Mobile apps open up new possibilities for mental health care

Last modified: 9/14/2014 11:49:00 PM
Could an app save someone’s life? Across New Hampshire, those who work in mental health are turning to mobile tools as added lifelines for people who might be at risk for suicide.

In some cases, that approach can be simple and straightforward – a host of apps are available for iPhones and Android devices to connect people to crisis response services and to outline information on coping strategies.

At an event tied to National Suicide Prevention Week, which ends today, representatives from the New Hampshire Suicide Prevention Council highlighted several such apps including: My 3, which lets users program three contacts to reach out to when they are feeling suicidal; Help, distributed by an Oklahoma-based call center for the National Suicide Prevention Lifeline; and the SAMHSA Behavioral Health Disaster app, developed by the Substance Abuse and Mental Health Services Administration.

Another app, PTSD Coach, includes a feature for users to assess symptoms of post-traumatic stress disorder and allows them to schedule reminders to take these assessments on a repeated basis. It allows users to select “Favorite” songs, images and contacts from the files on their device to be easily accessed when they’re feeling stressed. This app – a version of which can also be accessed online – was developed by the VA’s National Center for PTSD in partnership with the Department of Defense’s National Center for Telehealth and Technology.

Many of the apps available for suicide prevention come with lengthy user agreements, including disclaimers that they are not meant to be a substitute for clinical help and that the information submitted by users (in some cases) can be collected by those who make the apps. Before using them, it’s important for users to read through these agreements carefully and make sure they understand what the terms mean.

Paul Holtzheimer, director of the Mood Disorders Service at Dartmouth Medical School, said the technologies that are emerging to address mental health concerns have at least one major advantage: People are sometimes more honest with their cell phones than they are with their doctors.

“They will rate things on a seemingly impersonal app much more honestly than they would to an actual person,” said Holtzheimer, who specializes in treatment-resistant depression. “At a basic level, if the IT stuff can get more people engaged and thinking about how they’re feeling, that’s still a success.”

The future of mental health?

If an app can get someone thinking about their feelings and then, ideally, direct them into professional health screenings, Holtzheimer said that’s a good thing.

The “holy grail,” he said, would be technology that could identify patterns in someone’s behavior or brain signals that would alert that they’re in need of help and would use technology to administer treatment.

Researchers at the Center for Technology and Behavioral Health at Dartmouth College are exploring whether they might be able to get closer to achieving that kind of future.

Lisa Marsch, the center’s director, said developing effective mobile mental health technologies means first exploring several questions: Do people use these apps? Do they actually work? And how do you make sure the people who might benefit most from these tools actually engage with them?

One of the center’s researchers, Dror Ben-Zeev, has worked on apps that capture data from people living with schizophrenia. When the app detects that someone’s symptoms are escalating, Marsch said, it can direct that person to engage in behavioral strategies – breathing exercises, for example – to try to prevent a psychotic episode.

Other projects are exploring how to leverage the myriad data captured inside a cell phone’s sensors – sound coming in through its microphone, location information, light exposure and more – to monitor patterns that would be indicative of mental health problems, Marsch said. Researchers are, for example, monitoring whether the levels of ambient light in someone’s room or certain speech patterns can measure depression or sociability levels, she said.

As with other apps, Marsch said it’s critical for potential users to understand the level of sensitive data that they’d be sharing by engaging with these technologies. Providers would need to carefully review these issues with potential patients, she said, and it wouldn’t hurt to offer some kind of statement in writing about what using these apps would mean for patients’ privacy, medical or otherwise.

But if done right, Marsch said these apps could be immensely valuable as a new approach to community-based mental health.

That’s not to say that an app would or should replace a clinician as part of someone’s treatment, she said – but combining an in-person approach with mobile technologies can “extend the scope and reach” of mental health providers. That, in turn, could be particularly beneficial in places where community health centers are overburdened with a demand for treatment, as is the case across New Hampshire.

“Our work has repeatedly shown that you can increase the quality of service delivery, improve patient outcomes and maintain cost effectiveness when you embed technology systems as part of service delivery models,” Marsch said.

(Casey McDermott can be reached at 369-3306 or or on Twitter @caseymcdermott.)

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