Mobile early detection and connected intervention to coproduce better care in severe mental illness

Current approaches to the management of severe mentalillness have four major limitations: 1) symptom reporting isintermittent and subject to problems with reliability; 2) serviceusers report feelings of disengagement from their careplanning; 3) late detection of symptoms delay interventionsand increase the risk of relapse; and 4) care systems are heldback by the costs of unscheduled hospital admissions thatcould have been avoided with earlier detection andintervention. The ClinTouch system was developed to close theloop between service users and health professionals.ClinTouch is an end-to-end secure platform, providing avalidated mobile assessment technology, a web interface toview symptom data and a clinical algorithm to detect risk ofrelapse. ClinTouch integrates high-resolution, continuouslongitudinal symptom data into mental health care servicesand presents it in a form that is easy to use for targeting carewhere it is needed. The architecture and methodology can beeasily extended to other clinical domains, where the paradigmof targeted clinical interventions, triggered by the earlydetection of decline, can improve health outcomes

Physical activity based classification of serious mental illness group participants in the UK Biobank using ensemble dense neural networks

Serious Mental Illnesses (SMIs) including schizophrenia and bipolar disorder are long term conditions which place major burdens on health and social care services. Locomotor activity is altered in many cases of SMI, and so in the long term wearable activity trackers could potentially aid in the early detection of SMI relapse, allowing early and targeted intervention. To move towards this goal, in this paper we use accelerometer activity tracking data collected from the UK Biobank to classify people as being either in a self-reported SMI group or an age and gender matched control group. Using an ensemble dense neural network algorithm we exploited hourly and average derived features from the wearable activity data and the created model obtained an accuracy of 91.3%

Advances in Telecare over The Past Ten Years

This article reviews advances during the past decade or so in telecare (ie, computer-supported social care at home). The need for telecare is discussed along with how it relates to social and health care. The expected benefits of telecare are also discussed. The evolution of telecare technology is reviewed, covering various system generations. The capabilities of present day telecare are covered, along with its advantages, limitations, and barriers to uptake. Recent evaluations and exemplars of telecare are discussed. The user requirements for telecare are presented, complemented by a discussion of the issues in user and professional acceptance. The article concludes with a summary of past developments in telecare and the prospects for the future

Applications of Machine Learning in Mental Healthcare

This thesis summarizes three studies in the area of machine learning applications within mental heathcare, specifically in the area of treatments and diagnostics. Mental healthcare today is challenging to provide worldwide because of a stark rise in demand for services. Traditional healthcare structures cannot keep up with the demand and information systems have the potential to fill in this gap. The thesis explores online mental health forums as a digital mental health platform and the possibility to automate treatments and diagnostics based on user-shared information

TechCare – Mobile Assessment and Therapy for Psychosis: Feasibility Study of an Intervention for Clients within the Early Intervention Service

Background: Mobile digital health technologies, mHealth, is a growing field globally with a potential to improve mental health. Technological advances have shown promise across healthcare and particularly when delivering interventions for mental health problems such as psychosis. The use of mobile devices provides greater autonomy to service users who would otherwise be seen as a ‘hard to reach group’, with complex relationships between psychotic experiences, trust and engagement with services. A non-stigmatising approach is implicit within technological developments, as many service users experience mental health stigma, which can compound problematic engagement, treatment adherence and outcomes. This study was an original piece of work and has created new insights into mHealth technologies for individuals experiencing psychosis. Aim: The aim of the project was to develop and conduct a feasibility study of the mobile phone application (App) ‘TechCare’ for individuals with psychosis in the North West of England. Methods/Design: The feasibility study followed the National Institute of Health Research (NIHR) guidance on feasibility study design and consisted of both qualitative and quantitative components. The study was conducted across three strands as follows: 1) Qualitative work & Systematic review; 2) Test-run and Intervention refinement (developing the TechCare App); 3) Feasibility trial. The TechCare App assessed participants’ symptoms and responses and provided for a personalised guided self-help based psychological intervention, with the aim of reducing participants’ symptoms. In Strand 1 of the study, 16 service users and 16 health professionals from Lancashire Care NHS Foundation Trust, Early Intervention Service (EIS) were recruited to explore their experience of psychosis and give their opinions on the existing evidence based treatment (Cognitive Behavioural Therapy (CBT)) and how the mobile App could be developed (service users and staff). In Strand 2, a test-run with a small number (n= 4) of participating service users, was conducted to refine the mobile intervention (TechCare). Finally, in Strand 3 the TechCare App was examined in a feasibility study with a total of 12 service users. The study was also registered on ClinicalTrials.gov Identifier: NCT02439619. Results: The systematic review, found 7 studies which met the inclusion criteria, from a total of 5690 records. The included studies describing the feasibility of using mHealth technologies for psychosis, functionality and access to mHealth interventions and study outcomes. Overall, the systematic review results suggested that mHealth for psychosis is acceptable and feasible in the target population. Furthermore, the TechCare App had been developed, working alongside service users who consulted on the development of the App. The qualitative result of the study showed that the TechCare App was found to be an acceptable means of receiving interventions for the service users, with key themes around, the participant’s experience of using the App, the further development and refinement of the intervention and the usability of the intervention. In addition, the Strand 3 feasibility study, results showed that out of the 12 participants, a total of 83.33% of participants completed the 6 week intervention. Overall participants responded to the App notifications on average 2.95 time per day (Range: 0-11), with a reduction in average scores on the TechCare App, from baseline to week 6 for the depression scale questions (Week 1, M=29.13 (SD=18.29); Week 6 was M=17.50 (SD=11.92)) and paranoia scale questions (Week 1 M=38.00, SD=28.27; Week 6, M=33.92, SD=27.88). Discussion: The results of the study show promise in the feasibility and acceptability of the TechCare App. Based on these results I can now take the research forward as part of a future clinical and cost effectiveness trial. It has been suggested that there is a need, for a rapid increase in the evidence base for the clinical effectiveness of digital technologies, considering mHealth research can potentially be helpful in addressing the demand on mental health services in the UK and mental health inequalities

Social media in health and care co-production

The future of health and care services in the EU faces the three challenges of the aging population, fiscal restriction, and social inclusion. Co-production offers ways to manage informal care resources to enable them to better cater to the growing needs of elderly people. Social Media (SM) are seen as a critical enabler of co-production. This study investigates SM as an enabler of co-production in health and care for elderly people and develops a typology of opportunities and limitations of SM in relation to health and care. The study considers how SM acts as an enabler of co-production in health and care by facilitating its four underlying principles: equality, diversity, accessibility, and reciprocity. Normalization Process Theory (NPT) provides the theoretical framework for this qualitative study. Eighteen semi-structured interviews and observation of the activities of 10 online groups and individuals provide the data for the thematically-analysed findings. The study findings show how different SM are used to enable co-production through coordination and communication across boundaries. SM connects carers, disseminates information and engages volunteers. However, many types of SM are only rarely used in this sector due to their limitations. Nevertheless, carers of elderly patients demonstrated interest in using systems to engage people in the shaping of services, the sharing of experiences and encouraging activities. The study findings point to distinct patterns of feature use by different people involved in the care of elderly people. This diversity makes possible the principles of co-production by offering equality among users, enabling diversity of use, making experiences accessible, and encouraging reciprocity in the sharing of knowledge and mutual support. Exploitation of common resources also may lead to new forms of competition and conflicts. These conflicts require better management to enhance the coordination of the common pool of resources. The study finds that SM can facilitate co-production by offering mechanisms for coordination of the common pool of carer resources. It also enables better management of activities amongst other actors (professionals, patients, voluntary organisations, etc.). The study also demonstrates that, despite the capabilities of SM in achieving coproduction, many applications (both general and healthcare-specific) are not used to their full potential. The study also explores new innovations in this field and why they have failed to deliver their intended services

Pseudo National Security System of Health in Indonesia

ABstRACt Adolescence is a crucial period where one tends to identify who they are as an individual. However, as a teenager is struggling to find his/her place in this world, it is also a time where they are prone to engaging in risk behaviors, which tend to have an extreme psychological impact. The objective was to explore the experiences of an adolescent who engages in risk behaviors and to understand their level of personal fables. The study was a qualitative design with content analysis with semi-structured interviews of ten male adolescents aged 16-18 years. The major findings of the study indicated that adolescent’s pattern of thinking revolves around the fact that they are invincible and invulnerable. Furthermore, adolescents are aware of the risks they are putting themselves through and how in the process they are hurting others. The implications of the study are to conduct more life skill programs in schools; greater awareness has to be created on the impact and harmful effects of such behaviors

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT.

BACKGROUND: Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. OBJECTIVES: (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). DESIGN: Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. INTERVENTION DEVELOPMENT: Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. FEASIBILITY RCT: Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). SETTING: Community settings in London and Hertfordshire, UK. PARTICIPANTS: A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. MAIN OUTCOME MEASURES: Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. RESULTS: We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. CONCLUSIONS: Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. FUTURE WORK: A large, definitive RCT of the HomeHealth service is warranted. STUDY REGISTRATION: This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information