Remote continuous care is superior to episodic care for depression: Digital health is the only way to deliver it (Preprint)

2020 ◽  
Author(s):  
VALERIE FORMAN HOFFMAN ◽  
Joseph Kvedar ◽  
Kristian Ranta
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Digital Health ◽  
Single Treatment ◽  
Disease Treatment ◽  
Face To Face ◽  
Optimal Outcomes ◽  
Continuous Care ◽  
Remote Care ◽  
Delivery Models

UNSTRUCTURED Abstract Depression is a burdensome and costly disease. Treatment is not sought by over half of depressed patients, and many who suffer remain depressed despite treatment. Furthermore, there is no single treatment efficacious for all patients, with optimal outcomes precluded by access, adherence, and patient satisfaction issues. The recent proliferation of telehealth solutions has increased access to care, especially during the COVID pandemic, but problems with several of its traditional types of delivery models still exist. Rather than the provision of traditional episodic mental health care, creative mental health solutions that can provide continuous care with frequent patient-provider interactions are urgently needed. This Viewpoint explores how digital health solutions enable the provision of continuous types of remote care to provide relief for some of the access and capacity problems exacerbated by requirements for face-to-face types of care.

scholarly journals Service user experiences and views regarding telemental health during the COVID-19 pandemic: a co-produced framework analysis

2021 ◽  
Author(s):  
Norha Vera San Juan ◽  
Prisha Shah ◽  
Merle Schlief ◽  
Rebecca Appleton ◽  
Patrick Nyikavaranda ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Data Collection ◽  
Service User ◽  
Telemental Health ◽  
Service Users ◽  
Framework Analysis ◽  
Face To Face ◽  
Digital Exclusion ◽  
Remote Care

AbstractBackgroundThe prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in accessing good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable.MethodsWe conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants’ experiences and views regarding telemental health during the pandemic was identified and extracted. Data collection and analysis used a participatory, coproduction approach where lived experience researchers, clinical and academic researchers contributed to all stages of data collection, analysis and interpretation of findings.FindingsParticipants’ experiences and preferences regarding telemental health care were dynamic and varied across time, settings, and individuals. Participants’ preferences were shaped by the reason for contacting providers, their relationship with the care provider, and both parties’ access or acceptability to use remote technology. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important new challenges around safety and privacy in online settings, and gave examples of good remote care strategies, including scheduling regular phone calls and developing guidelines about how to access remote care tools.DiscussionParticipants in our study and previous literature have highlighted advantages of telemental health care, as well as significant limitations which hinder mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and to support staff in making effective and collaborative use of relevant technologies.

scholarly journals Service user experiences and views regarding telemental health during the COVID-19 pandemic: A co-produced framework analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257270
Author(s):  
Norha Vera San Juan ◽  
Prisha Shah ◽  
Merle Schlief ◽  
Rebecca Appleton ◽  
Patrick Nyikavaranda ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Data Collection ◽  
Service User ◽  
Telemental Health ◽  
Service Users ◽  
Framework Analysis ◽  
Face To Face ◽  
Digital Exclusion ◽  
Remote Care

Background The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. Methods We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants’ experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. Findings The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants’ preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties’ access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. Discussion Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.

scholarly journals Combining online and offline peer support groups in mental health care: A qualitative study of service users� experiences (Preprint)

2018 ◽  
Author(s):  
Monica Strand ◽  
Deede Gammon ◽  
Lillian Sofie Eng ◽  
Cornelia Ruland
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Peer Support ◽  
Support Groups ◽  
Local Community ◽  
Mental Health Problems ◽  
Service Users ◽  
Face To Face ◽  
Individual Interviews

BACKGROUND Peer support groups for people with long-term mental health problems are at the heart of recovery-oriented approaches in mental health care. When conducted face-to-face (offline) or on the Internet (online), peer support groups have proven to have differing strengths and weaknesses. Little is known about the benefits and challenges of combining the two formats. OBJECTIVE The aim of this study was to gain insights into the benefits and challenges of combining online and offline peer support groups facilitated through an Internet intervention designed to support recovery processes. METHODS In this exploratory and descriptive study, an e-recovery portal called ReConnect was used by service users in two mental health communities in Norway for 6-12 months. The portal included an online peer support forum which also facilitated participation in local in-person ReConnect-cafés. Both formats of peer support were facilitated by an employed service user consultant with lived experience of mental health problems and with training in peer support. Qualitative data about service users’ experiences of using the portal were collected through focus groups and individual interviews and inductively analyzed thematically with focus on benefits and challenges of peer support online and offline. RESULTS A total of 14 service users 22-63 years of age with various diagnoses, receiving services at both primary and specialist levels of mental health care participated in three focus groups and 10 individual interviews. Two main themes were identified in the analysis: 1) balancing anonymity and openness, and 2) enabling connectedness. These themes are further illustrated with the subthemes: i) dilemmas of anonymity and confidentiality, ii) towards self-disclosure and openness, iii) new friendships, and iv) networks in the local community. Three of the subthemes mainly describe benefits. Challenges were more implicit and cut across the subthemes. Identified challenges were linked to transitions from anonymity to revealing one’s identity, how to protect confidentiality, or to participation at face-to-face meetings in the local community. CONCLUSIONS Our study suggests that online peer support groups and offline meetings complement each other, and the combination is mainly beneficial to users. The identified benefits appeared to arise from participants’ options of one format or the other, or that they could combine formats in ways that suited their individual values and comfort zones. We also identified challenges related to combination of formats, and both formats require appropriate facilitation of peer support. Combining online formats that enable anonymity, a non-judgmental atmosphere, and 24/7 accessibility regardless of location, with offline formats that foster local, in-person community ties, is a promising concept for facilitating recovery-oriented care, and warrants continued research.

scholarly journals Digital Health Needs of Women With Postpartum Depression: Focus Group Study (Preprint)

2020 ◽  
Author(s):  
Madison E Lackie ◽  
Julia S Parrilla ◽  
Brynn M Lavery ◽  
Andrea L Kennedy ◽  
Deirdre Ryan ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Postpartum Depression ◽  
Mental Health Care ◽  
Focus Groups ◽  
Digital Health ◽  
Qualitative Description ◽  
New Mothers ◽  
Focus Group Study ◽  
Psychosocial Skills

BACKGROUND Although approximately 10% of new mothers in Canada develop postpartum depression (PPD), they face many barriers when accessing care. eHealth offers a unique opportunity to provide psychosocial skills and support to new mothers; however, patient populations are not consistently engaged in eHealth development processes. Thus, the diversity of women’s backgrounds and needs are often not reflected in existing tools. OBJECTIVE This study aims to engage women from a variety of backgrounds and locations around British Columbia (BC) who have previously experienced PPD to determine the unmet psychoeducational needs of women with PPD and how a web-enabled platform used to deliver psychosocial skills and education to assist in the management of PPD could fulfill those needs. METHODS Focus groups were conducted in 7 cities across BC with a total of 31 women (mean age 34.5 years, SD 4.9), with each group ranging from 2-7 participants. Focus groups were cofacilitated by the study coordinator and a local service provider in each community using a semistructured guide to discuss participants’ needs, ideas, and opinions as they relate to the use of technology in PPD management. Transcripts were approached inductively using thematic analysis to identify themes and qualitative description to frame what was observed in the data. RESULTS A total of 5 themes were identified: bridging gaps to meet needs; providing validation to combat stigma; nurturing capacity to cope, manage, and/or reach wellness; empowering people to take ownership over their mental health; and offering customization to ensure relevance. Each theme identified a need (eg, combatting stigma) and a way to address that need using a web-enabled intervention (eg, providing validation). At the intersection of these themes was the overarching value of promoting agency for women experiencing PPD. CONCLUSIONS Ultimately, new mothers require accessible mental health care that promotes their agency in mental health care decision making. Our participants believed that a web-enabled intervention could help meet this need. These data will be used to guide the design of such an intervention, with the eventual implementation of this resource as a first-line management option for PPD.

Enhancing Mental Health

2021 ◽  
pp. 264-269
Author(s):  
Parvind Gambhir
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Disorders ◽  
Health Priorities ◽  
Face To Face ◽  
Online Platforms ◽  
Diabetes Technology ◽  
The World ◽  
Challenging Situation

Mental health is one of the health priorities in the 21st century along with cardiovascular, cancer, and diabetes. Technology nowadays is most sought for getting any information. There are numerous online platforms that have been developed to assist in assessment, provide feedback, suggest management, and thereafter monitor mental disorders in target patients with a view to enhancing the quality of mental health care provided by traditional face-to-face services. In the current situation where the world is facing a challenging situation in COVID-19, technology has become highly sought after for managing the health of patients.

Principle-driven virtual care practice to ensure quality and accessibility

2021 ◽  
Vol 7 (2) ◽  
pp. 81-84
Author(s):  
Kendell Ho ◽  
Ken Harris ◽  
Toni Leamon
Keyword(s):  
Health Care ◽  
Health Professionals ◽  
Care Delivery ◽  
Digital Health ◽  
Professional Community ◽  
Alternative Form ◽  
Care Practice ◽  
Face To Face ◽  
Virtual Care ◽  
The Right

COVID-19 has accelerated the use of telehealth or virtual care (VC) as an alternative form of health care delivery. Clearly, VC provides unprecedented convenience and timeliness for patients seeking care from their health professionals. As a result, a substantial increase in telehealth providers is occurring, and the Canadian government is investing millions to support digital health care treatments and telehealth services. However, it is vital that the health professional community carefully examine the quality of care being delivered digitally and determine when it is appropriate to use VC as an alternative to face-to-face care. This article highlights some principles for health policymakers, health professionals, and health consumers to consider to ensure that VC is used appropriately and ethically for the right health conditions and in the right contexts.

The Digital Revolution in Behavioral Health

2019 ◽  
Vol 26 (1) ◽  
pp. 102-111 ◽  
Author(s):  
Michael J Hasselberg
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Behavioral Health ◽  
Digital Health ◽  
Behavioral Health Care ◽  
The United States ◽  
Care Providers ◽  
Digital Revolution ◽  
The University

BACKGROUND: Technology is disrupting every modern industry, from supermarkets to car manufacturing, and is now entering the health care space. Technological innovations in psychiatry include the opportunity for conducting therapy via two-way video conferencing, providing electronic consultations, and telementoring and education of community health care providers. Use of mobile health applications is also an expanding area of interest and promise. OBJECTIVE: The purpose of this article is to review the evolution and pros and cons of technology-enabled health care since the digital movement in psychiatry began more than 50 years ago as well as describe the University of Rochester’s innovative digital behavioral health care model. METHODS: A review of the literature and recent reports on innovations in digital behavioral health care was conducted, along with a review of the University of Rochester’s model to describe the current state of digital behavioral health care. RESULTS: Given the lack of access to care and mental health professional shortages in many parts of the United States, particularly rural areas, digital behavioral health care will be an increasingly important strategy for managing mental health care needs. However, there are numerous hurdles to be overcome in adopting digital health care, including provider resistance and knowledge gaps, lack of reimbursement parity, restrictive credentialing and privileging, and overregulation at both the state and federal levels. CONCLUSIONS: Digital health innovations are transforming the delivery of mental health care services and psychiatric mental health nurses can be on the forefront of this important digital revolution.

scholarly journals A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan)

10.2196/17481 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e17481
Author(s):  
Conor O'Grady ◽  
Ruth Melia ◽  
John Bogue ◽  
Mary O'Sullivan ◽  
Karen Young ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Suicide Prevention ◽  
Cause Of Death ◽  
Dialectical Behavior Therapy ◽  
Mobile Health ◽  
Mobile App ◽  
Suicidal Thoughts ◽  
Face To Face ◽  
Target User

Background Suicide is a prominent cause of death worldwide, particularly among young people. It was the second leading cause of death among those aged 15-29 years globally in 2016. Treatment for patients with suicidal thoughts or behaviors often includes face-to-face psychological therapy with a mental health professional. These forms of interventions may involve maintaining and updating paper-based reports or worksheets in between sessions. Mobile technology can offer a way to support the implementation of evidence-based psychological techniques and the acquisition of protective coping skills. Objective This study aims to develop a mobile app to facilitate service users’ access to mental health support and safety planning. This process involved eliciting expert input from clinicians who are actively engaged in the provision of mental health care. Methods A survey was distributed to targeted health care professionals to determine what features should be prioritized in a new mobile app relating to suicide prevention. On the basis of the survey results, a clinical design group, comprising 6 members with experience in fields such as mobile health (mHealth), clinical psychology, and suicide prevention, was established. This group was supplemented with further input from additional clinicians who provided feedback over three focus group sessions. The sessions were centered on refining existing app components and evaluating new feature requests. This process was iterated through regular feedback until agreement was reached on the overall app design and functionality. Results A fully functional mobile app, known as the SafePlan app, was developed and tested with the input of clinicians through an iterative design process. The app’s core function is to provide an interactive safety plan to support users with suicidal thoughts or behaviors as an adjunct to face-to-face therapy. A diary component that facilitates the generalization of skills learned through dialectical behavior therapy was also implemented. Usability testing was carried out on the final prototype by students from a local secondary school, who are representative of the target user population in both age and technology experience. The students were asked to complete a system usability survey (SUS) at the end of this session. The mean overall SUS rating was 71.85 (SD 1.38). Conclusions The participatory process involving key stakeholders (clinicians, psychologists, and information technology specialists) has resulted in the creation of an mHealth intervention technology that has the potential to increase accessibility to this type of mental health service for the target population. The app has gone through the initial testing phase, and the relevant recommendations have been implemented, and it is now ready for trialing with both clinicians and their patients.

scholarly journals “Breaking the silence”: Sexual victimisation in an old age psychiatry patient population in Flanders

2021 ◽  
Author(s):  
Anne Nobels ◽  
Ines Keygnaert ◽  
Egon Robert ◽  
Christophe Vandeviver ◽  
An Haekens ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Old Age ◽  
Health Care Professionals ◽  
Mental Health Problems ◽  
Physical Contact ◽  
Screening Tools ◽  
Face To Face ◽  
Old Age Psychiatry

AbstractBackgroundSexual violence (SV) is linked to mental health problems in adulthood and old age. However, the extent of sexual victimisation in old age psychiatry patients is unknown. Due to insufficient communication skills in both patients and healthcare workers, assessing SV in old age psychiatry patients is challenging.MethodsBetween July 2019 and March 2020, 100 patients at three old age psychiatry wards across Flanders participated in a face-to-face structured interview receiving inpatient treatment. The participation rate was 58%. We applied the WHO definition of SV, encompassing sexual harassment, sexual abuse with physical contact without penetration, and (attempted) rape.OutcomesIn 57% of patients (65% F, 42% M) SV occurred during their lifetime and 7% (6% F, 9% M) experienced SV in the past 12-months. Half of the victims disclosed their SV experience for the first time during the interview. Only two victims had disclosed SV to a mental health care professional before.InterpretationSexual victimisation appears to be common in old age psychiatry patients, yet it remains largely undetected. Although victims did reveal SV during a face-to-face interview to a trained interviewer, they do not seem to spontaneously disclose their experiences to mental health care professionals. In order to provide tailored care for older SV victims, professionals urgently need capacity building through training, screening tools and care procedures.

scholarly journals Remote mental health clients prefer face-to-face consultations to telehealth during and after the COVID-19 pandemic

2021 ◽  
pp. 103985622110435
Author(s):  
Andrew James Amos ◽  
Jocelyn Middleton ◽  
Fergus W. Gardiner
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Indigenous Australians ◽  
Face To Face ◽  
Far North ◽  
Mental Health Clients ◽  
The Impact

Objective: To guide the efficient and effective provision of mental health services to clients in Central West and Far North Queensland, we surveyed preferences for face-to-face or in-person contact. Methods: A clinician-designed survey of contact preferences was offered to 248 clients of mental health services in Far North and Central West Queensland in mid-2020. With the onset of COVID-19, the survey was modified to measure the impact of the pandemic. Results: Just over half of the services’ clients participated in the survey (50.4%), of whom more were female (63.2%). Of the participants, 46.3% in Far North and 8.6% in Central West Queensland identified as Indigenous. Strong resistance to telehealth before the pandemic across groups (76%) was moderated during COVID-19 (42.4%), an effect that appeared likely to continue past the pandemic for Central West clients (34.5%). Far North clients indicated their telehealth reluctance would return after the pandemic (77.6%). Conclusions: Our results suggest that remote Australians strongly prefer in-person mental health care to telehealth. Although the COVID-19 pandemic increased acceptance of telehealth across regions while social distancing continued, there was evidence that Indigenous Australians were more likely to prefer in-person contact after the pandemic.

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