Social media and E-Mental Health RM Krausz, University of British Columbia (UBC), Vancouver, Canada
Introduction
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German-Canadian for 10 years
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Professor of Psychiatry at the University of British Columbia (UBC)
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WPA Section Chair for E-Mental Health
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Several EMH and development projects
This topic on a Psychiatric conference? •
Building academic momentum in a new field
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Thought leaders like the former head of NIMH Tom Insel switching portfolios
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Its the only option to resolve some of the biggest problems in our field under resource restrictions
Dr.Tom Insel
Research on the rise
Hedman, E., Ljรณtsson, B., & Lindefors, N. (2012). Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert review of pharmacoeconomics & outcomes research,12(6), 745-764.
A disruptive change of our communication
Relevance for Psychiatry? •
Human communication around us, among all users of services and professionals changed
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Learning tools and mechanism are shifting to an online culture, leading universities becoming online hubs
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Human information and orientation is functioning more and more web based between online media and google maps
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Our patients are using it!
Ready for a paradigm shift in Mental Health care?
From reactive medicine to proactive supports
A shift to mental health care system in a changing environment •
With a web based framework making intense use of all new communicative tools for patient centered care
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With a web based framework as the backbone of an early intervention approach
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With a web based framework as integrative tool between all kind of clinical settings - face to face, online platforms, virtual clinics etc.
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With a web based framework to build capacity and improve quality
1. Accessibility of care
What is the problem? •
The global mental health system is only serving a small minority of patients in any way
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Even in highly developed countries there are long waiting times to see a specialist (in Vancouver 6-12 months)
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Marginalized populations or individuals in remote and rural areas are not having any access to care
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Access may come with a price tag unaffordable for some
The web as entry point •
Navigation of the system of care
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Self booking of appointments with the the healthcare system
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Online resources in preparation of meetings, for informed decision making etc.
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Online interaction between professionals and patients e.g. as part of a virtual clinic model including “video conferencing”
2. Smart assessment the interface to the system
Screening, monitoring, assessment
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An integration of screening, monitoring, gold standard assessment, outcome control with reminder functions
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Use of interactive and innovative assessment tools (like below)
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Online selective (AI informed) systems including standardized feed back and scoring
E.g. interactive suicide assessments
3. Capacity building
Online ressources •
are information, apps or systems, which can be used directly by patients to address their conditions
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Informed decision making and knowledge translation
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Assessment of self assessments
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Documentation tools
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Online therapies use as standalone or blended
Online ressources • The web is the only place where we could build and provide significant additional capacity
• Web based interventions are proven to be effective and are covering a broad range of conditions
• Critical is the implementation and the integration with other services
• The number of effective tools will increase!!
Web based psychotherapies •
Psychosocial interventions, which can be standardized in an effective and engaging way
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Cognitive behavioural therapy (CBT) for depression is the best developed and tested, very effective intervention
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CBT principles can be applied towards PTSD (PTSD coach), social anxiety etc.
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Psychoeducation is another effective intervention others are under development
Do computer-guided treatments work? Richards & Richardson (2012) Cohen s d interpretation d = .2 .5 .8
31 studies of 18 computerized depression tx s Mean d = 1.35 if therapist-supported Mean d = .95 if administrative support Mean d = .78 if no support
4. Patient engagement
Three settings of modern care Digital tools, which could be or are connected to different settings (HealthVault, EMR)
Web based interaction between Patients and professionals
Virtual Clinics
Integrated Web-solutions Existing face to face (Walkalong) health care Direct interaction between patients
 and health professionals
Interaction between patients
 and web based systems 23
Principles of virtual clinic approach •
Communication between patients and professionals via web based mostly asymmetric communication
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Using all kinds of communication modes most appropriate to support distant patient-therapist (email, chat, video etc) communication
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Integration with other settings of care like physical face to face or web based platforms (walkalong)
5. Peer involvement
The most under utilized resource •
Peers are an invaluable and most under utilized resource in health care!
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They can be involved in different ways like navigators and mentors, people with lived experiences or individual resource
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The web can facilitate the networking in groups or individual contacts, chats, emails, video or other channels
The E patient movement
Patient centered • Patients, peers and families are often not treated as partners in our system although it is often claimed
• The more they know, the more we respect their decisions and open the doors the more effective every intervention will be.
• The patients are the most underutilized resource in the system
6. Technical tools
Technical tools to improve care
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gadgets e.g. alcohol breathalyzer
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Technologies like virtual reality, artificial intelligence, etc. to support certain psychosocial interventions like treatment of anxiety (exposition)
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Allow to develop games in support of treatment (SPARX)
The Avatar therapy of hallucinations
New ways of research
Integrated research tools •
Data collection while using applications incl. automated reporting
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Embedded research trials incl. Randomized Clinical Trials (RCT)
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Algorithm to give intelligent recommendations (Artificial Intelligence)
Its about the message not the medium
What does disruptive mean for us clinicians? •
To make full use of the new potential of communication
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To reach out to those who now have little or no access to mental health care globally
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To provide care for youth in need with online lifestyle mentoring and early intervention
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To create a web based framework of care, which build capacity and online resources
The cost case •
resources in health care are limited in a situation of a growing burden of disease you need to find different approaches
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Just the continuation of an expansion of physical care is not sustainable
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A lot of countries don’t have any resources for mental health services. EMH can promote global synergy in a revolutionary way e.g. in the field of trauma support!
Lets create it together