Harnessing Mobile Health Technology to Digitally Engage Mental Health Consumers in Recovery

The landmark report of the President’s New Freedom Commission on Mental Health (2003) envisioned a future when every person afflicted with mental illness would recover and recommended integration of emerging technologies into the mental health care system in order to improve access to quality care and services. More than a decade later and with the current national health care climate that encourages innovations through the Health Information Technology for Economic and Clinical Health (HITECH) Act, the integration of health information technology (HIT) continues to make headway in mental health care. The concept of a person with mental illness being in recovery has also taken hold in the mental health field. The rapid advances in health information and digital health technologies are allowing us to move forward toward achieving the promise of a transformed mental health care system that supports individual recovery. Technological advances provide innovative tools to the mental health providers and can help empower consumers in their recovery. One of the more recent technological advancements in the behavioral and mental health care arena is the delivery of care via mobile devices, better known as “mHealth.”

Mobile devices offer a large collection of applications and services that, together, provide valuable resources for both patients and health care providers. More specifically, the current mobile applications market for mental health serves the following areas: developmental disorders, cognitive disorders, substance-related disorders, psychotic disorders, mood disorders, anxiety disorders, eating disorders, and sleep disorders. Generally, most applications provide a mechanism for targeted data capture (i.e., journaling, self-assessments), which are later uploaded to a centralized repository, sometimes known as the “cloud,” for later retrieval and further processing. Other applications provide trigger notifications to both the user and the health care professional for rapid interventions. Some applications also provide video-conferencing capabilities, or “one-touch” access to hotlines (i.e., suicide prevention), which are triggered by logic embedded in the applications themselves. The National Center for Telehealth and Technology (2014) has a collection of mHealth mobile apps used in the military to help servicemen and their health care providers in managing a range of psychological health issues and concerns. These evidence-based mHealth digital tools are available at http://www.t2.health.mil/products/mobile-apps.

While the current landscape of mHealth applications in mental health is considered to be more “mainstream,” a new generation of applications is emerging. The applications leverage emerging device capabilities, such as global positioning system and wearable sensors. An important advantage of these newer technologies is that they enable real-time user feedback and analysis (Haniff, n.d.). As consumer adoption of wearable technologies increases, the convenience factor for mental health users also increases in capturing valuable biofeedback, such as the use of small-sized measurement devices embedded in state-of-the-art sensorized garments that are enabled to collect real-time biometric and physiological data to determine anxiety and stress levels in humans (Seoane et al., 2014). Gamification, which entails the use of game-like methodology in nongame environments, also serves as a catalyst for user adoption because it provides rewards and incentives for users based on their behavior against certain predefined targets or objectives. For example, in a study by Dennis and O’Toole (2014), a single session of the attention-biased modification training delivered in an appealing mobile gaming app format using video games, animated characters, and sound effects demonstrated promising benefits in reducing subjective anxiety and observed stress levels among highly anxious research subjects.

It is also worth noting that when designing mHealth applications, limitations of mobile devices themselves can be overcome by leveraging external resources and robust digital infrastructure like the cloud. For example, when conducting mHealth research, a customary mobile device such as a smartphone may not be best suited for doing heavy data analysis due to inherent limits in data storage, memory capacity, and processing power. But it can send data to the cloud for analysis, and in turn leverage data aggregated from a network of other mobile devices connected to the cloud to improve accuracy, as well as possibly unveiling correlations that would not otherwise be possible working at a smaller scale using a single mobile device.

According to the most recent data from the Pew Research Internet Project’s (2014) research on mobile technology, almost 90% of American adults have cell phones, 58% have smartphones, 32% own e-readers, and 42% own tablet computers. The convergence of portability and the rise of high-speed power of the Internet have made these various digital mobile devices commonplace in our society. In the health care sector, there is considerable interest in using various forms of mHealth technology because it has the potential to transform the health care system and help achieve the triple aim of improving care and outcomes while lowering costs and offering the promise of convenience and enhanced care access (Steinhubl, Muse, & Topol, 2013).

Recently, the Substance Abuse and Mental Health Services Administration (SAMHSA, 2014) sought public comments for its proposed strategic plan for 2016 to 2018 in an online document titled, Leading Change 2.0: Advancing the Behavioral Health of the Nation. The plan outlines six key strategic initiatives that SAMHSA has committed to focus on in order to improve the behavioral health of our nation and its citizens through pervasive prevention efforts, access to treatment, and wellness and mental health recovery support services. Realizing the significant potential that HIT plays in improving the mental health for millions of Americans and their communities, one of SAMHSA’s proposed strategic initiatives (No. 5) is geared toward the use of HIT and other technological tools with potential uses in the behavioral health field that are emerging in this digital age. In fact, SAMHSA has been a proponent of the use of mHealth in mental health with the release of its digital tools such as the SAMHSA Behavioral Health Disaster Response App and Bullying Prevention App. These mHealth tools not only offer innovative ways in providing increase access to care in underserved communities but also provides self-management support to mental health consumers and foster engagement in treatment using nontraditional methods that leverage digital technology (SAMHSA, 2014).

Although there are still a number of limitations and constraining factors that must be considered when integrating mHealth into behavioral and mental health care, mHealth technology offers significant potential to facilitate the delivery of evidence-based behavioral health treatments. mHealth holds potential to make behavioral and mental health treatment more accessible and interactive (Luxton, McCann, Bush, Miskind, & Reger, 2011). In doing so, mHealth will align health care delivery with today’s diverse mental health consumers that are increasingly mobile, connected, and technologically savvy. With various emerging and evolving digital technologies continuing to reshape the current health care landscape, the ways in which mental health consumers engage in their own treatment and recovery are also shifting. Put simply, the increasing convenience of mental health care delivery through the use of mHealth technology can be an effective digital strategy to engage the mental health consumers and help them navigate the path toward continued wellness and recovery.