Understanding Mental Health Apps — Neurotech SF presentation
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What does the mental health app and psychiatry informatics landscape look like? A brief 15-minute look given at Neurotech SF conference at UCSF Mission Bay, by Steven Chan — University of California, Davis researcher and resident physician — on barriers, challenges, and near-term solutions on psychology, psychotherapeutics, and digital mental health.
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Understanding Mental Health Apps — Neurotech SF presentation
- 1. @StevenChanMD @StevenChanMD UNDERSTANDING MENTAL HEALTH APPS BOKEH iMAGE: https://www.flickr.com/photos/stignygaard/5192721433 MBA UCSF MISSION BAY CONFERENCE CENTER • 6 APRIL 2016 @UCDavisHealth. Special thanks to Lisa Intrator, Arshya Vahabzadeh, Peter Yellowlees, American Psychiatric Association.
- 2. @StevenChanMD 1 in 5U.S. adults suffer from a mental health condition in a given year. https://www.nami.org/Learn-More/Mental-Health-By-the- Numbers @StevenChanMD
- 3. @StevenChanMD This imag e cann ot curre ntly be displ ayed. Among Southeast Asians… 71%meet criteria for major mood disorders like depression— with 81% among Cambodians — & 85% among Hmong.
- 4. @StevenChanMD CAUSES OF DISABILITY World Health Organization, retrieved 10/2015. http://www.nimh.nih.gov/health/statistics/disability/us-leading-categories-of-diseases-disorders.shtml US Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA, 310(6): 591-608, 2013. MENTAL & BEHAVIORAL DISORDERS NEUROLOGICAL DISORDERS NEUROPSYCHIATRIC DISORDERS CARDIOVASCULAR & CIRCULATORY NEOPLASMS MUSCULOSKELETAL DIABETES, UROGENITAL, BLOOD, ENDOCRINE CHRONIC RESPIRATORY OTHER NON-COMMUNICABLE DISEASES UNINTENTIONAL NON-TRANSPORT INJURIES SELF-HARM & INTERPERSONAL VIOLENCE TRANSPORT INJURIES
- 5. @StevenChanMD time happy neutral sad Feeling down No pleasure Suicidal plans & intent unipolar depression Thi s ima ge
- 6. @StevenChanMD happy neutral sad time bipolar hypomania bipolar mania overexcitement euphoria delusions overactivity bipolar depression
- 9. @StevenChanMD IMAGE: : https://www.flickr.com/photos/porsche-linn/7085203423/ USED UNDER CREATIVE COMMONS.
- 10. @StevenChanMD http://www.dhhs.saccounty.net/BHS/Documents/Advisory-Boards-Committees/Mental-Health-Board/MHB-General-Meeting-Minutes- 2011/2011-10-05_MHB_Gen_Minutes--AttC_Mental_Health_Service_Continuum_FY2011-2012.pdf Acute PCP Human Resources Consultants Northgate Point Visions Transcultural Wellness Center (FSP) Sierra Elder Wellness (FSP) Telecare SOAR (FSP) Turning Point ISA - (FSP) Specialty Mental Health Services Primary Care Center FQHC FQHC w/Behavioral Health Other FQHCs & Healthcare Clinics Community Resources Alcohol & Drug Services CalWORKs ELIGIBILITY: Adults who are a danger to themselves or others or require 24-hour care in a locked setting. HRC - TCORE Sub Acute ELIGIBILITY: 18-59 years of age, must be ambulatory and three days of sobriety. ELIGIBILITY: Target population criteria, is unable to reside in the community as a result of psychiatric conditions. Often have co-morbid medical or substance abuse disorders. Clients in secure settings are on LPS Conservatorship. Crestwood PHF Sutter Center for Psychiatry Heritage Oaks Hospital Sierra Vista Out of County FUNDING SOURCES MHSA Realignment/General Fund FFP/Medi-Cal SAMHSA CalWORKs PATH Prevention and Early Intervention Project 1 Suicide Prevention Crisis Line Postvention Support Supporting Community Connections Community Support Team Project 2 Strengthening Families Quality Child Care Collaborative HEARTS for Kids School and Community- Based Services Building Life Skills for Teens and TAY Project 3 Integrated Health and Wellness Screening, Assessment, Brief Treatment and Peer Support – Community Health Care Clinics SacEDAPT SeniorLink Project 4 Mental Health Promotion Campaign Multi-Media Campaign Community Outreach and Engagement Speakers Bureau Community Education Mental Health Treatment Center Inpatient Authorization Intensive Placement Team Intensive and Subacute Services El Hogar Guest House Homeless Services Sacramento County Access Team (Low to High Intensity Planned Services) Trans Res Willow Glen MHRC Crestwood Sacramento Angwin Bakersfield San Jose SNF - L Stockton Modesto Redding Neuro Behaviorial Idylwood Fremont Medical Hill Garfield Napa State Hospital Community Supports Access Points Low Intensity Moderate Intensity High Intensity Regional Support Teams County Operated Clinics El Hogar CSH Wellness & Recovery Centers North South Turning Point Crisis Residential MHTC CSH Office of Patient’s Rights APSS Clinic - Bowling APSS Aftercare Clinic Turning Point Pathways (FSP) El Hogar – Guest House / Outreach Services & Access Point TLCS – New Direction (FSP) Homeless Services ELIGIBILITY: Target Population, Homeless, At Risk of Homeless Morton Baker KEY SAAC – Southeast Asian Assistance Center HWHA – Hmong Women’s Heritage MHANC – Mental Health America of Northern California PCP – Primary Care Physician FQHC – Federally Qualified Health Care Clinic APSS – Adult Psychiatric Support Services FSP – Full Service Partnership ISA – Integrated Service Agency CSH – Consumer Self Help Trans Res – Transitional Residential Program MHRC – Mental Health Rehabilitation Center SNF-L – Skilled Nursing Facility – Locked PHF – Psychiatric Health Facility TLCS – Transitional Living & Community Support Southeast Asian Assistance Center Interpreter & Translation Services System wide Community Emergency Rooms serving Psychiatric & Residential Facilities High Intensity Jail Psych Peer Partners MHANC HWHA Mental Health America of Northern California Consumer Advocate Liaison to Division of Behavioral Health Adult & Family Advocate Liaison to Division of Behavioral Health Communitysupports Accesspoints SpecialtyOutpatient Acute Acutelocked Subacutelocked PreventionandPromotion
- 11. @StevenChanMD Those are the hardest patients I never want to deal with. There are definitely businesses there…but you’re not picking the low hanging fruit." Lucian Iancovici, MD, Senior Investment Manager - Qualcomm Ventures “
- 12. @StevenChanMD SPARX cognitive behavioral therapy game MerryS, Stasiak K et al. The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial. BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2598(Published 19 April2012) http://www.bmj.com/content/344/bmj.e2598.Also covered at http://www.imedicalapps.com/2014/01/video-game-depression-anxiety-kids- diabetes-asthma-linkedwellness/
- 13. @StevenChanMD CBT = Cognitive Behavioral Therapy thoughts feelingsbehavior 1. Identify critical behaviors 2. Determine if critical behaviors are excesses OR deficits 3. Evaluate critical behaviors for frequency, duration, or intensity 4. If excess, attempt to decrease. If deficits, attempt to increase behaviors.
- 14. @StevenChanMD It’s no longer adequate to have an app layer, even if you’re doing CBT. I don’t think that answers the real problem within the healthcare system.” Lynne Chou O'Keefe, Partner - Kleiner Perkins Caufield and Byers “
- 15. @StevenChanMD SUICIDE WARNING SIGNS Depressed mood Suicide plans & intention Drugs & alcohol use
- 17. @StevenChanMD Published in 2012 4 years ago None of the apps cited are available or updated for years. http://berkeleysciencereview.com/can-your-phone-cure-depression/ APPS GET OUTDATED QUICKLY
- 20. @StevenChanMD Huckvale et al. BMC Medicine (2015) 13:214 DOI 10.1186/s12916-015-0444-y x79
- 21. @StevenChanMD PRIVACY RISKS Huckvale et al. BMC Medicine (2015) 13:214 DOI 10.1186/s12916-015-0444-y Half of apps (50 %, n = 35/70) included strong identifiers in transmitted information. Two-thirds of these (66 %, n = 23/35, 29 % of all apps) sent identifying information without encryption, including email addresses (n = 5), account login details (n = 5), full name (n=2) or date of birth (n=2).
- 22. @StevenChanMD “CRITERIA” FOR DOCTORS 1 Use reputable institutions & verified developers. 2 Try an app yourself first. If an average person can use it — prescribe it. 3 Informed consent on security, privacy, and lack of testing is key.
- 23. @StevenChanMD VA APP STORE — mobilehealth.va.gov 11 total mental health apps
- 24. @StevenChanMD APP COUNT Search done April 5, 2016 for search terms in AppAnnie. Based on Chan SR, Torous J, Hinton L, Yellowlees P. “Mobile Tele-Mental Health: Increasing Applications and a Move to Hybrid Models of Care.” Healthcare 2014, 2(2), 220-233; doi:10.3390/healthcare2020220 Keyword Android iPhone Depression 233 795 Anxiety 236 1185 Schizophrenia 224 32 Bipolar 245 172 Alcoholism 224 60 Perfectionism 0 0
- 25. @StevenChanMD ANGELLIST total # of mental health startups 0 20 40 60 80 100 120 140 160 180 200 3 9 53 162 175 TOTAL
- 26. @StevenChanMD BEYOND APPS: NEW MENTAL HEALTH TECH https://angel.co/mental-health-3 & @StevenChanMD graphics & analysis Of the 175 MH startups on AngelList, 109 joined in 2015.
- 27. @StevenChanMD Verily’s involvement signals their confidence in technology’s role in one of the most underserved areas of medicine. Alphabet is actively looking at augmented reality, diabetes, geriatrics, & AI in healthcare. “Technology can cover much of the diagnostic process ... Also, a lot of the treatments for mental health are psychosocial interventions, and those can be done through a smartphone.” — THOMAS INSEL, M.D., SEPT 21, 2015 http://www.technologyreview.com/news/541446/why-americas-top-mental-health-researcher-joined-alphabet/
- 28. @StevenChanMD Tasha Glenn, Scott Monteith.” New Measures of Mental State and Behavior Based on Data Collected From Sensors, Smartphones, and the Internet” Curr Psychiatry Rep (2014) 16:523 DOI 10.1007/s11920-014-0523-3 location accelerometer net usage text analysis voice pattern light & imaging
- 29. @StevenChanMD Three categoriesof mental health apps For communications & coordination. As an extension of face-to-face clinic. As new intervention & monitoring.
- 30. @StevenChanMD FOR COMMUNICATIONS Doctors on Demand HealthLinkNow American Well 1docway Talkspace MDLive Breakthrough
- 31. @StevenChanMD Three categoriesof mental health apps For communications & coordination. As an extension of face-to-face clinic. As new intervention & monitoring.
- 32. @StevenChanMD Courtesy Kimberlie Cerrone, Tiatros TIATROS IN PTSD STUDIES
- 33. @StevenChanMD https://developer.ibm.com/watson/blog/2015/03/23/ibm-watson-personality-insights-science-behind-service/ Machine learning & big data to drive population health and individual health.
- 34. @StevenChanMD POLARIS HEALTH + MD ANDERSON CANCER CENTER Breast cancer trial Using responsive-adaptive questions & self-report, generating good referrals, & “Expected Treatment Response” predictions $13m+ in NIH funding In oncology, addiction, women’s health, DV, primary care. http://www.polarishealth.com/what-is-empower/
- 35. @StevenChanMD Three categoriesof mental health apps For communications & coordination. As an extension of face-to-face clinic. As new intervention & monitoring.
- 36. @StevenChanMD SPECIFIC PHOBIAS SOCIAL ANXIETY ALCOHOL USE PTSD RELAXATION Psious Affordable virtual reality can enhance psychotherapy.
- 37. @StevenChanMD .. BRAIN POWER SYSTEM Wearable Educational System for Autism
- 38. @StevenChanMD Duke University + Apple ResearchKit face emotion-detection for autism https://autismandbeyond.researchkit.duke.edu , https://today.duke.edu/2015/10/autismbeyond
- 39. @StevenChanMD Courtesy Helen S. Koo PhD, @UCDavis — http://helenskoo.com WEARABLE TECH + CLOTHING
- 40. @StevenChanMD Three categoriesof mental health apps For communications & coordination. As an extension of face-to-face clinic. As new intervention & monitoring.
- 41. @StevenChanMD Mental health apps UC Davis Behavioral Center of Excellence, MIND Institute, Psychiatry, School of Nursing — Tara Niendam, Anthony Jerant, Peter Yellowlees, Cam Carter, Tony Simon UC San Francisco DRIVE, YAFC — Danielle Schlosser, Kim Norman UC Riverside Brain Game Center — Aaron Seitz UCLA M2 project — Bonnie Zima
- 42. @StevenChanMD Fragmented systems create opportunity for new mental health platforms.
- 43. @StevenChanMD $26.4m TELEHEALTH in MENTAL HEALTH $23.0bn PSYCHIATRIC HOSPITALS $17.2bn MH + SUD CLINICS $34.2bn COUNSELING + CRISIS SVC $7.8bn ALCOHOL / DRUG REHAB
- 44. @StevenChanMD Recent HIMSS announcement The Centers for Medicare and Medicaid Services finally is offering Meaningful Use-type incentives to long-term care, behavioral health and substance abuse care providers. ... The 2009 HITECH Act…excluded nonphysician behavioral health…addiction professionals…long-term care facilities. http://medcitynews.com/2016/03/cms-health-it-ltc- behavioral-health/?rf=1 “
- 45. @StevenChanMD American Telemedicine Association Mental Health track Behavioral “NatCon” tech track ACM CHI Mental Health, Affective Computing, Pervasive Computing ? MENTAL HEALTH TECH EVENTS
- 46. @StevenChanMD PSYCHIATRY INNOVATION.COM Pitch-a-thon & design session with judges from start-ups, U.S. HHS, APA, & more Submit your idea by April 29, 2016
- 47. @StevenChanMD @StevenChanMD UNDERSTANDING MENTAL HEALTH APPS BOKEH iMAGE: https://www.flickr.com/photos/stignygaard/5192721433 MBA UCSF MISSION BAY CONFERENCE CENTER • 6 APRIL 2016 @UCDavisHealth. Special thanks to Lisa Intrator, Arshya Vahabzadeh, Peter Yellowlees, American Psychiatric Association.