Fact sheet 02-2016

Digital Services for my Mental Health

E-health solutions (videoconferencing, online and mobile services) for mental health are available for a wide range of needs and purposes – from health promotion and prevention, to treatment and aftercare for persons with long-term support needs.

The solutions that have been researched the most, and thus have the best evidence, are cognitive behavioural therapies for mild and moderate anxiety and depressive disorders (1,2). Among these in Norway are eMeistring from the University of Bergen, a therapist-assisted treatment program, which has enabled therapists to treat far more patients. MoodGYM is conveyed by UiT The Arctic University of Norway, and is a self-help program that is being examined in the EU MasterMind project, in line with a ‘stepped-care’ model within primary and secondary health services. With increased implementation nationally, for instance in relation to initiatives such as Quick mental health care (“Rask psykisk helsehjelp”), such solutions may have significant implications for public health and labour market participation.

For persons with severe and enduring mental health issues, health authorities in a number of countries are in the process of turning from a traditional focus on reducing symptoms to a greater focus on recovery – that is, the process towards a meaningful life despite mental symptoms (3,4). This is reflected in increasing research on e-health solutions for chronic conditions that may be equally relevant in somatic medicine and mental health (5,6). Such solutions frequently combine self-management resources, peer support and support in the communication and follow-up of the patients’ own goals and activity plans, interaction with their helpers as well as facilitating involvement in the local community. ‘Reconnect’ is one such solution in Norway, and has been developed with strong user involvement in a collaboration between the Norwegian Centre for E-health Research and Oslo University Hospital (7). Such solutions can help strengthen the dissemination of evidence-based interventions – such as Individual Placement and Support (IPS) (8), and Illness Management and Recovery (IMR) (5). Internationally, research is still in an exploratory pilot phase, but it is developing rapidly.

In Norway, the development will accelerate through Helsenorge.no and citizens’ access to their own health records (EHR). However, increased user involvement in the patients’ own treatment processes is unlikely to occur automatically through the portal and EHR access. The whole sector will need to work together in making the most of the opportunities the portal provides for health promotion and user involvement. The fact box at the top shows an example from a Canadian patient portal study in which all patients in a major tertiary psychiatric hospital were given access to their own EHR, as well as options to notify their therapists (9). Among the 432 portal users, one found increased patient activation and treatment, as well as organizational benefits in the form of fewer canceled appointments and fewer requests for information. Another study also shows promising findings related to personal electronic health records for those with serious comorbid psychiatric and somatic conditions (10).

Despite promising results, there will be a continuing need for measures against digital divides in the population due to differences in health and e-health ‘literacy’ (11) – that is, the ability to make use of these opportunities. Furthermore, it has been highlighted that both recovery thinking and e-health solutions may shift power between users/patients and therapists in ways that may be experienced as challenging for the sector (12,13). There are also ethical/legal challenges involved in this. Therefore, skills development, organizational development and implementation strategies are important for the Directorate of e-health’s strategies for e-health in mental health.

References

1. Olthuis JV, Watt MC, Bailey K, Hayden JA and Stewart SH. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews. 2016.
2. Andersson G and Titov N. Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry. 2014; 13: 4-11.
3. Mental Health Commission of Canada. TOWARD RECOVERY & WELL-BEING: A Framework for a Mental Health Strategy for Canada. National Library of Canada2009.
4. Commonwealth of Australia. A national framework for recovery-oriented mental health services: Policy and theory. Canberra, Australia2013.
5. Beentjes TA, van Gaal BG, Goossens PJ and Schoonhoven L. Development of an e-supported illness management and recovery programme for consumers with severe mental illness using intervention mapping, and design of an early cluster randomized controlled trial. BMC Health Serv Res. 2016; 16: 20.
6. Gammon D, Berntsen G, Koricho A, Sygna K and Ruland C. The chronic care model and technological research and innovation: a scoping review at the crossroads. J Med Internet Res. 2015; 17: e25.
7. Gammon D, Strand M and Eng LS. Service users’ perspectives in the design of an online tool for assisted self-help in mental health: a case study of implications. International Journal of Mental Health Systems. 2014; 8: 2.
8. Lord SE, McGurk SR, Nicholson J, et al. The potential of technology for enhancing individual placement and support supported employment. Psychiatric Rehabilitation Journal. 2014; 37: 99-106.
9. Kipping S, Stuckey MI, Hernandez A, Nguyen T and Riahi S. A Web-Based Patient Portal for Mental Health Care: Benefits Evaluation. J Med Internet Res. 2016; 18: e294.
10. Stein B, Kogan J, Mihalyo M, et al. Use of a Computerized Medication Shared Decision Making Tool in Community Mental Health Settings: Impact on Psychotropic Medication Adherence. Community Ment Health J. 2013; 49: 185-92.
11. Karasouli E and Adams A. Assessing the Evidence for e-Resources for Mental Health Self-Management: A Systematic Literature Review. JMIR Mental Health. 2014; 1: e3.
12. Naslund JA, Aschbrenner KA, Marsch LA and Bartels SJ. The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences. 2016; 25: 113-22.
13. Alvarez-Jimenez M, Alcazar-Corcoles MA, González-Blanch C, Bendall S, McGorry PD and Gleeson JF. Online, social media and mobile technologies for psychosis treatment: A systematic review on novel user-led interventions. Schizophrenia Research. 2014; 156: 96-106.
14. Krägeloh CU, Czuba KJ, Billington DR, Kersten P and Siegert RJ. Using Feedback From Patient-Reported Outcome Measures in Mental Health Services: A Scoping Study and Typology. Psychiatric Services. 2015; 66: 224-41.
15. Markham S. Development of an online clinical trial recruitment portal for the NIHR mental health BRC. Research Involvement and Engagement. 2016; 2.
16. Swan M. Crowdsourced health research studies: an important emerging complement to clinical trials in the public health research ecosystem. J Med Internet Res. 2012; 14: e46.
17. Kayser L, Kushniruk A, Osborne RH, Norgaard O and Turner P. Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users’ Needs. JMIR Human Factors. 2015; 2: e9.
18. Park M, Zafran H, Stewart J, et al. Transforming mental health services: a participatory mixed methods study to promote and evaluate the implementation of recovery-oriented services. Implementation Science. 2014; 9: 119.
19. Bjerkan J, Vatne S and Hollingen A. Web-based collaboration in individual care planning challenges the user and the provider roles – toward a power transition in caring relationships. Journal of Multidisciplinary Healthcare. 2014; 2014:7 561-72.