Advances in Mobile Mental Health: Opportunities and Implications for the Spectrum of E-Mental Health Services
Abstract
Introduction
Level | Source/entry | Initiator goals/aims | Pros | Cons/liabilities | Comments/suggestions |
---|---|---|---|---|---|
1 | Website information | Obtain health information and read ‘in-time’ or follow-up on physician’s verbal instructions | Get information, understand how to approach a problem and triage problem | Quality of information varies Inaccurate patient self-diagnosis | Better if referred to a site by clinician who made appropriate diagnosis |
2 | Support/chat groups or “communities” | Gain support, answers, tips and perspective | Get a sense as to what are others doing for treatment and to cope; feel part of a group | The patients may or may not be similar; quality of information varies | Support in group format is nice for some |
3 | SM | Person/patient/caregiver: additional option for interaction; clinician: skeptical unless known commodity | Feeling understood, heard; more ‘in-time’ | Not HIPAA compliant, no time for this for most clinicians, significant boundary issues ( e.g., self-disclosure, invading patient privacy) | Clinician should ask what platforms patient uses, but not promise to participate or track, triage acute issues to phone or in-person |
4 | Self-directed assessment by using screening tools with feedback | Person/patient: good habits, reflection tips; caregiver: reflection tips, tools to assess loved ones; clinician: refer patients to tips on clinical care | Customized to learning preference/style; make progress outside of a clinic; reduced clinician time demand | Not all problems can be self- assessed; some illnesses affect insight; quality of assessment varies | Good for motivated persons and even better if referred by clinician who has checked it out |
5 | Formal educational materials | Person/patient: education; caregiver: education, supports, and advice; clinician: CME | In-depth and evidence-based education; document progress in learning | Less interaction with instructors compared to in-person; may not fit all learning styles | Tend to be higher quality, but may cost money to obtain |
6 | Self-care decision-making options by one-time assessment by a professional | Person/patient/caregiver: additional options; clinician: skepticism unless known commodity | Customized preference/style; empowered; increased self-efficacy | What if the path of steps is not clear: should I do A or B? | Using members of an interdisciplinary team in a stepped care approach is better; linked to clinician |
7 | Email/text | Person/patient: common and fabric of life; apps ‘log’ experience and give data to clinician; clinician: used and incorporated into EHR | Patient gets quick advice, details on routine matters; convenient easier for teen patients: prefer texts to calls? | Occasional use for acute issues; HIPAA compliance issues if not secure; patient may expect future response | Better if email is within EHR; HIPAA compliant; things taken out of context; and miscommunication |
8 | Mobile health, psych apps, sensors and other technologies | Access, mobility, and low cost option. apps ‘log’ experience and give data to clinician; clinician: better integrated, longitudinal assessment | Convenient improved cueing of patients (i.e., to appointments); good narrative by ecological collection of data) | HIPAA issues for compliance may be more complex; patient may expect future response; data integration issues are complex | Better if integrated within HER; can systems to monitor respond ‘in time’? Private and public data may not be integrated |
9 | Synchronous, traditional or TMH care | Person/patient: it really works and is much more convenient; clinician: if patients like it, it is a good option | There is no shortcut to synchronous decision-making (patient-clinician; primary care-psychiatry) | It always has to be scheduled (and paid for) | A great option; not always needed due to lesser, easier options |
10 | De facto hybrid care (synchronous and asynchronous technology) to technology-based integrated care | Person/patient: I connect in-person and via technology; clinician: a team leader in a true system of care | A multi-modal approach for patients, clinicians and programs is a start; progressive healthcare systems are doing this | Linkage with interdisciplinary staff helps discussion, prioritization and planning | Not always available, but eventually folks will shift if healthcare financing shifts; paradigm shift is needed. |
mHealth, mobile MH and MH/psychiatric apps
An Overview of mHealth
![](/cms/10.1176/appi.focus.16301/asset/images/large/appi.focus.16301f1.jpeg)
mMH and MH/Psych Apps
Internet and other technology-based options for patients, caregivers and clinicians
Support Groups and Participation in a “Community”
Structured Information and Tools for Self-Directed Habit, Lifestyle or Illness Changes
Informal Advice from Health Professionals Without Guidance
Traditional Clinician-Assisted Decisions, Telepsychiatric Care and Other Evidence-Based Options
Clinical care, training/education, system administration: approaches and preliminary guidelines
Technology Integrated into Clinical Practice
![](/cms/10.1176/appi.focus.16301/asset/images/large/appi.focus.16301f2.jpeg)
Training and Education
![](/cms/10.1176/appi.focus.16301/asset/images/large/appi.focus.16301f3.jpeg)
Developing an Administrative Approach
Guidelines
![](/cms/10.1176/appi.focus.16301/asset/images/large/appi.focus.16301f4.jpeg)
Discussion
Conclusions
REFERENCES
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