The state of mental health in the U.S. Could mHealth offer a better solution?


In a given year, 1 in 25 adults experience a serious mental illness in the U.S. Furthermore, almost 18.5% of U.S adults will experience some form of mental illness in that year. Despite the high prevalence of mental disorders in the U.S., studies have shown that only 52.8% of adults with severe mental illness (SMI) received mental health treatment. [1] The situation is similar with children who have mental disorders. Over 1 in 5 youth between the ages of 13-18 years has a serious mental illness, yet only about 50% in need of mental health care. [2]

Barriers to receiving mental health services can be attributed to factors such as a shortage of mental health professionals, insurance problems leading to the inability to cover mental health costs, lack of perceived need for treatment by the patient, stigma from a mental illness and fragmented treatment services or structural barriers including an inability to obtain appointments. [3]

In a study by Valire et al, additional barriers recognized were inadequate knowledge of available services or lack of awareness thereof, perception of poor quality of services by patients and the challenge of primary care physicians in identifying mental illness in racial and ethnic minorities. A worsening problem is the significant drop out rate from treatment in individuals with severe symptoms.

Furthermore, while mental healthcare costs on the economy can be assessed directly, the indirect result of a population with a high prevalence of mental health disorders may be grossly underestimated. Indirect costs are incurred through reduced labor supply, public income support payments, reduced educational attainment and costs associated with other consequences such as incarceration and homelessness. Another kind of indirect cost results from the high rate of medical complications associated with serious mental illness, that often lead to high rates of emergency room care and early mortality. [4]

One solution to addressing challenges of mental health care access is the use of mobile technology or mobile health (mHealth). mHealth is becoming an integral part of clinical practices around the U.S. and physicians are increasingly using mHealth as a part of mainstream treatment for chronic health conditions. Per a survey from Healthcare Information and Management Systems Society (HIMSS), 83 percent of physicians have reported using mobile technology. [5] The ubiquitous use of mobile technology was also observed in the general public. In 2015, approximately 92% of American adults reported having a mobile phone; and 68% had a smartphone. [6]

The adaptation of telemedicine in clinical care offers an exciting opportunity to reduce negative clinical outcomes. By using mobile technology in monitoring a patient’s symptoms between visits, managing the illness and giving the patient access to a supportive virtual community, mHealth could be used as a complementary tool in addressing some of the immediate barriers to mental health care access.

Even resource deprived neighborhoods and populations without stable housing may benefit from the increased accessibility to health care via mHealth. One study shows that 44% of a sample of a homeless population had mobile phones and 80% of them owned their phones while the rest either borrowed long-term or rented. [7]

Recent research shows that people with severe psychiatric disabilities are increasingly using mobile phones to support their rehabilitative care. [8] Ben-Zeev et al proposed using patient-initiated dialogue or personalized messages keyed to environmental cues to improve access to mental care services. [9] Additionally, Prince et 2014 suggest that mHealth offers an effective use of mobile applications to “(a) increase access to evidence-based care; (b) better inform consumers of care and more actively engage them in treatment; (c) increase the use of evidence-based practices; and (d) enhance care after formal treatment has concluded". [10]

Mobile health technology has tremendous potential to be an adjunct to clinical care for serious mental illnesses. It could provide support to patients who have limited access to psychiatric care. Additionally, engaging and continuous monitoring of patients allow for treatments that are evidence-based and personalized. Furthermore, the breadth of data could be useful for identifying markers as the illness improves or worsens, and would advance understanding and treatment of serious mental illnesses. While all of this is exciting, the field is is rapidly expanding and largely unregulated. Therefore it is important to keep patients’ wellness and privacy secure as the use of mobile technology advances. While several studies have shown the feasibility and acceptability of mobile health technology in preventing relapses in patients with severe mental illnesses, large randomized studies are lacking for additional evidence.

References

1.​ Administration SAaMHS. Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings. Department of Health and Human Services: Substance Abuse and Mental Health Services Administration

Center for Behavioral Health Statistics and Quality 2013.

2.​ More Americans continue to receive mental health services, but substance use treatment levels remain low [press release]. SAMHSA2015.

3.​ Mojtabai R, Olfson M, Sampson NA, et al. Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychol Med. 2011;41(8):1751-1761.

4.​ Insel TR. Assessing the economic costs of serious mental illness. Am J Psychiatry. 2008;165(6):663-665.

5.​ Mcaskill R. The benefits of mobile health strategies. 2015, 2016

6.​ Center PR. Three Technology Revolutions. Pew Research Center;2016.

7.​ Eyrich-Garg KM. Mobile phone technology: a new paradigm for the prevention, treatment, and research of the non-sheltered "street" homeless? Journal of urban health : bulletin of the New York Academy of Medicine. 2010;87(3):365-380.

8.​ Ben-Zeev D, Davis KE, Kaiser S, Krzsos I, Drake RE. Mobile technologies among people with serious mental illness: opportunities for future services. Administration and policy in mental health. 2013;40(4):340-343.

9.​ Ben-Zeev D, Schueller SM, Begale M, Duffecy J, Kane JM, Mohr DC. Strategies for mHealth research: lessons from 3 mobile intervention studies. Administration and policy in mental health. 2015;42(2):157-167.

10. ​Price M, Yuen EK, Goetter EM, et al. mHealth: a mechanism to deliver more accessible, more effective mental health care. Clinical psychology & psychotherapy. 2014;21(5):427-436.

Authors: Tiara Ahmed, Syed Haider, Harrysh Indranathan, Selassie Ogyaadu, Victoria Osasah

Syed F Haider: M.D Candidate, Icahn School of Medicine, Mount Sinai

Harrysh Indranathan: B.S. in Computer Engineering, Fordham College at Lincoln Center

Tiara R. Ahmad: Ph.D. Candidate, Pathobiology & Molecular Medicine, Columbia University

Selassie Ogyaadu, MD, MPH: Public Health, Icahn School of Medicine at Mount Sinai

Victoria Osasah, MPH: Epidemiology, Icahn School of Medicine at Mount Sinai

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