Could smart phones help provide mental health care?

There is a shortage of talking therapy available to people with mental health problems. But Lord Darzi, a former Labour health minister and the current executive chair of the World Innovation Summit for Health (WISH) suggests mobile technology could be used to help fill the gap. In the UK, one in four people will experience a mental health problem at some point in their lives. Mental illness can be unforgiving and can often leave people feeling hopeless. While treatments do vary depending on the individual or type of illness, they will often include a mixture of therapy, self-help, or medication. People also turn to exercise, meditation and creative art therapies, to help in their recovery process. Often it is a combination of these things that works best. But are there more innovative alternatives we can offer? 'An issue that won't go away' Increasingly we rely on smart phones in our daily lives, from checking emails and reminders or monitoring social media to purchasing goods and services. But I believe mental health services are behind the curve and should be better utilising the communication technology patients already have at their fingertips. Even with the successful introduction of the Improving Access to Psychological Therapies (IAPT) service, there is a shortage of trained professionals who provide the kind of care patients need. That's an issue which will not go away. It needs to be addressed with innovative thinking. Mobile technologies are still largely untapped sources of innovation for the NHS. The portability, privacy, and round-the-clock availability of mobile phones offer mental health workers and patients a direct, private, and instantaneous method of communication as well as access to information and self-care support. 'Buyers beware' There are thousands of mental health apps available directly to consumers, bypassing support from trained NHS clinicians. Could this be because these apps are discovered privately, through a medium they trust, are instantly accessible, are in patients' hands at almost any time of day? But buyers beware: most direct-to-consumer apps have no evidence from clinical trials. Even those with a promising but small evidence base lack the necessary funding to run the type of large clinical trials that would allow them to be evaluated for inclusion in NHS treatment recommendations. I believe mobile technology can be used as an extension of existing one to one or group therapy, so that when a patient leaves their weekly session they still feel connected to the health service, even if not physically. This kind of engagement could achieve a great deal in getting more patients into treatment, and helping more patients with ongoing support and recovery. If implemented effectively then patients could benefit from a quicker recovery process and shorter waiting lists while the health service will accrue benefits from a shift of burden towards increased patient self-care. Potential For example, there is an app called 'Viary' created by Swedish startup Hoa's Toolshop, which prompts users to engage in behaviours known to relieve depression, such as writing in a journal, and tracks patients' progress over time and location. The app accumulates data and then visually presents triggers; progress; setbacks; and patterns over time and across locations that the patient and therapist can view together and look at ways to address problems. A nine-week trial of the app was conducted in Sweden in 2013. Eighty-eight participants with depression received either four face-to-face sessions of cognitive behavioural therapy plus the use of Viary or 10 face-to-face sessions of CBT alone. The study found no between-group differences on levels of depression, which indicates that four sessions of CBT plus Viary were as effective as 10 sessions of CBT. While this was only a small study, this - and other similar work that has been done - demonstrates the potential for mobile technologies to support the treatment of a wide range of mental health issues. Health leaders need to consider greater collaboration with innovators in technology and academic and private-sector cooperatives should be encouraged to foster innovation in this area. Mental health care professionals deliver fantastic care every day but with such demand it is not an easy task. Bold and innovative thinking is needed to ensure that people living with mental health get the best service possible. The World Innovation Summit for Health (WISH) is an initiative of Qatar Foundation for Education, Science and Community Development. The Summit takes place on 17/18 February 2015. Prof Lord Darzi of Denham, is executive chair of the World Innovation Summit for Health (WISH) and director of the Institute of Global Health Innovation at Imperial College London.
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