Researchers at the Dartmouth Psychiatric Research Center in Lebanon are developing mobile apps to assess and treat patients who have severe mental illness. These apps could help patients in crises and also help them manage their illnesses in the crucial time between visits to the doctor.
Jose Caraballo lives in Chicago. Recently he experienced symptoms of schizophrenia.
"I had racing thoughts, not thinking well, feel confused where I’m going when I get out of my house."
Soon after, he heard about a new study involving a mobile app called FOCUS. The app was developed by researchers at Dartmouth College.
"Let’s put it to the test. Hello, have you been bothered by voices today? I’m extremely bothered by voices."
That’s Dr. Dror Ben-Zeev. He’s a researcher at the Dartmouth Psychiatric Research Center and part of the team working on the FOCUS application. His app asks patients about their symptoms.
It says, “Do you think that the voices are uncontrollable, all-knowing, powerful, or a symptom of your condition?”
Then it gives suggestions:
“'Try this experiment. Take a moment and think of one thing that the voices were wrong about in the last week. Go ahead. You can do it.' And we have this little thumbs-up icon on it. It gives you very quick and dirty real-time interventions that could help someone in the moment."
In the digital age, Ben-Zeev says, mental health apps have a wide reach. Underserved populations who can’t afford personal computers or home Internet service are using smartphones instead to access the Internet. A recent study out of Dartmouth found that 72 percent of people with severe mental illness had a mobile device.
"There are more mobile phones in the world than toothbrushes and far more than toilets."
Dr. John Kane is a professor of psychiatry at Hofstra University. He directs the Advanced Center for Interventions and Services Research in Schizophrenia. Up till now, he says, mental health care has been slow to join the emerging field of mobile health, or mHealth. But things are changing. Recent mass shootings have drawn attention—and grant money—to the need to address severe mental illness quickly.
"The tragedy is that people with schizophrenia are not inherently violent."
Kane thinks using apps to intervene early will limit the problems that come with untreated psychosis—including crisis medical care. Statistics from the National Institute of Mental Health show one in a hundred Americans have schizophrenia.
"The costs are enormous. So if you look at a visit to an emergency room or a hospitalization, we’re talking about tremendous costs."
But the goal of the doctors working on the FOCUS app goes beyond averting trips to the hospital.
Again, Dr. Dror Ben-Zeev: "Our objective is recovery and high functioning."
"I’m on the faculty at the medical school at Dartmouth, I run my own company."
That’s Dr. Patricia Deegan. Long before she got her Ph.D. in psychology and founded a software company, Deegan was diagnosed with schizophrenia. She was seventeen. Her psychiatrist gave her what she calls a “prognosis of doom:” she would never get better and she’d have to be medicated her entire life.
"And I remember walking out of the office, and I felt this really angry indignation riseup inside of me. And it was like something just caught on fire. And I just remember thinking to myself, “You’re wrong. You’re wrong about who I am. I am going to be somebody.”
Now, Deegan develops mental health apps, including one called CommonGround. It helps people with severe mental illness work with their doctors to make decisions about their treatment plans. Though many people live with mental illness their whole lives, Deegan says it’s a vulnerability you can manage:
"To live in recovery means to have a job, get a paycheck, and have a date on a Friday night. You know, you’re living your life outside of the human services landscape. You’re living in the community with a life that, for all intents and purposes, is indistinguishable from other citizens'."
And according to Deegan and others who live with mental illness, that life between doctor’s visits is where a lot of recovery takes place. Back in Chicago, Jose Caraballo says that his mental health app helped him take steps to manage his illness in his daily life.
"Sometimes the FOCUS application come on and it reminded me of call someone, to talk to someone, to keep in touch with the world. Have you talked to someone? How many people have you contacted today?"
The FOCUS app is in clinical trials and it might be a while before it goes public. In the meantime, Dr. Ben-Zeev and Dr. Kane are working on another app. This one gathers information about changes in patients’ speech, sleep, and activity patterns that precede a psychotic episode:
" The next time around, where we see that combination of behaviors that we think might be dangerous for that individual, we’ll communicate through messaging on the phone and to their clinical team that we think that that person might be at especially high risk, and it might make sense to have more outreach and better care."
Ben-Zeev says the future of mobile health is care that’s personalized and there when you need it. Schizophrenia? Pretty soon, there may be an app for that.