Category Archives: Mental Health

As Demand For Mental Health Care Continues: Technology May Be An Important Answer

Although the COVID-19 pandemic has eased, the demand for mental health care continues to persist.

A newly published 2022 COVID-19 Practitioner Impact survey by the American Psychological Association of U.S. psychologists reports that a growing demand for help with depression, anxiety and substance use issues means many psychologists across the United States are unable to take on new patients.

Over 2,200 licensed psychologists nationwide responded to the APA’s third annual practitioner survey in late September and early October. About 60% said they no longer can take on new patients and 72% said they have longer waitlists than before the pandemic. On average, psychologists said 15 people a week contact them seeking new care.

The survey reported that 79% said they have seen more patients with anxiety disorders since the pandemic began. approximately 66% have seen increased demand for depression treatment; 47% for substance use treatment, and 64% for trauma. About two-thirds of psychologists described the patients’ symptoms as being more severe this year.

Young people, especially 13- to 17-year-olds, represented the largest increases in seeking care. Many psychologists also saw a need for more care in children under 13 and among 18- to 25-year-olds.

Nearly half of psychologists reported a rising number of health care workers seeking treatment since the start of the pandemic. According to Arthur Evans Jr., chief executive officer of the APA, “Having timely access to psychological services is critical for addressing the needs of those diagnosed with behavioral health challenges,” Evans said in an association news release. “But we need to tackle this problem with a variety of solutions, beyond individual therapy.”

He cited the need to support and expand the psychologist workforce; to integrate behavioral health into primary care, and use technology and innovation to reach more patients.

About 11% of psychologists now see all patients in person, up from 4% in 2021. More than half (58%) see some patients remotely and some in person. About 31% see all patients via telehealth.

The APA noted that telehealth can expand access to care for patients from underserved communities, including those in rural areas and people of color. The APA continues to advocate for expanded coverage of telehealth by insurance companies.

With the high patient demand, about 45% of psychologists said they feel burned out. But 60% said they have sought peer consultation or support to manage it. About 77% said they were able to practice self-care and 63% said they have been able to maintain a positive work-life balance.

APA Survey Link

World Mental Health Day – October 10, 2022

Monday, October 10th, is the annual World Mental Health Day as designated by the World Health Organization (WHO). The theme this year is “Making Mental Health and Well-Being for All a Global Priority,” and for everyone to be a voice about what needs to be done to promote, de-stigmafy, and facilitate the availability and delivery of mental health treatment.

Can Technology Help?

According to the National Institute of Mental Health, “technology has opened a new frontier in mental health support and data collection. Mobile devices like cell phones, smartphones, and tablets are giving the public, doctors, and researchers new ways to access help, monitor progress, and increase understanding of mental wellbeing.”

Mobile technology can help to facilitate access to treatment and support. For example, anyone with the ability to send a text message can contact a crisis center. New technology can also be packaged into an extremely sophisticated app for smartphones or tablets. Such apps might use the device’s built-in sensors to collect information on a user’s typical behavior patterns. If the app detects a change in behavior, it may provide a signal that help is needed before a crisis occurs. Some apps are stand-alone programs that promise to improve memory or thinking skills. Others help the user connect to a peer counselor or to a health care professional.

App development has generated a great deal of enthusiasm and possibilities However, there are thousands of mental health apps available for smartphones, and the number is growing every year. However, this new technology frontier includes a lot of uncertainty. There is very little industry regulation and very little information on app effectiveness, which can lead consumers to wonder which apps they should trust.

The NIMH Highlights A Number of Pros and Cons of Mental Health Apps

Experts believe that technology has a lot of potential for clients and clinicians alike. A few of the advantages of mobile care include:

  • Convenience: Treatment can take place anytime and anywhere (e.g., at home in the middle of the night or on a bus on the way to work) and may be ideal for those who have trouble with in-person appointments.
  • Anonymity: Clients can seek treatment options without involving other people.
  • An introduction to care: Technology may be a good first step for those who have avoided mental health care in the past.
  • Lower cost: Some apps are free or cost less than traditional care.
  • Service to more people: Technology can help mental health providers offer treatment to people in remote areas or to many people in times of sudden need (e.g., following a natural disaster or terror attack).
  • Interest: Some technologies might be more appealing than traditional treatment methods, which may encourage clients to continue therapy.
  • 24-hour service: Technology can provide round-the-clock monitoring or intervention support.
  • Consistency: Technology can offer the same treatment program to all users.
  • Support: Technology can complement traditional therapy by extending an in-person session, reinforcing new skills, and providing support and monitoring.
  • Objective data collection: Technology can quantitatively collect information such as location, movement, phone use, and other information.

This new era of mental health technology offers great opportunities but also raises a number of concerns. Tackling potential problems will be an important part of making sure new apps provide benefits without causing harm. That is why the mental health community and software developers are focusing on:

  • Effectiveness: The biggest concern with technological interventions is obtaining scientific evidence that they work and that they work as well as traditional methods.
  • For whom and for what: Another concern is understanding if apps work for all people and for all mental health conditions.
  • Privacy: Apps deal with very sensitive personal information so app makers need to be able to guarantee privacy for app users.
  • Guidance: There are no industry-wide standards to help consumers know if an app or other mobile technology is proven effective.
  • Regulation: The question of who will or should regulate mental health technology and the data it generates needs to be answered.
  • Overselling: There is some concern that if an app or program promises more than it delivers, consumers may turn away from other, more effective therapies.

Currently, there are no national standards for evaluating the effectiveness of the hundreds of mental health apps that are available. Unfortunately, most apps do not have peer-reviewed research to support their claims, and it is unlikely that every mental health app will go through a randomized, controlled research trial to test effectiveness. Consumers should be cautious about trusting a program.

NIMH offers some suggestions recommended to consumers when considering using a ‘mental health’ app.

  • Ask a trusted health care provider for a recommendation. Some larger providers may offer several apps and collect data on their use.
  • Check to see if the app offers recommendations for what to do if symptoms get worse or if there is a psychiatric emergency.
  • Decide if you want an app that is completely automated or an app that offers opportunities for contact with a trained person.
  • Search for information on the app developer. Can you find helpful information about his or her credentials and experience? 
  • Beware of misleading logos. The National Institute of Mental Health (NIMH) has not developed and does not endorse any apps. However, some app developers have unlawfully used the NIMH logo to market their products.
  • Search the PubMed database offered by National Library of Medicine. This resource contains articles on a wide range of research topics, including mental health app development.
  • If there is no information about a particular app, check to see if it is based on a treatment that has been tested. For example, research has shown that Internet-based cognitive behavior therapy (CBT) is as effective as conventional CBT for disorders that respond well to CBT, like depression, anxiety, social phobia, and panic disorder.
  • Try it. If you’re interested in an app, test it for a few days and decide if it’s easy to use, holds your attention, and if you want to continue using it. An app is only effective if keeps users engaged for weeks or months.

It is clear that mental health needs more attention in the United States, as indicated by the recent polls about our deteriorating mental health. A new survey indicates that 90% of adults believe that there is a mental health crisis.1 A very recent poll by the American Psychiatric Association conveys that almost 80% agree that more attention to mental health by lawmakers is needed.2

  1. CNN Health/Kaiser Foundation. 90% of US adults say the United States is experiencing a mental health crisis
  2. Americans Believe Mental Health Is a Public Health Emergency That Needs More Attention from Lawmakers.

App for serious mental illness starts clinic-training phase

The Patient-Centered Outcomes Research Institute (PCORI) announced funding ($1.8 million) to bring a mental health smartphone app into real world practice. The app is called FOCUS, which has shown promise as a supportive therapy for people who have serious mental illness such as schizophrenia and bipolar disorder. 

The development team,headed by Dror Ben-Zeev, Ph.D. a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, have guided the app’s development through early user studies, the most recent of which showed that patients found the digital therapy more engaging than a scheduled trip to the clinic — the far more resource-intensive conventional care.

The next step for FOCUS involves rolling out a system aimed at teaching clinicians how to engage patients to use the app confidently and how to get the most information from patients’ use.

“We demonstrated that FOCUS is clinically potent in several studies, but to move this from academic research to real-world practice, we need an implementation approach that includes digital trainings for clinicians who are not used to mental health apps. This will support their journey as digital health adopters, which is a daunting task for some. We’re creating evergreen materials so any clinician will be able to get FOCUS up and running with their patients quickly,” Ben-Zeev said.

Part of the study is to understand how different clinic staff might need different information upfront about FOCUS to introduce it in a compelling way to their colleagues.

“It could be frontline clinicians or admin support people or team leaders, so we need to ensure that we finely tune the information that helps FOCUS make the greatest impact it can,” Ben-Zeev said.

The FOCUS app has written and video content adapted from in-person, evidence-based interventions. Its treatment domains address:

  • auditory hallucinations (“hearing voices”)
  • mood problems (typically depression and anxiety)
  • sleep
  • social functioning such as social skills training or paranoia
  • medication use (reminders and information to examine counter-therapeutic beliefs that people might have about their medications)

The App is Always Available

The app’s 24/7 availability is a huge advantage for patients who may have mental health needs outside clinic hours and who otherwise might need to wait several weeks or more to address an episode in a clinic environment. 

Moreover, many patients with serious mental illness receive services at community mental health centers. These facilities often are under-resourced and less able to provide continuity of care due to high turnover rates among their staff. FOCUS can provide continuity of care as clinical staffing ebbs and flows, Ben-Zeev said. 

The study will be conducted in collaboration with the adult outpatient programs at community mental health agencies in New Hampshire and Missouri that care for people with serious mental illness: 

Sources:

UW Medicine Newsroom

PCORI News

BRITE Center (Focus Developers)

NICE’s Early Value Assessment for Medtech

The explosion in digital health products has left National Health Service commissioners in the UK wondering how they can possibly sift out what works and what provides maximum benefit for the service and for patients.

The Early Value Assessment for Medtech will offer a rapid assessment of digital products, devices and diagnostics for clinical effectiveness and value for money. The goal of this new approach is that the service and patients will be able to benefit sooner.

Early Value Assessment is being designed to draw in the most promising and impactful medical technologies where the evidence base is still emerging, starting with digital products, in areas where there is greatest need.  Whether its empowering patients to better manage their own health and seek clinical advice, reducing admissions and waiting lists or supporting clinicians and other front-line staff to provide better quality care this new program will help to alleviate system pressures as the NHS recovers from the COVID pandemic.

In this accelerated approach, the first two pilot digital health topics will begin their early value assessments this month (June) with a view to publishing findings in October. This is much faster than a full NICE Medtech evaluation meaning benefits will be realized sooner, while companies generate more evidence required for a full NICE evaluation at a later stage.  

The first two pilots are digital apps for depression and anxiety in children and others will quickly follow in adult mental health, early cancer diagnosis, cardiovascular disease and other areas that support elective recovery following the pandemic.

In this ‘fast-track’ approach, NICE is working closely with NHS England and all its system partners to help develop commercial and data collection arrangements to support the technologies that go through early value assessment in adoption and scaling and to make this new program of work deliver on the potential of digital health for patients.

Source: NHS Blog

Long-term Risks of Mental Health Outcomes Post-Covid-19

The short-term consequences from COVID-19 have been described after the initial “acute” infection passes. These have included not only a variety of physical symptoms, but also psychiatric symptoms have been reported. A team of VA researches has been shining a light on various dangerous and enduring consequences that can arise following the initial COVID bout. These COVID complications include mental health disorders.

A study published this week in the British Medical Journal (BMJ) by researchers with the VA St. Louis Health Care System focused on mental health disorders following COVID-19 infection.  They found that, even in people not needing hospitalization while infected with COVID-19, serious health issues related to mental health could persist, or pop up, in the weeks and months following the acute stage. They describe that the reasons for the increased mental health risks after COVID are not completely clear. Biologic changes may occur in the body that affect the brain, and nonbiologic changes such as social isolation and trauma may also be at play.

The researchers analyzed medical records in a database within VA, which operates the largest integrated health care system in the United States. The analysis included nearly 154,000 patients who had tested positive for COVID-19 in a defined time frame from March 2020 into January 2021. (The time frame predated the delta and omicron variants, as well as wide availability of vaccines.) A comparison was made of these patients’ health information with data from more than 11 million people who had not had COVID-19 infection—about half of them from the same time frame and the other half from a pre-pandemic timespan.

The research group compared the mental health risks for those who had COVID-19 and survived the first 30 days of infection with the same health outcomes among those who were not infected. Over a study period of about a year, the researchers identified elevated risks for issues such as anxiety, depression, stress disorders, opioid use, substance use disorders, and sleep conditions. 

“We’ve all suffered some sort of distress from this pandemic—maybe a measure of anxiety or difficulty sleeping,” says lead investigator Al-Aly. “But these challenges are magnified, especially in those who were admitted to the hospital during the acute part of their COVID battle but also in many who experienced only mild or moderate symptoms.”

Compared to those who did not have COVID, those in the COVID group had a 60 percent higher risk of having any mental health disorder or mental health-related prescriptions.

Findings by the type of mental health issue were:

  • Anxiety: 35 percent higher risk in the COVID-19 group
  • Depression: 39 percent higher risk
  • Sleep disorder: 41 percent higher risk
  • Opioid use: 76 percent higher risk
  • Opioid use disorder: 34 percent higher risk
  • Non-opioid substance use disorders: 20 percent higher risk.
Hospitalized COVID-19 patients fared the worst. (BMJ 2022)

Given the large number of people with COVID-19, these findings could translate into a huge impact in the United States and around the world, the authors point out. A strength of our research was the large number of patients and the ability to leverage the breadth and depth of the VA’s electronic health records system,” highlights Al-Aly. As a pioneer in the use of electronic health records, VA “can offer answers to questions about areas including the pandemic that would be hard for others to address.”

The researchers were a multidisciplinary research team for making the rigorous analysis possible brought together public health experts from across disciplines, successfully marrying the medical and research perspectives. An Editorial in the BMJ by lead researcher points out that mental health disorders represent one part of the multifaceted nature of long covid which can affect nearly every organ system (including the brain, heart, and kidneys). Our results should be used to promote awareness of this risk among people with covid-19 and to guide efforts for the early identification and treatment of affected individuals.

Research Article: Xie Y, Xu E, Al-Aly Z. Risks of mental health outcomes in people with covid-19: cohort study. BMJ 2022; 376 (Published 16 February 2022)