Smartphones and hope for mental illness

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Elizabeth Newman
Elizabeth Newman

Recently, my husband's smartphone died in the middle of a business trip to Salt Lake City, a sign his technology is as melodramatic as is his wife.

Being more stoic than I am, my husband managed to get by, and he ordered a new phone upon his return. If the same thing had happened to me, I would have bitterly complained that I might as well go live in the wilderness, in a yurt, hunting my own food. While I will plead guilty to being dramatic, journalists also now live in a tornado of news coverage. Without your smartphone, you're likely to be five steps behind when returning from lunch.

But of course, it's not just us. While there is some evidence that children's time on smartphones should be limited, and certainly there's a need for adults to occasionally disconnect, researchers at Dartmouth University are using smartphones in a new and interesting way. They've developed a plan for geriatric patients to better manage their mental illness.

Geriatric psychiatry care is a sticky issue for long-term care providers. Many administrators, especially those in rural areas, have told me how hard it is to take residents to appointments. There are the issues of transportation and time away: An hour drive to and from an appointment with a staff member, on top of an hourlong appointment, can not only suck up staff time but take the resident away from his or her home and potentially favorite activity. There's also an issue of finding a good match — in addition to issues around insurance, anyone who has ever gone to therapy can attest to the need to be with someone with whom they feel comfortable.

There are great psychiatry programs happening with long-term care and telemedicine. But the Dartmouth researchers took a different approach. They developed smartphone content and modified an existing smartphone platform, specifically by adapting a psychosocial self-management intervention.

While the study was small, with 10 participants with a mean age of 55, all subjects had serious mental illness and comorbid chronic health conditions. This puts them at risk not only for premature death, but it also meant they had astronomical healthcare costs. Care coordination of this population is a challenge, and the costs really matter when a provider is in a bundled payment program, for example.

The app took patients through 10 sessions over a period of three months, covering topics such as medication adherence and strategies, medication abuse and stress vulnerability. Physicians can monitor responses, and patient engagement seemed to increase.

Using mobile health interventions for adults with serious mental illness is “a promising approach that has been shown to be highly feasible and acceptable," explained lead investigator Karen L. Fortuna, Ph.D., of the Dartmouth Centers for Health and Aging and the Geisel School of Medicine at Dartmouth. "These technologies are associated with many advantages compared with traditional psychosocial interventions, including the potential for individually tailored, just-in-time delivery along with wide dissemination and high population impact. Nevertheless, the process of adapting an existing psychosocial intervention to a smartphone intervention requires adaptation for a high-risk group with limited health and technology literacy."

Even those with limited technical abilities could use the app successfully, researchers found.

Results appeared in the American Journal of Geriatric Psychiatry, which focused in its latest issue on technology development with a total of nine papers.

It “represents a major step in developing a body of research to guide how technologies can interface with clinical care," noted guest editor Ipsit V. Vahia, MD, McLean Hospital, Belmont, MA, and the Department of Psychiatry, Harvard Medical School.

As Vahia went on to add, the “work is just getting started.” That should be a refreshing piece of good news for nursing home managers looking to make the lives of mentally ill residents better.

Follow Senior Editor Elizabeth Newman @TigerELN.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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