the use of digital tools is becoming “the norm rather than the exception.” It’s a trend that’s just getting started.

With nearly one in five (52.9 million) Americans battling a mental illness and approximately half (28.6 million) of them not receiving treatment in the past year,1 there’s a significant need to improve their care. That’s especially true for people with a serious mental illness (SMI)—which may significantly impair a patient’s ability to live a productive life.1

“It’s usually more difficult for a person with an SMI to hold a job or to have a strong friend network,” says Alexis Skoufalos, program director for Jefferson College of Population Health’s Doctor of Health Science in Population Health. For that reason, she adds, “they’re at higher risk of being unemployed and isolated.”

Despite the crucial need to help these patients,2 mental healthcare access is challenging in the U.S. due to social stigma and scarcity of services,3 made worse by an ongoing mental health provider shortage.4 “The biggest barrier for everybody is access,” says Teri Brister, chief program officer for research, support, and education at the National Alliance on Mental Health (NAMI).

The digital advantage

Mental health providers have long treated patients using a combination of medication and face-to-face psychotherapy.5 However, what patients experience daily with SMI may have a significant impact on how providers formulate those treatment plans.6 Patients may sometimes struggle to recall what happens on a day-to-day basis,7 which may present a challenge for providers trying to piece together a complete picture of the factors that may be influencing a patient’s experience.

Digital tools—including mobile apps, wearables, activity trackers and remote monitoring technologies—may help give providers insight into a patient’s objective data,8 especially with SMI patients. “A digital tool may provide patients with a means to capture or record important information about their experience with their condition between visits, so they may share that information with their healthcare provider during their next appointment,” Chen says.

“One of the hallmarks of psychotherapy is self monitoring,” Brister says. “There’s something about just paying attention to what you’re doing, and writing it down or putting it into an app that may be extremely cathartic in terms of making a change happen.” What’s more, she says, “doing it digitally may make it happen instantaneously, so that your therapist has access to that information when you enter it on your watch or your smartphone or whatever you’re plugging it into.”

This information may benefit everyone involved in the patient’s treatment. “It would really be ideal for clinicians to have data to be able to know if patients are regularly taking their medication,” Skoufalos says. One study found that physicians, even those with well-established patient relationships, overestimated their patients’ consistency in taking their medications as prescribed for 44% of cases.9

When patients are asked how they’ve been doing between visits, the response is subjective, Chen says. In addition, “If I have a digital tool that may help my patient keep track of their diet, activity levels and how they are feeling, I would get a bigger, better impression of the time in between visits.” Multiple sources of data may help physicians tailor a more personalized treatment regimen.10

Building a treatment team

“Digital tools like this may allow others who are vested in the wellness of the patient to have a better understanding of how to support,” Chen says. If a patient forgets to take their medication, for example, then a treatment team member could have that conversation with the patient.

Digital tools may also help patients and physicians collaborate for the patient’s care. “It’s about giving patients the opportunity to be a voice in the treatment decisions that are being made, rather than just being a passive participant and following orders,” Skoufalos says. Digital tools allow for the sharing of data that may help inform a decision. That data may be used during the clinician’s assessment of the patient’s health status and determine the next steps in treatment.2

“By having them be an active participant and allowing them to provide information about their needs, their preferences, and other challenges that they’re dealing with, patients may give their clinical care provider insights into what they’re dealing with,” Skoufalos says. “Shared decision making may strengthen the therapeutic alliance—that critical bond and relationship between the patient and their clinical care provider.”

A transition in the works

Recent research points to increasing interest in digital tools for mental health11.  These current advances may be a part of a treatment plan to help improve patient care12. “The digital tools allow us to gather much more specific data, so that we may target our treatments for our unique patients,” Chen says. He believes the use of digital tools in mental health treatment is just beginning; “there’s going to be an evolution in terms of the way we manage our patients’ illnesses.” A result of the growing use of digital tools could mean more mental health patients have access to treatment and an opportunity to be involved in their care13.

Dr. Frank Chen and Alexis Skoufalos, EdD are paid consultants for Otsuka America Pharmaceutical, Inc.

References:

  1. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness 
  2. Kreyenbuhl, J., Nossel, I. R., & Dixon, L. B. Schizophrenia bulletin, 35(4), 696–703 (2009).
  3. Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. SSM – population health, 15, 100847 (2021).
  4. KFF. Mental Health Care Health Professional Shortage Areas (HPSAS) (2021) https://www.kff.org/other/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas/
  5. American Psychiatric Association. https://www.psychiatry.org/patients-families/psychotherapy
  6. Treichler, E., Evans, E. A., & Spaulding, W. D. Psychological services, 18(1), 93–103 (2021).
  7. Kessels R.P. J. Royal Soc Med 96(5), 219–222 (2003).
  8. Northeast Business Group on Health. https://nebgh.org/initiative/mental-health/
  9. Stephenson, J.J., et al. Int J ClinPract, 66: 565-573 (2021).
  10. Hallgren, K, Bauer, A, Atkins, D. Digital Technology and Clinical Decision Making in Depression Treatment: Current Findings and Future Opportunities, 494-501 (2017)
  11. Insel, T, Naslund, J.A. & Aschbrenner, K.A. J Affect Disord Reports, 24(S2), 100227 (2021).
  12. Coravos, A., et al. Digital biomarkers, 3(2), 31–71 (2019).
  13. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/topics/technology-and-the-future-of-mental-health-treatment