- freely available
Healthcare 2014, 2(2), 220-233; doi:10.3390/healthcare2020220
Abstract: Mobile telemental health is defined as the use of mobile phones and other wireless devices as applied to psychiatric and mental health practice. Applications of such include treatment monitoring and adherence, health promotion, ecological momentary assessment, and decision support systems. Advantages of mobile telemental health are underscored by its interactivity, just-in-time interventions, and low resource requirements and portability. Challenges in realizing this potential of mobile telemental health include the low penetration rates of health applications on mobile devices in part due to health literacy, the delay in current published research in evaluating newer technologies, and outdated research methodologies. Despite such challenges, one immediate opportunity for mobile telemental health is utilizing mobile devices as videoconferencing mediums for psychotherapy and psychosocial interventions enhanced by novel sensor based monitoring and behavior-prediction algorithms. This paper provides an overview of mobile telemental health and its current trends, as well as future opportunities as applied to patient care in both academic research and commercial ventures.
2. Potential Advantages of Smartphones in Telehealth
3. Challenges to Adopting Mobile Devices in Telehealth
3.1. Health Applications Have Low Penetration Rates
3.2. Current Published Research Tends to Evaluate Older Technologies
3.3. Current Mobile Health Studies Need Improved, Newer Research Methodologies
4. Taking Advantage of Mobile Devices for Mental Health
|Search terms||Google Play|
|iOS App Store|
- a communications medium for psychotherapy
- an extension of psychotherapy
- a psychosocial intervention using novel monitoring approaches
4.1. A Videoconferencing Medium for Psychotherapy
4.2. As an Extension of Psychotherapy
5. Challenges for Mobile Tele-Mental Health
Conflicts of Interest
- US Department of Health and Human Services. Telehealth. Available online: http://www.hrsa.gov/ruralhealth/about/telehealth/ (accessed on 15 November 2013).
- Yellowlees, P.; Burke, M.M.; Marks, S.L.; Hilty, D.M.; Shore, J.H. Emergency telepsychiatry. J. Telemed. Telecare 2008, 14, 277–281. [Google Scholar] [CrossRef]
- Nelson, E.-L.; Davis, K.; Velasquez, S.E. Ethical considerations in providing mental health services over videoteleconferencing. In Telemental Health: Clinical, Technical, and Administrative Foundations for Evidence-based Practice; Turvey, C., Myers, K.M., Eds.; Elsevier: London, UK, 2013; pp. 47–62. [Google Scholar]
- Hilty, D.M.; Ferrer, D.C.; Parish, M.B.; Johnston, B.; Callahan, E.J.; Yellowlees, P.M. The effectiveness of telemental health: A 2013 review. Telemed. E Health 2013, 19, 444–454. [Google Scholar] [CrossRef]
- WHO Global Observatory for eHealth. mHealth New Horizons for Health through Mobile Technologies; World Health Organization: Geneva, Switzerland, 2011. [Google Scholar]
- The Nielsen Company. Mobile Majority: US. Smartphone Ownership Tops 60%. Available online: http://www.nielsen.com/us/en/newswire/2013/mobile-majority--u-s--smartphone-ownership-tops-60-.html/ (accessed on 1 February 2014).
- Maeve, D. Cell Phone Activities 2013; Pew Internet & American Life Project; Pew Research Center. 2013. Available online: http://pewinternet.org/Reports/2013/Cell-Activities.aspx/ (accessed on 24 November 2013). [Google Scholar]
- Steinhubl, S.R.; Evan, M.D.; Eric, T.J. Can mobile health technologies transform health care? JAMA 2013, 310, 2395–2396. [Google Scholar] [CrossRef]
- Ly, K.H.; Trüschel, A.; Jarl, L.; Magnusson, S.; Windahl, T.; Johansson, R.; Carlbring, P.; Andersson, G. Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: A randomised controlled trial. BMJ Open 2014, 4, e003440. [Google Scholar] [CrossRef]
- Shand, F.L.; Ridani, R.; Tighe, J.; Christensen, H. The effectiveness of a suicide prevention app for indigenous Australian youths: Study protocol for a randomized controlled trial. Trials 2013, 14, 396. [Google Scholar] [CrossRef]
- Klasnja, P.; Pratt, W. Healthcare in the pocket: Mapping the space of mobile-phone health interventions. J. Biomed. Inf. 2012, 45, 184–198. [Google Scholar] [CrossRef]
- Ellis, L.A.; Collin, P.; Davenport, T.A.; Hurley, P.J.; Burns, J.M.; Hickie, I.B. Young men, mental health, and technology: Implications for service design and delivery in the digital age. J. Med. Internet Res. 2012, 14, e160. [Google Scholar]
- Pakyurek, M.; Yellowlees, P.; Hilty, D. The child and adolescent telepsychiatry consultation: Can it be a more effective clinical process for certain patients than conventional practice? Telemed. E Health 2010, 16, 289–292. [Google Scholar] [CrossRef]
- Fox, S.; Maeve, D. Mobile Health 2012; Pew Internet & American Life Project; Pew Research Center. 2012. Available online: http://www.pewinternet.org/Reports/2012/Mobile-Health.aspx/ (accessed on 30 May 2013). [Google Scholar]
- Parish, M.B.; Yellowlees, P. The rise of person-centered healthcare and the influence of health informatics and social network applications on mental health care. In Mental Health Informatics; Lech, M., Song, I., Yellowlees, P., Diederich, J., Eds.; Springer: Berlin, Heidelberg, 2014; Volume 491. [Google Scholar]
- Free, C.; Phillips, G.; Watson, L.; Galli, L.; Felix, L.; Edwards, P.; Patel, V.; Haines, A. The effectiveness of mobile-health technologies to improve health care service delivery processes: A systematic review and meta-analysis. PLoS Med. 2013, 10, e1001363. [Google Scholar]
- Centers for Medicare & Medicaid Services. Innovators’ Guide to Navigating Medicare 2010. Available online: http://www.cms.gov/Medicare/Coverage/CouncilonTechInnov/downloads/InnovatorsGuide5_10_10.pdf (accessed on 25 January 2014).
- Demaerschalk, B.M.; Vegunta, S.; Vargas, B.B.; Wu, Q.; Channer, D.D.; Hentz, J.G. Reliability of real-time video smartphone for assessing National Institutes of Health Stroke Scale scores in acute stroke patients. Stroke 2012, 43, 3271–3277. [Google Scholar]
- Luxton, D.D.; Mishkind, M.C.; Crumpton, R.M.; Ayers, T.D.; Mysliwiec, V. Usability and feasibility of smartphone video capabilities for telehealth care in the US Military. Telemed. E Health 2012, 18, 409–412. [Google Scholar]
- Tomlinson, M.; Rotheram-Borus, M.J.; Swartz, L.; Tsai, A.C. Scaling up mhealth: Where is the evidence? PLoS Med. 2013, 10, e1001382. [Google Scholar] [CrossRef]
- Ranney, M.; Boyer, E.; Jackson, J.; Rosen, R.; Scher, D.L. Facilitating Cross-Talk: How to bridge the interdisciplinary divides in mhealth intervention design. Available online: http://www.mhealthsummit.org/program-details/facilitating-cross-talk/ (accessed on 1 February 2014).
- Nilsen, W.; Intille, S.; Korhonen, I.; Pavel, M.; Spruijt-Metz, D. Research Symposium: Using new technologies & modeling techniques to understand health behavior, behavior change, and maintenance—Findings from an International Workshop. Available online: http://www.mhealthsummit.org/program-details/using-new-technologies/ (accessed on 1 February 2014).
- Nahum-Shani, I. Experimental Designs for Optimizing Interventions. Available online: http://www.mhealthsummit.org/program-details/nih-mhealth-training-institute/ (accessed on 1 February 2014).
- Nahum-Shani, I.; Qian, M.; Almirall, D.; Pelham, W.E.; Gnagy, B.; Fabiano, G.A.; Waxmonsky, J.G.; Yu, J.; Murphy, S.A. Experimental design and primary data analysis methods for comparing adaptive interventions. Psychol. Methods 2012, 17, 457–477. [Google Scholar] [CrossRef]
- Chan, S. Why is it so Tough to Change Patient Behaviors? Current Challenges in mHealth Behavioral Intervention Research. iMedicalApps 2014. Available online: http://www.imedicalapps.com/?p=55746/ (accessed on 25 January 2014).
- Compton, M.T.; Reed, T.; Broussard, B.; Powell, I.; Thomas, G.V.; Moore, A.; Cito, K.; Haynes, N. Development, implementation, and preliminary evaluation of a recovery-based curriculum for community navigation specialists working with individuals with serious mental illnesses and repeated hospitalizations. Community Ment. Health J. 2013, 50, 383–387. [Google Scholar]
- Kowalczyk, L. Want to See Doctor at Your Home? There’s an App for That. Boston Globe 2013. Available online: http://www.bostonglobe.com/lifestyle/health-wellness/2013/12/06/mass-company-offers-visits-with-primary-care-doctors-via-smartphone-tablet-computer/0AJD7jA5wf9ij3ysZKlAKL/story.html/ (accessed on 15 December 2013).
- Harrison, V.; Proudfoot, J.; Wee, P.P.; Parker, G.; Pavlovic, D.H.; Manicavasagar, V. Mobile mental health: Review of the emerging field and proof of concept study. J. Ment. Health 2011, 20, 509–524. [Google Scholar] [CrossRef]
- Ben-Zeev, D.; Davis, K.E.; Kaiser, S.; Krzsos, I.; Drake, R.E. Mobile technologies among people with serious mental illness: Opportunities for future services. Adm. Policy Ment. Health 2013, 40, 340–343. [Google Scholar] [CrossRef]
- Torous, J.; Friedman, R.; Keshvan, M. Smartphone ownership and interest in mobile applications to monitor symptoms of mental health conditions. JMIR mHealth uHealth 2014, 2, e2. [Google Scholar] [CrossRef]
- Donker, T.; Petrie, K.; Proudfoot, J.; Clarke, J.; Birch, M.-R.; Christensen, H. Smartphones for smarter delivery of mental health programs: A systematic review. J. Med. Internet Res. 2013, 15, e247. [Google Scholar]
- McCracken, H. Who’s Winning, iOS or Android? All the Numbers, All in One Place: A Comprehensive Look at the Competitive Situation, from Unit Sales to Profit Margins. Technologizer. 2013. Available online: http://techland.time.com/2013/04/16/ios-vs-android/ (accessed on 7 July 2013). [Google Scholar]
- Cruz, M.; Cruz, R.F.; Krupinski, E.A.; Lopez, A.M.; McNeeley, R.M.; Weinstein, R.S. Effect of camera resolution and bandwidth on facial affect recognition. Telemed. J. E Health 2004, 10, 392–402. [Google Scholar]
- Administrator Account. Give an Hour to Launch on Helpouts by Google. Give an Hour Featured Announcements 2013. Available online: http://www.giveanhour.org/Announcements/tabid/155/vw/1/ItemID/1369/Default.aspx#!/ (accessed on 12 December 2013).
- Pho, K. Google Helpouts will Bring Telehealth to the Masses. KevinMD: Social Media’s Leading Physician Voice 2013. Available online: http://www.kevinmd.com/blog/2013/11/google-helpouts-bring-telehealth-masses.html/ (accessed on 12 December 2013).
- American Well. ValueOptions and American Well Partner to Deploy the First National Behavioral Telehealth Network. Available online: http://www.americanwell.com/pressRelease_ValueOptions_and_American_Well_Partner_to_Deploy_the_First_National_Behavioral_Telehealth_Network.html/ (accessed on 26 January 2014).
- HealthLinkNow. How It Works—HealthLinkNow. Available online: http://www.healthlinknow.com/patients/how-it-works/ (accessed on 26 January 2014).
- Bittner, M.C. The Mental Health Advocate: Talksession’s Melissa Thompson Thompson Is Using Mobile Technology to Revolutionize the Mental Health Care Industry. Fast Company: Mobilize 2013. Available online: http://www.fastcompany.com/3019564/mobilizing/the-mental-health-advocate-talksessions-melissa-thompson/ (accessed on 15 December 2013).
- Turvey, C.; Coleman, M.; Dennison, O.; Drude, K.; Goldenson, M.; Hirsch, P.; Jueneman, R.; Kramer, G.M.; Luxton, D.D.; Roberts, L.J.; et al. ATA practice guidelines for video-based online mental health services. Telemed. E Health 2013, 19, 722–730. [Google Scholar]
- Google Helpouts for “Psychologist” in Health. Available online: https://helpouts.google.com/search?cat=/t/c/04&num=10&q=psychologist/ (accessed on 15 December 2013).
- Moskowitz, D.S.; Young, S.N. Ecological momentary assessment: What it is and why it is a method of the future in clinical psychopharmacology. J. Psychiatry Neurosci. 2006, 31, 13–20. [Google Scholar]
- Runyan, J.D.; Steenbergh, T.A.; Bainbridge, C.; Daugherty, D.A.; Oke, L.; Fry, B.N. A smartphone ecological momentary assessment/intervention “app” for collecting real-time data and promoting self-awareness. PLoS One 2013, 8, e71325. [Google Scholar]
- US Department of Veterans Affairs. Department of Veterans Affairs (VA) Mobile Health Fact Sheet Final. 2013. Available online: //mobilehealth.va.gov/sites/default/files/files/VAMobileHealthFactSheet.pdf (accessed on 12 December 2013). [Google Scholar]
- National Center for Telehealth and Technology. PTSD Coach. Available online: http://www.t2.health.mil/apps/ptsd-coach/ (accessed on 12 December 2013).
- US Department of Veterans Affairs. Mobile App: CBT-i Coach. Available online: http://www.ptsd.va.gov/public/pages/cbti-coach-app.asp/ (accessed on 12 December 2013).
- National Center for Telehealth & Technology. PE Coach. Available online: http://www.t2.health.mil/apps/pe-coach/ (accessed on 15 December 2013).
- US Department of Veterans Affairs. Mobile App: Stay Quit Coach. Available online: http://www.ptsd.va.gov/public/pages/stayquit coach app.asp/ (accessed on 15 December 2013).
- Pulverman, R.; Yellowlees, P.M. Smart devices and a future of hybrid tobacco cessation programs. Telemed. E Health 2014, 20, 241–245. [Google Scholar] [CrossRef]
- Burns, M.N.; Begale, M.; Duffecy, J.; Gergle, D.; Karr, C.J.; Giangrande, E.; Mohr, D.C. Harnessing context sensing to develop a mobile intervention for depression. J. Med. Internet Res. 2011, 13, e55. [Google Scholar]
- Palmier-Claus, J.E.; Ainsworth, J.; Machin, M.; Barrowclough, C.; Dunn, G.; Barkus, E.; Rogers, A.; Wykes, T.; Kapur, S.; Buchan, I.; et al. The feasibility and validity of ambulatory self-report of psychotic symptoms using a smartphone software application. BMC Psychiatry 2012, 12, 172. [Google Scholar]
- McClernon, F.J.; Roy Choudhury, R. I am your smartphone and i know you are about to smoke: The application of mobile sensing and computing approaches to smoking research and treatment. Nicotine Tob. Res. 2013. [Google Scholar] [CrossRef]
- Hertzberg, J.S.; Carpenter, V.L.; Kirby, A.C.; Calhoun, P.S.; Moore, S.D.; Dennis, M.F.; Dennis, P.A.; Dedert, E.A.; Beckham, J.C. Mobile contingency management as an adjunctive smoking cessation treatment for smokers with posttraumatic stress disorder. Nicotine Tob. Res. 2013, 15, 1934–1938. [Google Scholar] [CrossRef]
- McTavish, F.M.; Chih, M.-Y.; Shah, D.; Gustafson, D.H. How patients recovering from alcoholism use a smartphone intervention. J. Dual. Diagn. 2012, 8, 294–304. [Google Scholar]
- Chan, S. How Innovation in Mobile Health is Reshaping Mental Health iMedicalApps 2014. Available online: http://www.imedicalapps.com/2014/01/mobile-mental-health-behavioral-sensor-frameworks-schizophrenia/ (accessed on 25 January 2014).
- Merry, S.N.; Stasiak, K.; Shepherd, M.; Frampton, C.; Fleming, T.; Lucassen, M.F.G. The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: Randomised controlled non-inferiority trial. BMJ 2012, 344, e2598. [Google Scholar] [CrossRef]
- Chan, S. SPARX Aims to Use Gamification to Help Kids Manage Diabetes, Asthma, and Other Chronic Conditions. iMedicalApps 2014. Available online: http://www.imedicalapps.com/2014/01/video-game-depression-anxiety-kids-diabetes-asthma-linkedwellness/ (accessed on 25 January 2014).
- Mohr, D.C.; Burns, M.N.; Schueller, S.M.; Clarke, G.; Klinkman, M. Behavioral intervention technologies: Evidence review and recommendations for future research in mental health. Gen. Hosp. Psychiatry 2013, 35, 332–338. [Google Scholar] [CrossRef]
- Aitken, M.; Gauntlett, C. Patient Apps for Improved Healthcare: From Novelty to Mainstream 2013. Available online: http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Health%20Institute/Reports/Patient_Apps/IIHI_Patient_Apps_Report.pdf (accessed on 24 November 2013).
- US National Institutes of Health. Search of: Smartphone|Open Studies—Results by Topic—ClinicalTrials.gov. Available online: http://www.clinicaltrials.gov/ct2/results/browse?term=smartphone&recr=Open&brwse=condcat BXM/ (accessed on 25 November 2013).
- Weinstein, R.S.; Lopez, A.M.; Joseph, B.A.; Erps, K.A.; Holcomb, M.; Barker, G.P.; Krupinski, E.A. Telemedicine, Telehealth and mHealth Applications that Work: Opportunities and Barriers. Am. J. Med. 2013, 127, 183–187. [Google Scholar]
© 2014 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).