Can Mental Health Apps Help?

The headline of a review of recently published research said it all, “Online Suicide Intervention Works, but Most Patients Don’t Want It.” It was a review of a study of an automated, web-based program for people who were experiencing suicidal ideation – a potential precursor to suicide. In this study while the use of a web-based program was better than no treatment, 78% of the participants receiving treatment, discontinued use before the end of the study, and about 8% attempted suicide.

This wrong-headed study is like so many others. The researchers attempted to help people who are experiencing very difficult life challenges, without human intervention. There are probably hundreds of apps and many more under development that are trying to do the same thing. When there is no human component, treatments become more available, scalable and very cheap. The rationale for doing so is that this is a way to help many more individuals utilizing a more attractive business model.

The obvious problem with this fully automated approach is that it lacks the human touch. When we are struggling with one or more difficulties in our lives, we are usually not well served by a machine no matter how clever or cute. No one would ever say about a human-less service, “Thank you for being here with me in a crisis! I'm now going to be OK.” Or “You are more valuable and helpful in my life than I can express.” These are anonymous post meeting comments from individuals who have met via video with a Certified Peer Specialist – a person with similar experience who has been trained to help others.

Using peer coaches or “expert patients” as they are called in Europe, is an effective and relatively inexpensive way to provide help to others. In studies of peer support, we see some really great recipient outcomes, not the least of which are large (~70%) reductions in hospital readmissions.

The really great news about peer support is that it can be leveraged and it’s reach expanded by gathering individuals into video groups of eight to 12. In these groups, the role of the peer specialist shifts to helping the participants to help each other and backfilling the conversation as needed. These meetings also include science-based self-help information. As it turns out, the results are very strong. In our study of 142 participants in this type of video group, hospital readmissions were down 69% and use of urgent care and emergency rooms were cut in half. Participants love this way to get help. They have said, "This experience was a blessing. I came away from the meeting feeling better" or “My very first meeting and I felt safe in the room. Safe enough to talk about my issues. It made me feel better. I'm not alone.”

When we create services to try to help the growing number of people who are troubled because of behavioral health, chronic illnesses or rare diseases, we need to put their humanness first. Technology can help us to more efficiently connect individuals. Peers can help provide the social support so essential to well-being.

Depression Trends and Facts

Many of the participants in Peer Support Solutions meetings report intense feelings of isolation and loneliness, a common sign of depression. After a few sessions, many report lessening of this debilitating aspect of this problem. One of the things commonly talked about in support group meetings, is the increasing number of individuals who are suffering with depression.

In fact, recent research indicates that the rate at which depression strikes is on the rise. Today about 6 to 7% of the U.S. adult population suffers from depression at any one point in time. This rate is ten times more than it was in 1960.

Another interesting trend is that people are first experiencing depression at a younger average age. In 1960 the average age of a first episode was 29.5 years. Today, it is 14.5 years.

Current estimates are that one out of five people will have at least one major depressive episode in their lives. The World Health Organization projects that by 2020, depression will globally be the 2nd biggest healthcare problem (after heart disease) based on its economic and social impact.

Depression has become one of the costliest worker healthcare problems. It accounts for five times more absences than non-depression related problems. In fact, a new term has been coined to describe the impact of depression on productivity: “presenteeism”. Presenteeism refers to employees who are “on” the job in body, but not spirit. These employees contribute 2.3 days less effort per month than those who are not depressed.

Research shows that peer support for depression can reduce symptoms and use of medical services. Our platform allows individuals to easily access the understanding and care of a peer support group to help them move forward and regain their energy.

Peer Support and Boat Maintenance

Last weekend I took a dinghy out of the water that hadn’t been used for about six months. What an amazing number of things had grown and attached themselves to the bottom! There were a few kinds of algae and slimy stuff, barnacles and mussels all over the hull. It took more than an hour to scrub it all off of this small boat. If I had tried to use the boat with all of this marine growth attached it would have gone very slowly indeed.

I realized that when we have experienced a behavioral health issue in our lives all kinds of things attach themselves to us and slow us down. We form relationships that are dysfunctional or codependent and they sap our time and energy. We develop bad lifestyle habits that might include a poor diet, not enough exercise or insufficient sleep and we become stressed or ill. We can also have bad habits of mind “attach” themselves to us and drag down our mood or keep us from getting things done.

What can we do to remove these and other barnacles from our lives? There are at least three steps we must take. First, we need to “pull ourselves out of the water”. We have probably picked up the most issues from wherever we have spent the most time. We need to go someplace else, at least for a while, so we can start to sort things out. Some time at a coffee shop, a library, at the beach or in a park can help break the “psychological set” we develop from too familiar surroundings. Second, we need to look objectively at what has become attached to us. We can often do this better with the help of a trusted friend or peer. Third, we need to remove our dysfunctional and troublesome items. This can be the hardest part of this simple process. Unlike with my dinghy, we may need to attack one item or one area at a time and patiently, slowly repair the part of us that needs to be restored. This is where an ongoing peer support group can be particularly helpful. It’s only when we have worked through our issues, with the encouragement and help from others, that we can enjoy the benefits of having a smoother life that allows us to glide forward.