Post on 14-Apr-2017
transcript
@StevenChanMD
@StevenChanMD
UNDERSTANDINGMENTAL 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.
@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
STEVEN
@StevenChanMD
@StevenChanMD
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Among Southeast Asians…
71%meet criteria for major mood disorders like depression—with 81% among Cambodians — & 85% among Hmong.
@StevenChanMD
CAUSES OF DISABILITY
World Health Organization, retrieved 10/2015. http://www.nimh.nih.gov/health/statistics/disability/us-leading-categories-of-diseases-disorders.shtmlUS 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 DISORDERSCARDIOVASCULAR & CIRCULATORY
NEOPLASMSMUSCULOSKELETAL
DIABETES, UROGENITAL, BLOOD, ENDOCRINECHRONIC RESPIRATORY
OTHER NON-COMMUNICABLE DISEASESUNINTENTIONAL NON-TRANSPORT INJURIES
SELF-HARM & INTERPERSONAL VIOLENCETRANSPORT INJURIES
@StevenChanMD
time
happy
neutral
sad
Feeling downNo pleasureSuicidal plans & intent
unipolar depression
This image
@StevenChanMD
happy
neutral
sad
time
bipolar hypomaniabipolar mania
overexcitementeuphoriadelusionsoveractivity
bipolar depression
@StevenChanMD
MoodTrek
http://mood-trek.com/moodtrek-for-consumers/
@StevenChanMD
CHAT THERAPY
Courtesy @MichielRauws2, @X2_AI
@StevenChanMDIMAGE: : https://www.flickr.com/photos/porsche-linn/7085203423/ USED UNDER CREATIVE COMMONS.
@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
ADULT MENTAL HEALTH SERVICE CONTINUUM
Human Resources Consultants
Northgate Point
Visions
Transcultural Wellness Center
(FSP)
Sierra Elder Wellness (FSP)
Telecare SOAR(FSP)
Turning PointISA - (FSP)
Specialty Mental Health Services
FY 2011-2012
Primary Care Center FQHC
FQHCw/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 SOURCESMHSA
Realignment/General FundFFP/Medi-Cal
SAMHSACalWORKs
PATH
Prevention and Early Intervention
Project 1Suicide PreventionCrisis LinePostvention SupportSupporting Community ConnectionsCommunity Support Team
Project 2Strengthening Families
Quality Child Care CollaborativeHEARTS for KidsSchool and Community-Based ServicesBuilding Life Skills for Teens and TAY
Project 3Integrated Health and Wellness
Screening, Assessment, Brief Treatment and Peer Support – Community Health Care ClinicsSacEDAPTSeniorLink
Project 4Mental Health Promotion
CampaignMulti-Media CampaignCommunity Outreach and EngagementSpeakers BureauCommunity Education
Mental Health Treatment Center
Inpatient Authorization
Intensive Placement Team
Intensive and Subacute Services
El Hogar Guest HouseHomeless 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
NeuroBehaviorial
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
CSHWellness &
Recovery Centers
North
South
Turning Point Crisis Residential MHTC
CSHOffice of
Patient’s Rights
APSS Clinic -Bowling
APSS Aftercare Clinic
Turning PointPathways (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
KEYSAAC – Southeast Asian Assistance CenterHWHA – Hmong Women’s HeritageMHANC – Mental Health America of Northern
CaliforniaPCP – Primary Care PhysicianFQHC – Federally Qualified Health Care ClinicAPSS – Adult Psychiatric Support ServicesFSP – Full Service PartnershipISA – Integrated Service AgencyCSH – Consumer Self HelpTrans Res – Transitional Residential ProgramMHRC – Mental Health Rehabilitation CenterSNF-L – Skilled Nursing Facility – LockedPHF – Psychiatric Health FacilityTLCS – 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 PartnersMHANCHWHA
Mental Health America of Northern California
Consumer Advocate Liaison to Division of Behavioral Health
Adult & Family Advocate Liaison to Division of Behavioral Health
Com
mun
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sup
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Acc
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poi
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Spec
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Acu
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Acu
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Sub
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Prev
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@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
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@StevenChanMD
SPARX cognitive behavioral therapy game
Merry S, 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 April 2012) 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/
@StevenChanMD
CBT = Cognitive Behavioral Therapy
thoughts
feelingsbehavior
1. Identify critical behaviors2. Determine if critical behaviors
are excesses OR deficits3. Evaluate critical behaviors for
frequency, duration, or intensity4. If excess, attempt to decrease.
If deficits, attempt to increase behaviors.
@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
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@StevenChanMD
SUICIDE WARNING SIGNS
Depressed mood
Suicide plans & intention
Drugs & alcohol use
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MY3 SUICIDE SAFETY
@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
@StevenChanMD
http://www.fastcompany.com/3057073/most-mental-health-apps-are-based-on-flimsy-science-says-task-force-chair
@JohnTorousMDHarvard University
@StevenChanMD
http://www.nature.com/news/mental-health-there-s-an-app-for-that-1.19694
@JohnTorousMDHarvard University
@StevenChanMD
Huckvale et al. BMC Medicine (2015) 13:214 DOI 10.1186/s12916-015-0444-y
x79
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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).
@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.
@StevenChanMD
VA APP STORE — mobilehealth.va.gov
11 total mental health apps
@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 iPhoneDepression 233 795Anxiety 236 1185Schizophrenia 224 32Bipolar 245 172Alcoholism 224 60Perfectionism 0 0
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ANGELLIST total # of mental health startups
020406080
100120140160180200
39
53 162
175 TOTAL
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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.
@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 thediagnostic 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/
@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
@StevenChanMD
Three categories of mental health apps
For communications & coordination.
As an extension of face-to-face clinic.
As new intervention & monitoring.
@StevenChanMD
FOR COMMUNICATIONS
Doctors on Demand
HealthLinkNow
American Well
1docway
Talkspace
MDLive Breakthrough
@StevenChanMD
Three categories of mental health apps
For communications & coordination.
As an extension of face-to-face clinic.
As new intervention & monitoring.
@StevenChanMD
Courtesy Kimberlie Cerrone, Tiatros
TIATROS IN PTSD STUDIES
@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.
@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/
@StevenChanMD
Three categories of mental health apps
For communications & coordination.
As an extension of face-to-face clinic.
As new intervention & monitoring.
@StevenChanMD
SPECIFIC PHOBIAS
SOCIAL ANXIETY
ALCOHOL USE
PTSD
RELAXATIONPsious
Affordable virtual reality can enhance psychotherapy.
@StevenChanMD..
BRAIN POWER SYSTEM Wearable Educational System for Autism
@StevenChanMD
Duke University + Apple ResearchKit face emotion-detection for autismhttps://autismandbeyond.researchkit.duke.edu , https://today.duke.edu/2015/10/autismbeyond
@StevenChanMDCourtesy Helen S. Koo PhD, @UCDavis — http://helenskoo.com
WEARABLE TECH + CLOTHING
@StevenChanMD
Three categories of mental health apps
For communications & coordination.
As an extension of face-to-face clinic.
As new intervention & monitoring.
@StevenChanMD
Mental health appsUC 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
@StevenChanMD
Fragmented systems create opportunity for new mental healthplatforms.
@StevenChanMD
$26.4m TELEHEALTH in MENTAL HEALTH
$23.0bnPSYCHIATRIC HOSPITALS
$17.2bnMH + SUD CLINICS
$34.2bnCOUNSELING + CRISIS SVC
$7.8bnALCOHOL / DRUG REHAB
@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 nonphysicianbehavioral health…addiction professionals…long-term care facilities.
http://medcitynews.com/2016/03/cms-health-it-ltc-behavioral-health/?rf=1
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@StevenChanMD
American Telemedicine AssociationMental Health track
Behavioral “NatCon” tech track
ACM CHI Mental Health, Affective Computing, Pervasive Computing
?MENTAL HEALTH TECH EVENTS
@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
@StevenChanMD
@StevenChanMD
UNDERSTANDINGMENTAL 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.