Digital Tools Can Augment Care for People With SMI

Digital and mobile technology might offer a path to improved care for patients with serious mental illness (SMI), including severe depression, bipolar disorder, and schizophrenia. During a session at this year’s IPS: The Mental Health Services Conference, a trio of researchers described some digital tools they developed to help support patients with SMI and their doctors.

John Torous, M.D., director of the digital psychiatry division at Harvard’s Beth Israel Deaconess Medical Center, described a mobile app known as mindLAMP, which attempts to evaluate patients in real time.

This app combines online clinical assessments and cognitive games with the passive collection of smartphone metadata (for example, movement tracked by the accelerometer or the number of keystrokes each day). Torous noted that such information allows the app to record more than answers to a screening test such as the Patient Health Questionnaire-9 (PHQ-9); it also documents how long it took a user to answer each question.

“We might see that someone did not answer positive on the PHQ-9 suicidal ideation question, but they spent three minutes thinking about it, which may tell us something, depending on what other information the patient provides,” he said.

“With such an app, clinicians can learn how someone’s cognition, mood, activity, sleep, and screen time change in between visits,” Torous explained. “We get a better sense of the patient’s lived experience, which can help us provide more holistic care.”

The specific assessments, games, and metrics used can be customized for each individual patient, Torous explained. The patient and doctor have an initial interview to discuss treatment goals, at which point the patient receives a unique code to use when signing on to the app. The patient can then log on to a personalized mindLAMP dashboard. Torous noted that this customization provides patients with a measure of control in their treatment, which is something they value.

Maintaining a healthy weight can be a challenge for people living with SMI, Alexander Young, M.D., a professor of psychiatry at the University of California, Los Angeles (UCLA), reminded the audience at the session.

“Weight management programs do work for SMI patients, but they require a lot of staff time and are difficult to implement in a typical health care setting,” he said. webMOVE—an interactive online weight management system that combines educational modules, diet and exercise trackers, and phone-based peer support—removes some of these barriers by allowing the patients to access a weight management program from home, he said.

Young recently completed a controlled trial that found webMOVE was better than in-person weight management at promoting weight loss in people with SMI. After six months, webMOVE participants lost an average of six pounds compared with no net change in the in-person group.

Young attributed much of webMOVE’s success to the fact that the patients did not have to come to the clinic each week for their session. Peer coaching and encouragement were other features that patients noted they liked about the program, he said.

Another significant problem that hinders productivity in SMI patients is diminished functional capacity— “the cognitive ability to carry out tasks like making phone calls, writing checks, or ordering and picking up the right prescription,” explained Joseph Ventura, Ph.D., a senior research psychologist at UCLA’s Semel Institute for Neuroscience.

A patient’s functional capacity is most commonly assessed with an in-person performance skills assessment. This test uses role-playing activities to evaluate real-world skills like communication, basic finance, and activity planning. Though effective, these tests take about 45 minutes to administer and another 15 minutes to score.

Ventura helped develop a virtual reality–based functional capacity assessment tool (VR-FCAT), which can assess a patient’s functional capacity within 20 minutes. In this game-like assessment, patients complete a series of linked objectives. The person has to find the correct items in a kitchen to make a meal, then catch the right bus (and pay with exact change) to go to a grocery store to get missing items, find those items on the store shelves, pay for them, and then successfully bus home again.

Functional capacity is calculated based on the total time it takes patients to complete the task and the total number of errors they make. “We found that the VR test correlates well with the pen-and-paper functional capacity test, so it has potential,” Ventura said.

The VR software is appealing since it offers a short and standardized assessment, but one that is also adaptable, he added. “What’s nice about virtual reality is you can make variations in the activities for different populations based on their specific needs,” he said.

In closing, Torous noted that just as many SMI patients are not fearful of digital health tools, professionals should not be either. He noted that APA’s new SMI Adviser has several webinars that focus on digital health and that the consult service is also prepared to answer technology-related queries.

None of the presenters noted any financial conflicts of interest, as all their programs are used for research studies and are not commercialized. ■

Young’s study, “Improving Weight in People With Serious Mental Illness: The Effectiveness of Computerized Services With Peer Coaches,” is posted here.