Professor Krausz' presentation

Page 1

Social media and E-Mental Health RM Krausz, University of British Columbia (UBC), Vancouver, Canada


Introduction

German-Canadian for 
 10 years

Professor of Psychiatry at the University of British Columbia (UBC)

WPA Section Chair for 
 E-Mental Health

Several EMH and development projects


This topic on a Psychiatric conference? •

Building academic momentum in a new field

Thought leaders like the former head of NIMH Tom Insel switching portfolios

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

Learning tools and mechanism are shifting to an online culture, leading universities becoming online hubs

Human information and orientation is functioning more and more web based between online media and google maps

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

With a web based framework as the backbone of an early intervention approach

With a web based framework as integrative tool between all kind of clinical settings - face to face, online platforms, virtual clinics etc.

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

Even in highly developed countries there are long waiting times to see a specialist (in Vancouver 6-12 months)

Marginalized populations or individuals in remote and rural areas are not having any access to care

Access may come with a price tag unaffordable for some


The web as entry point •

Navigation of the system of care

Self booking of appointments with the the healthcare system

Online resources in preparation of meetings, for informed decision making etc.

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

An integration of screening, monitoring, gold standard assessment, outcome control with reminder functions

Use of interactive and innovative assessment tools (like below)

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

Informed decision making and knowledge translation

Assessment of self assessments

Documentation tools

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

Cognitive behavioural therapy (CBT) for depression is the best developed and tested, very effective intervention

CBT principles can be applied towards PTSD (PTSD coach), social anxiety etc.

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

Using all kinds of communication modes most appropriate to support distant patient-therapist (email, chat, video etc) communication

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!

They can be involved in different ways like navigators and mentors, people with lived experiences or individual resource

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

gadgets e.g. alcohol breathalyzer

Technologies like virtual reality, artificial intelligence, etc. to support certain psychosocial interventions like treatment of anxiety (exposition)

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

Embedded research trials incl. Randomized Clinical Trials (RCT)

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

To reach out to those who now have little or no access to mental health care globally

To provide care for youth in need with online lifestyle mentoring and early intervention

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

Just the continuation of an expansion of physical care is not sustainable

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



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