When I was asked to do this by my supervisor, Prof Patrick Pietroni, I was a little intimidated. My experience of rural health comes mainly from growing up in rural Ireland – and it became clear over the course of the conference that this is not really considered rural, especially by those in Australia! But I do know my way around technology for mental health and there are some universals in rural health that it was clear to me could potentially be tackled by an app.
Mobile devices are incredibly exciting for a geek like me. Even though I am old enough to remember a world that could survive without smartphones I’m not really sure how the adult world worked without them. They fill a niche that we never even knew we had – I check my bank balance in the queue, do my shopping on the train home. In the past 20 years ownership of both mobiles and smartphones have grown exponentially, in rural and urban areas (albeit at different rates). Cost has always been a significant factor but as coverage widens, need increases and the inbuilt accessibility and privacy of a smartphone make them a good alternative to the more complicated, costly computers. It often provides a direct link to populations who had never previously used technology. Including babies.
A study that I often like to quote is the result of a World Health Organisation Mental Health Survey (Andrade et al, 2014). In it they addressed the barriers to treatment in a global population of people with diagnosable mental health conditions. 63.8% wanted to handle their mental health on their own. Whilst the authors saw this as a barrier I see this as an opportunity. If something both acceptable and appropriate can be found it could be a significant game changer.
The thing with mental health apps is there is so much potential:
- Provide information in the right place at the right time
- Provide non-invasive, real-time communication and delivery
- Provide increased reach through ubiquity and accessibility options
- Provide motivation through notifications and gamification techniques
On my iPhone I have over 200 apps in the area of mental health and this is but a drop in the ocean. Whilst various numbers have been suggested it is probable that the number of mental health apps available number near to 100,000 by now (Donker et al., 2013; Kamerow, 2013). They can do so much… What’s My M3 offers assessments, Bipolar Connect offers access to an online forum, Recovery Record for monitoring eating disorders, Phobia Free to provide systematic desensitization for arachnaphobia (with augmented reality!) and Joining Forces providing targeted mental health information. The functionality is impressive.
That is key with the smartphone. Functionality is only limited by imagination. StudentLife is an app developed by a Dartmouth Professor to track and correlate mood with activities ( Wang, Chen, Chen, & Li, 2014) . Not only could it use the GPS but it picked up audio in conversations as well. One day an app like this could alert you when your stress levels increased and perhaps you could use a biofeedback device, like BellyBio, to regain composure – prevention in real time.
Best of all, certain types of smartphone apps can work without network coverage or internet. In rural health this lack of connectivity is often a barrier to providing real-time help. But as the algorithms get better, and the battery life too, it may be possible that continuous monitoring and timely prevention could become a reality.
If you are interested in my thoughts about Regulations – Intended Use and Unintended Consequences or on ResearchKit they will be linked to once I have time to post.
Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., … Kessler, R. C. (2014). Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychological Medicine, 44(6), 1303–17. doi:10.1017/S0033291713001943
Donker, T., Petrie, K., Proudfoot, J., Clarke, J., Birch, M.-R., & Christensen, H. (2013). Smartphones for smarter delivery of mental health programs: a systematic review. Journal of Medical Internet Research, 15(11), e247. doi:10.2196/jmir.2791
Kamerow, D. (2013). Regulating medical apps: which ones and how much? BMJ (Clinical Research Ed.), 347, f6009. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24103694
Wang, R., Chen, F., Chen, Z., & Li, T. (2014). StudentLife: assessing mental health, academic performance and behavioral trends of college students using smartphones. Proceedings of the ACM Conference on Ubiquitous Computing. doi:10.1145/2632048.2632054