Posted: Tuesday, August 30, 2016
In twenty years, how will mental health diagnoses like bipolar and depression be treated? That’s the question behind a Dartmouth Medical School research study in which TPC was selected to participate earlier this year. The study, called “Using Automated Telehealth to Improve Psychiatric Illness Management,” uses tablets with specially tailored content to monitor and connect with clients who suffer from severe mental illness.
TPC’s clinical professionals at are constantly looking for innovative ways to remove barriers to access for clients, and technology will likely play an increasingly important role in the future. There are already a myriad of popular smartphone apps designed to treat conditions like anxiety and depression, and this month, Time magazine featured a story about telemedicine as a way to provide much-needed treatment to teens in underserved rural areas. And with health care costs now rising faster than inflation, the potential cost-savings of technology solutions will be attractive to insurers if proven effective.
The study’s lead researcher, Sarah Pratt, PhD, an Assistant Professor in Psychiatry at The Geisel School of Medicine at Dartmouth, was initially approached by a community mental health center in New Hampshire in 2008 about the possibility of conducting research on an automated telehealth intervention that had been used with medical issues. “They had a few clients using the telehealth program to monitor unstable medical conditions like diabetes and heart disease, and were wondering whether the technology could be applied to manage unstable psychiatric illness,” said Pratt. “I was intrigued by the possibilities, so with the help of a colleague, I developed psychiatric content that was loaded onto the telehealth platform.”
The psychiatric content creates a library of support for clients so that if a certain problem is triggered, clients receive an immediate response that helps them manage their symptoms in a concrete and clinically effective way. The clients and the tablet responses are monitored by a clinician who regularly checks in with clients and provides immediate support if a critical problem is identified on the tablet.
Pratt’s original study, which provided 40 individuals with the telehealth intervention for six months, found that clients with serious mental illness who received the treatment experienced an 82% decrease in hospital stays and a 75% decrease in emergency room visits, while also “showing improvement in quality of life, severity of depressive symptoms, and mental health status.”
These encouraging results led to a grant from the National Institute of Mental Health for an expansion of her research, and Pratt reached out to The Providence Center. “I had worked with TPC since 2010 on projects designed to improve integration of physical and behavioral health for people with serious mental illness, so I knew that the team and the agency had the ability to effectively provide innovative interventions and to successfully implement research,” said Pratt.
TPC has devoted 3 full-time staff members to the study, and are hoping to enroll 100 participants in the first year. The project targets TPC clients who have experienced significant recent psychiatric instability, defined as at least 2 or more psychiatric hospitalizations or emergency room visits, multiple calls to the crisis line during the past 12 months and diagnosis of one of the following disorders:
Clients who meet the criteria come to TPC for a baseline assessment and are then randomized to either receive the telehealth intervention for 12 months or to continue with their usual care and simply return for follow-up assessments. Participants have a 50/50 chance of either receiving the ”Tele-friend” program or continuing with their regular care, but all clients involved in the study are expected to come in four times over 12 months for a compensated assessment interview.
Participants who receive the Tele-friend complete a 5-10 minute session on their device daily, receiving education about their illness and answering questions that are designed to detect early warning signs of illness. The questions in the sessions are as simple as “did you take your medication?,” or “have you experienced any mood fluctuations in the past 24 hours?”
Taylor D’Addario, a manager at TPC who is in charge of overseeing the staff for the study, is excited about the close connection between clients and the education and monitoring that the devices provide. “A patient in regular treatment that needs a medication adjustment may not have their next appointment for another few months,” said D’Addario. “With these devices, we have a chance at identifying and responding to an issue right away, which can avert a relapse and the client won’t have to start from square one.”
If the results of the study are positive, TPC will likely consider implementing a program using similar technology.