Understanding Mental Health Apps — Neurotech SF presentation

@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

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sup

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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

“

@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

“

@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

@StevenChanMD

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

@StevenChanMD

ANGELLIST total # of mental health startups

020406080

100120140160180200

39

53 162

175 TOTAL

@StevenChanMD

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

“

@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.