Treating and preventing mental illness through your smartphone

Jan. 14--More than two years ago, the St. Louis counseling center Provident added an interactive website FeelingKindaBlue.com to its arsenal of telephone and face-to-face services to help those dealing with depression.

The website started with about 745 members, and today has more than 4,650 -- a more than sixfold increase, according to Provident clinician Billie Hartgrove. Last year, nearly 1,432 calls were made to the 24-hour crisis hotline listed on the site, and counselors called 533 members they felt needed intervention.

"It's doing what we felt like it was going to do within the community, encouraging individuals to reach out," Hartgrove said.

With the prevalence of mental illness and shortage of mental health providers, clinicians are increasingly interested in how mobile applications and social media can be used to help improve care. Consumers are interested as well, because of the proliferation of smartphones and desire to take a more active role in their health.

The result is a growing number of health apps. In two years, the number of health apps has doubled to more than 165,000, according to a recent report by the IMS Institute for Healthcare Informatics. Nearly one-third are related to mental health -- most addressing anxiety, depression, autism spectrum disorder, attention deficit hyperactivity disorder or Alzheimer's.

Social media and mobile apps can be especially helpful when it comes to mental health, providers say. They help overcome obstacles such as fears of reaching out, medical bills and long wait times for an appointment.

Stephen Schueller, a researcher at Northwestern University'sCenter for Behavioral Intervention Technologies, said having help at a person's fingertips improves success. He likened the advantage to being hungry in your kitchen and searching the Internet for instructions on how to make an omelette; as opposed to scheduling a cooking class in eight weeks and eating an omelette later when you don't even want one.

"An app can bring services to people at the time and place when people need it the most," Schueller said.

THERE'S NO PANACEA APP

When people are dealing with depression or anxiety, Hartgrove pointed out, they often struggle with leaving the house or meeting others in person. Interactive media can easily combat the isolation."When you can barely get out of bed and sometimes don't have any contact with the outside world, this is a chance for them to reach out to someone." she said. "It shows there are others out there having the same experiences."

On the Feeling Kinda Blue site, users can take a depression quiz and learn about resources for help. Members can sign up to participate in online chats with others and join various groups tailored to their concerns, such as bipolar disorder or self-harm. Counselors at Provident monitor the comments.

The coping suggestions and encouragement among members are extremely helpful, Hartgrove said. "It's amazing to watch just how supportive everyone is of each other."

Despite the growing interest in mobile health, providers still have concerns about how the use of apps and social media could be detrimental instead of helpful for someone with mental illness.

When Provident agreed to administer the website, created by a University City woman who lost her son to suicide, they worried about inappropriate or dangerous comments and how to monitor the chats. Hartgrove said requiring members to register with biographical and contact information has worked well.

Schueller said his biggest concern is that someone will decide to download a health app, fail to get better and and give up.

"Recognize that if it doesn't work, it doesn't mean you've failed therapy, you're hopeless or things won't get better. There's no panacea app that cures ails for everyone," he said. Just try another one.

WHERE WE ARE GOING

Many mental health apps lack research on their effectiveness, Schueller warned. Look for apps that include proven interventions such as cognitive behavioral therapy and those affiliated with academic research institutions or government funding agencies, he said. "If things end in .org or .edu that is a good sign. If things end in .com, it's not usually such a good sign."Most apps are targeted to certain behaviors such as improving sleep, setting goals or changing negative thoughts. Find an app that helps with what you struggle with most, Schueller suggested. Ask providers for recommendations.

Providers are starting to "prescribe" apps to help their patients, he said, but they also struggle to keep up with the market.

Many clinicians look to apps created by a Department of Defense telehealth organization that has been at the forefront of mobile health efforts to help military service members, veterans and families with psychological health issues.

The center at Northwestern University has created IntelliCare, a suite of 14 apps for Android users targeting different causes of depression and anxiety that are part of a nationwide study funded by the National Institutes of Health. Services like AppScript.net also review and recommend apps for providers.

At Provident, Hartgrove said therapists met over the summer to create a list of helpful apps to suggest to clients. Provident also hopes to create a Feeling Kinda Blue app in addition to the website.

"Mobile sites and websites seems to be where we are going in the future," Hartgrove said. "What I'm seeing is that social media is going to play a big part in how we address mental illness in the community and reaching out to people who might not have any other means of getting direct support."

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MENTAL HEALTH APPS

Provident counseling services has created the following list of mental health apps to suggest to clients. They are available on Android and iPhones and free unless otherwise noted:

Virtual Hope Box: Provides help with emotional regulation and coping through supportive audio, messages, video, pictures, games, mindfulness exercises, activity planning and other tools. Designed for use by patients and their behavioral health providers, who work together to personalize the content.

LifeArmor: Contains information on 17 topics such as sleep, depression, anxiety and relationship issues. Within each topic users can take a self-assessment, learn tools to help manage and watch video testimony from the military community about their struggles.

Pacifica: Provides daily tools to manage stress and anxiety based on cognitive behavioral therapy and mindfulness. It includes mood ratings, meditations, deep breathing exercises, muscle relaxation guidance, ways to record and analyze thoughts and set goals.

Happify: Games and activities to help meet mental health goals such as lowering anxiety or stress levels.

PTSD Coach: Helps people with PTSD learn about and cope with symptoms. Provides tools for screening and tracking symptoms, coping skills and direct links to support and help.

PFA Mobile: Assists those who have received training to provide psychological first aid while in the field responding to a crisis or disaster. It reviews ways to engage with disaster survivors in a supportive manor, provides practice scenarios and reviews self-care actions.

Mindfulness Daily: Guides users through quick, effective practices to reduce stress, improve performance and enhance sleep. iPhone only. Cost is $1.99.

My3: Helps users with thoughts of suicide by customizing a safety plan with personal warning signs, coping strategies and personal networks to reach out to for help. Has buttons to call a lifeline or 911 and a list of referrals.

Others suggested by Stephen Schueller, researcher at Northwestern University'sCenter for Behavioral Intervention Technologies:

Koko: Allows you to anonymously reveal your stress to other users, and in return receive peer support to help calm your mind. Within minutes, users receive helpful insights and alternative perspectives. iPhone only.

SuperBetter: Increases resilience and problem-solving through game-like play involving quests, power-ups, bad guys and allies.

Michele Munz -- 314-340-8263

@michelemunz on Twitter

mmunz@post-dispatch.com

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