Smartphones are everywhere, or so it seems. Latest statistics convey that more than 77 percent of us have one and that includes people with schizophrenia. The National Alliance on Mental Illness (NAMI) says that approximately 1 percent of Americans have this disorder, but that the economic burden is more than $60 billion per year. Some people think technology may help ease this burden and the signs are surely promising.
As the National Institute of Mental Health (NIMH) declares, "technology has opened a new frontier in mental health support and data collection."
The positives of technology, says NIMH, include:
- An introduction to care for those who've avoided mental health care in the past
- Lower cost than traditional care
- The ability to reach more people
- Potential to be more appealing and interesting
- The ability to complement traditional therapy
Not 'just' a phone
In 2014, NAMI commissioned Harris Poll to interview 457 people age 18 and older with schizophrenia to investigate how technology impacted them. In brief, these were the main findings shared in the organization's 2016 report:
- The majority or 90 percent of people living with schizophrenia have access to more than one device, usually a personal computer, followed by a smartphone at 54 percent. Six in 10 people accessed two to three devices. One in three accessed four or more.
- Among those, people living with schizophrenia spend, on average, five hours per day on a personal computer and four hours on a smartphone.
- Surfing the internet and talking on the phone are activities most likely to be rated highly for helpfulness in improving or managing schizophrenia.
- People with schizophrenia do look at health websites to learn more about their condition.
- Two-thirds or 66 percent said technology will become a bigger part of their recovery in the coming years.
Respondents also said they used technology to cope with their disorder, that they used it more when feeling well than not, that they used music or audio files to help block or manage voices, and used tech in general to help identify coping strategies.
Clearing the air
In a late 2017 story in Psychiatric Times, John Torous, M.D., MBI, said of the research of which he was an author, that "patients were not only open to using technology, but using it did not induce or trigger paranoia or delusions. We also reviewed all the published literature on smartphones and monitoring for schizophrenia last year and did not identify a single case of harm."
Considered an expert in the field, among his many credits, Dr. Torous is director of the digital psychiatry division in the psychiatry department at Beth Israel Deaconess Medical Center. He spoke to HealthCentral in a telephone interview about what else he and his colleagues have learned since their original study.
"With more access to smartphones now, some people with schizophrenia may be smartphone dependent, as it's their primary way to connect to the internet," he says. But don't assume anything.
"Having a smartphone doesn't mean you download health apps, and having access to health apps does mean you download mental health apps, and having a mental health app doesn't mean that you use it," Dr. Torous says. "Engagement remains a big issue."
The same considerations that make an app useful for the rest of us also apply for those with schizophrenia, he says. "People are not going to tolerate one that's difficult to use."
Contact is key
Dr. Torous also co-authored a systematic review and meta-analysis in Schizophrenia Bulletin in 2015 that looked at mobile phone use in people with psychotic disorders, including schizophrenia. The researchers found that "the majority of patients responded in favor of using mobile phones to enhance contact with services and support self-management."
He says that more people may be using apps than is documented, since "some people with schizophrenia may not want to tell their psychiatrist they're using an app, and most of us don't ask."
Dr. Torous surmises from his observations that "maybe 10 percent of my patient population uses an app, and up to 40 percent have tried one or considered it. Younger patients are more interested, and so are urban residents."
All app-using consumers, be careful, he warns. "Apps aren't well regulated, and there are very few barriers to putting one on iTunes or making really bold claims." He also worries about lack of privacy around protections for consumers since apps aren't marketed as medical devices. That eliminates regulations for developers by the U.S. Food and Drug Administration and reduces other federal privacy protections overall. Think about it: The user is entering personal health data and other information just to use the app.
It doesn't discriminate
Schizophrenia can disproportionately affect people with limited resources and limited ability to reach out for support, especially when they're managed by local mental health systems, says Steven Chan, M.D., M.B.A.. Dr. Chan is U.C. San Francisco’s (UCSF's) inaugural clinical informatics physician fellow and is an actively-practicing physician in psychiatry and behavioral sciences.
"Having any way to increase someone's access to connectivity with mobile phones and apps can be helpful," he told HealthCentral in a telephone interview. He's continually looking ahead for other possible applications.
"With apps still in the works, but not implemented yet for various reasons, we want to try and catch symptoms before they get worse — like you would with an infection. With someone who's relapsing, having more hallucinations or fears, we want to identify those before their world spirals out of control."
For example, for people using Wraparound case services — a specific, supportive approach and process for care planning — text messages and social media help case managers reach out to clients more frequently and easily, he says.
"In the future, smartphones will have sensors built in that track geography or even show if someone is staying indoors all the time — a sign of depression," Dr. Chan says, adding that he currently evaluates "a lot of tech for psychiatrists and other healthcare professionals."
"I look to see if it's feasible or just hyperbole," he says. "There's a lot of promise that hasn't been fully unlocked. For instance, in education, putting training videos on apps can be more interesting, engaging, and fun than having the person read a handout. Sometimes anything is better than a dry piece of paper."
One app that does get high marks from the mental health community is Schizophrenia HealthStorylines, to manage and monitor symptoms, medications, and more. For a comprehensive list of mental health apps vetted by responsible partners, try PsyberGuide.