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Using Technology to Improve Care of Serious Mental Illness
A panel of presenters at the upcoming virtual 2021 American Psychiatric Association Annual Meeting, will examine how digital technology could be used to facilitate long-term recovery in patients with first episode psychosis.
In this video, presenter John Torous, MD, MBI, gives an overview of the session and its key takeaways and discusses how digital tools are currently being used in psychiatry and potential future uses. Dr. Torous is Director, Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston Massachusetts. He will present the session with Mario Alvarez-Jimenez, PhD, and Tristan Gorrindo, MD, at 4 p.m. on May 1, 2021.
Read the transcript:
Hello, I’m Dr. John Torous. I'm a psychiatrist and the Director of Digital Psychiatry at Beth Israel Deaconess Medical Center. I'm also the technology expert adviser for SMI Adviser, which is a SAMHSA [Substance Abuse and Mental Health Services Administration] and APA Initiative.
In this session, we're talking about different ways that technology can help advance and augment care for serious mental illnesses. Specifically, we're looking at schizophrenia, and we're looking at how technology can bring benefit in these illnesses.
I think one interesting aspect that Mario [Alvarez-Jimenez, PhD] is covering is really looking at moderated online social media therapy. I have to get it. It's moderated online social media therapy. It's MOST. It's an interesting and exciting model he's talking about, because there's several advantages to this that we don't really often take advantage of in regular clinical care.
One is we know that positive social experiences can be tremendously beneficial in clinical care. They can offer so much, and I think we've seen that social media can be a source of good or bad, but think about the connections people can find if unwell. The resources that you could find on the Internet, the inspiration you can find, careers even now you can find, because they're helping people use technology, and especially around to social aspects for good, are terrific.
The moderated part of it, again, really makes sure it's safe. We're having to write content. We're avoiding stigmatizing content. We're pushing it the same way. I think, when you're looking at social, what's interesting is it becomes distributed.
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It doesn't have to be one clinician working directly with one person, which is good. Again, that's not always as scalable. We can't always reach as many people. When we're doing things, especially using these forms of asynchronous telehealth—one-to-many, and not in real time—we can really actually increase the reach of people that we're going for and helping today.
I think there's a lot of advantages to things like this moderated online therapy.
There's also many other things that we're covering as well. There's smartphone apps. There's a lot of traditional . . . I guess, by now, in 2021, they're not as exciting. But I think there's things that, again, apps can be doing well in helping capture the real-time experiences of patients. We can understand beyond someone's experiences, but understand how is sleep impacting it? How is your environment impacting your symptoms? What changes over time?
That can be very important, too. We're really bringing in these new dimensions of, say, space and time into how people experience illness. That can be useful for 2 things. It can help us better understand, diagnose, monitor.
It can also help us prescribe medications better, figure out what type of therapy would be best for someone, understand how interventions like sleep, diet, and exercise really can be customized or most effective for people.
I think what we're seeing here is really exciting ways that technology can be used to augment and to supplement care. At this point, no one's saying this is replacing care. It's, again, to make it a little bit better. It's not yet a substitute.
That leads into thinking about, well, how are these tools really being used here, now, and today? What are we doing with these tools in care, and what are we not doing with them, which is just as important? If you look at them, very few of tools, at least in the US context, have FDA approval.
The ones that do have FDA approval, often, it's in conjunction with being used with a clinician. Most of these technology companies will say, if you read the privacy policies, they're not to be a substitute for care. Again, they're here to augment.
That's because there's a lot of interesting things we can do with them today. In part, again, what we can do is use technology to help monitor and to help quantify and understand people's experience. That could be something as simple as medication tracking.
It could be mood tracking. It could be helping understand people's exercise. If you put that together, we can answer interesting questions. How does exercise impact mood? How does sleep impact depression? How is anxiety impacted by green space exposure?
There's a lot of interesting questions just in there, and again, I think if any of us have been to the iTunes and Android store, we know there's a lot of apps that are offering mindfulness. Some are offering psychoeducation information. Some are offering different meditation and relaxation interventions. Some are offering journaling. There's a whole bunch of them out there.
I think what we're seeing in care especially is, in part, people are turning to these apps naturally. They're seeing ads directly on TV, and sometimes social media, about these ads. I think clinicians are getting a little bit more comfortable recommending them, per se. I think we're seeing these apps being used in this augment or supplementary role in care today.
Certainly with COVID and remote care, it's expanded, and I think we've seen more interest and uptake, again, from both patients and clinicians around this. In terms of using moderated social media platforms Mario's talking about, I think he's expanding that platform tremendously. It's being used as different sites in different parts of the world, as he was talking about. It's not yet a standard part of care. It may very well soon be, if the evidence continues to show how well it's working, and we do more training of people on it.
In part, if we take a step back and say, "It's great we're using all these pieces today," but to really get them used more, we have to do 2 things. We have to focus on what can we do to help patients use these technologies, and what can we do to help clinicians use them?
In terms of patients, again, Mario's talking about patients with schizophrenia and serious mental illness, and that research will also talk about work that our teams are doing. I think we really have to focus on how do we make sure that patients have the digital literacy and these skills and confidence and knowledge to successfully navigate technology, to log onto online portals, to download apps, to connect to WiFi, to save their battery, to respond to messages.
These are some things that sometimes we take for granted that everyone can use a smartphone. Most people can, but I think sometimes we find that people really benefit from a little bit of additional training or help, and anyone can learn it. People with serious mental illness can certainly learn that.
On the clinician side, I think there's some pretty strong evidence that clinician enthusiasm, having a clinician champion, is a very strong and predictive way of getting a technology used.
That can really give you a census of how well this is going to be implemented and what's going to happen. One of the projects we're doing with SMI Adviser is called digital navigator training. The idea is can we begin to offer clinicians, but also offer volunteers, offer a peer specialist, extra training, so they can help support and use apps in care, and help facilitate and implement that.
The analogy may be thinking about, say, a radiology tech and radiologist, or a pathology tech in pathology. They're helping interface through technology. They're doing some quality control. They're helping run some of these machines, set them up.
We could think that a digital navigator could be an important new member of the care team that really helps facilitate and implement technology.
As I said, we'll talk about our SMI Adviser efforts towards that, as well as just offering broad education to helping clinicians learn about what's different about telehealth, in light of COVID. What are best practices? How do you get started with telehealth? If you do telehealth, how do you increase engagement?
I think we're focusing on the technology itself, but also a step backwards. How do we build patients and clinicians to be confident and comfortable using this?
The Future of Technology in Mental Health Care
I think that, if we look far forward, and we say, "Well, what's going to happen in 5 to 10 years? Where is this really going?" I think the way that we practice and consider mental health care is going to be a little bit different.
I think the things like the moderated online social therapy that Mario's talking about are likely going to take off. We're going to see really using social media, harnessing it for good. We're going to eventually distill out those negative elements, those stigmatizing elements, the false information from it, and really harness it.
I think we're going to see more people helping people, but we're going to have clinicians helping as well. We're going to see the whole new workforce, where we're going to match people to similar experiences. We're going to be able to really, again, meet the demand for more care with a new type of providers.
As I said, we'll still have psychologists. We'll still have psychiatrists. We'll still have wonderful nurse practitioners and social workers and peer specialists, but I think we're going to see that we're really going to be training and bringing on new workforces to make technology work.
I think as we refine how these apps work and wearables, we're going to really better understand each person's experience of mental health and their pathway. I think we can all agree that we have terms like depression and anxiety today that are useful, but these illnesses, they're different for every person.
If you think about 2 people you know who have had depression, you probably realize they've had very different courses and very different experiences. I think, with technology, we're going to be able to, again, help refine what people's unique experiences are and use those to personalize care.
I'd love to see us move towards more personalization of care and preventative care. It's something we often don't talk a lot about in mental health or psychiatry today. We're more reactive. People come to the emergency room in crisis.
We often first see people once they're having a depressive episode or once they're having a psychotic episode. I think we can begin to move the field towards more preventative care. An analogy may be thinking the evolution of cardiology, how cardiology has reduced mortality.
A lot of that was, again, because they had better biomarkers, better ways to understand illness, and moving it towards preventative. I think that's looking into the future.
Key Takeways
If we said, "Well, what can we do here, now, and today, John? What's working? What's not working?"
The first key takeaway is there's a lot of good tools that exist today that you can use. Even the work that Mario's talking about, I would email him and say, "I'm interested in it. Is it possible to use it? Can I get some training?"
These tools exist. They're good. They're ready to use, in some ways. You may need additional training. There's a lot more tools in the wings, and I think to get yourself ready and to be able to basically, you don't have to use every tool, but to be able to say, "Hey, I like this one. I don't like this one." To be in a position where you're making decisions, it's important to be educated about these digital health technologies and be able to understand the risks and benefits, be able to use them, be able to think about their pros and cons.
I think that's in part where SMI Adviser has a really important role. We have many aspects of the project, but the one I'm most familiar with, again, is thinking about how to help everyone use technology, learn about it, take our courses. You can watch videos and webinars. It's all completely free, but to really say, "Look, I want to just become well-versed and myself digitally literate in these technologies, so again, I can understand these really cool advances, like what Mario's talking about, come along. Does this make sense for me and for my practice?"
Again, how do you separate out the good ones and perhaps some of the ones that aren't as ideal? We know that the pace of technology is not going to slow down. We know that, if anything, COVID has accelerated interest in it. I think, again, there's great ways for the field to sit there and help shift how this is going to go. That first part is, again, just being educated and informed.
Thank you for listening and tuning in. To learn more, you can visit our website, smiadviser.org.
John Torous, MD, MBI, is the director of the digital psychiatry division in the Department of Psychiatry at Beth Israel Deaconess Medical Center, a Harvard Medical School-affiliated teaching hospital, where he also serves as a staff psychiatrist and assistant professor. He has a background in electrical engineering and computer sciences and attended medical school at the University of California, San Diego. He completed his psychiatry residency, fellowship in clinical informatics, and master's degree in biomedical informatics at Harvard. Dr. Torous is active in investigating the potential of mobile mental health technologies for psychiatry and has published more than 200 peer-reviewed articles and 5 book chapters on the topic. He serves as editor-in-chief for an academic journal on technology and mental health, JMIR Mental Health, and chairs the American Psychiatric Association’s Health IT committee.
