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Categories Insights Tags Behavioral Health, COVID-19, Cybersecurity, Data Analysis, Healthcare, Information Technology, Mental Health, Mobile Applications, National Institute of Mental Health (NIMH), Substance Abuse and Mental Health Services Administration (SAMHSA), Telehealth

Mobile Mental Health Apps: Weighing the Pros and Cons

Mobile Mental Health Apps: Weighing the Pros and Cons

By: Randolph Edmead, MS and Laura LaRue Gertz, MSW, LCSW

As symptoms of stress, anxiety, and depression are increasing during the global COVID-19 pandemic, people may be exploring technology-based strategies to relieve symptoms and to supplement mental health care. Increasingly, telehealth is a service covered by insurance providers. In addition, many people are interested in using mobile apps to supplement their care, track and improve their symptoms, and take proactive steps to improve their mental health through strategies such as stress reduction, relaxation, and cognitive behavioral techniques. Yet individuals may also be wondering how to evaluate if a mobile app is useful, evidence-based, and will safeguard their privacy.

Technology-based strategies such as mobile apps for mental health have many potential advantages. Technology has enormous capacity to gather assessment and monitoring data that can provide valuable insights about symptoms, useful strategies and could lead to more effective treatment. Technology can help overcome access barriers for individuals with mobility issues, for individuals living in rural areas or areas with a shortage of providers, and for individuals who have been reluctant to seek conventional mental health services. And now, mobile access is even more important as individuals may be simultaneously coping with increased symptoms of stress, anxiety, and depression during the pandemic, while experiencing isolation and reduced access to their usual support systems due to physical distancing.

Although there are many potential advantages of mobile apps to supplement mental health care, there are still many barriers and risks, including lack of effectiveness data; challenges with reproducibility, implementation, and dissemination; concerns about the privacy and confidentiality of data and use or misuse of data; and challenges with integration of technology strategies and data into the treatment plan and the health care system. However, there are useful, accessible strategies that can help people assess the safety and usefulness of a mobile app.

The APA App Evaluation Model is an evaluation roadmap to guide informed decision-making in choosing mobile apps in clinical care. The guideline provides a series of questions, organized by levels, that help consumers and providers decide whether to use a mobile app (Torous et al., 2018). This model does not endorse specific apps, but rather promotes a systematic approach to evaluating apps.

The five levels of the APA App Evaluation Model are:

  1. Access and Background: Assesses background information needed prior to evaluation
  2. Privacy and Security: Considers many aspects of app security and privacy
  3. Clinical Foundation: Evaluates any evidence for potential benefits
  4. Usability: Evaluates how usable the app is for the consumer
  5. Data Integration towards Therapeutic Goal: Examines whether the app’s output can be used in a clinically meaningful way

The PsyberGuide, developed through Northwestern University’s Center for Behavioral Intervention Technologies with funding from the One Mind Institute, reviews and rates apps that claim to treat mental health conditions. The publicly available guide helps consumers make informed choices. PsyberGuide provides app ratings based on three metrics:

  1. Credibility: Evaluates the strength of the scientific research for the app, as well as the therapeutic interventions provided by the app
  2. User Experience: Uses the Mobile App Rating Scale (MARS) developed by Stoyanov et al. (2015) to assess the design and user interface
  3. Transparency: Evaluates the clarity of the app’s privacy policy regarding data storage and collection procedures of the app and associated servers

Technology will not replace the human connection that is a central part of the care of individuals experiencing stress, anxiety, and depression. But when technology-based strategies are thoughtfully developed, evaluated, and implemented, they have tremendous potential to augment and expand care, to enhance engagement and treatment, and to improve the quality of life for individuals living with mental health conditions.

Randolph Edmead, MS, Vice President of Federal Government Programs. Randolph Edmead has an extensive background managing large teams in the mental health treatment, substance abuse prevention and treatment, policy, and evaluation service areas. Mr. Edmead has over 18 years of experience developing, implementing, and managing the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Centers for Mental Health Services and Substance Abuse Treatment and Prevention programs; providing curricula and training to SAMHSA and health care providers and staff on leading practices, human resources, accreditation survey support, skills development, and cultural competency; and consulting with healthcare organizations and treatment facilities. Mr. Edmead holds a Master of Science Degree in Clinical Psychology.

Laura LaRue Gertz, MSW, LCSW, Public Health Analyst/Scientific Writer. Laura LaRue Gertz has over 30 years of experience in health and mental health, as a clinician, analyst, writer, researcher, and project manager. She developed literature reviews and reports on evidence-based treatments for individuals with serious mental illness for a federal contract with the SAMHSA Center for Mental Health Services (CMHS). She has also worked on contracts with the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and numerous other U.S Department of Health and Human Services (HHS) agencies. Ms. Gertz holds a Master of Social Work Degree and is a Licensed Clinical Social Worker.

The Bizzell Group (Bizzell) was founded by President & CEO Anton C. Bizzell, M.D., a leading behavioral health expert and former Medical Officer for the U.S. Department of Health and Human Services (HHS). Bizzell’s team of public health experts have created and led comprehensive behavioral health prevention and treatment initiatives and education and training programs. Bizzell’s recent work includes systematic, integrated approaches designed to effect lasting change in health and behavioral health care through work with the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Department of Defense (DOD). Learn more about how Bizzell advances data-driven, research-informed, innovative solutions to solve complex-real-world challenges: https://BizzellUS.com/

References

Stoyanov, S. R., Hides, L., Kavanagh, D. J., Zelenko, O., Tjondronegoro, D., & Mani, M. (2015). Mobile app rating scale: A new tool for assessing the quality of health mobile apps. JMIR mHealth and uHealth, 3(1), e27.

Torous, J. B., Chan, S. R., Gipson, S. Y. M. T., Kim, J. W., Nguyen, T. Q., Luo, J., & Wang, P. (2018). A hierarchical framework for evaluation and informed decision making regarding smartphone apps for clinical care. Psychiatric Services, 69(5), 498-500.

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Categories BHARC Tags Behavioral Health, COVID-19, Mental Health, National Institute of Mental Health (NIMH), Special Populations, Substance Abuse and Mental Health Services Administration (SAMHSA), Substance Use Disorder (SUD), Thought Leadership

Supporting Teen Mental Health During a Pandemic

Supporting Teen Mental Health During a Pandemic

Written By: Todd W. Mandell, MD and Rhonda Waller, PhD

The global COVID-19 pandemic is casting new urgency on the topic of teen mental health. Adolescence is already a time of significant physical, mental, emotional, and social development. It is normal for teens to experience a wide range of emotions and unpredictable moods. The COVID-19 pandemic has added a new set of  challenges as teens navigate disruptions to their usual school, extracurricular, and social routines due to lockdowns, social distancing restrictions, and uncertainty about the future. According to a review of relevant research published in June 2020, many teens may experience isolation and loneliness which could lead to or exacerbate feelings of depression and anxiety. Currently, there is little data that examines the impact of pandemics such as COVID-19 on teens’ mental health, though some researchers are starting to explore this topic. Oxford University recently initiated a study that will track adolescents’ mental health to identify factors that hinder and promote resilience during the pandemic. In the meantime, we know that rates of teen depression and anxiety have risen during the past decade.

A 2019 study that examined National Survey on Drug Use and Health (NSDUH) data found that from 2005 to 2017, the percentage of adolescents (12 to 17 years old) experiencing at least one major depressive episode increased from 8.7 percent to 13.01 percent—a 52% increase. In 2018, the rate was 14.4 percent—roughly 3.5 million adolescents. The National Institute of Mental Health reports that nearly one-third (32 percent) of adolescents 13-18 years old experience an anxiety disorder. A 2018 study that examined data from the National Survey of Children’s Health (2003, 2007 and 2011-2012) found that anxiety similarly appears to be on the rise.

While there is no conclusive answer for why teen depression and anxiety are rising, some common themes in research include:

  • Increased awareness about mental health issues might increase disclosure of symptoms and identification of mental health disorders.
  • Continuous exposure to social media and news that may have an adverse impact on teen’s mental health.
  • Increased social and academic pressures and expectations for youth may contribute to depression and anxiety.

In addition, health inequities and social determinants of health such as socioeconomic status, education, social support networks, and access to health care can influence adolescent mental health.

The bottom line, however, is that mental health disorders are a real concern for teens—and the COVID-19 pandemic may exacerbate these issues for some youth. Left untreated, mental health disorders can have a lifelong impact on health. Parents, teachers, coaches, and others who interact with teens should stay alert for signs of anxiety and depression. Warning signs and symptoms may include:

  • Loss of interest in activities previously enjoyed
  • Avoiding school, activities, and social interactions with friends and family
  • Changes in grades
  • Trouble sleeping/concentrating
  • Engaging in self-harming or risky behaviors such as substance abuse
  • Chronic physical complaints
  • Sleeping too much or too little
  • Increased irritability or moodiness

The American Academy of Pediatrics’ parenting website offers  practical information from child health experts on how to support teens’ mental health  during the COVID-19 pandemic, including strategies for healthy routines, effective communication, safe virtual connections, family support, and physical and emotional health. However, parents who observe or are concerned about signs of depression or anxiety in their teen should discuss this with their pediatrician or a health care provider. The U.S. Department of Health and Human Services has also compiled a comprehensive list of Resources to Support Adolescent Mental Health. In addition, the National Institute of Mental Health recommends that teens save several emergency numbers in their cell phones to ensure immediate help for themselves or a friend in an emergency—including the non-emergency local police department number, the Crisis Text Line (741741) and the National Suicide Prevention Lifeline (1-800-273-TALK).

From a public health perspective, increased screening for depression and anxiety and access to health care could result in earlier detection and treatment, which is particularly important during the pandemic. Many experts, including the U.S. Prevention Screening Task Force (USPSTF) and the American Academy of Pediatrics, recommend annual screening of teens for depression. Most insurance companies are now covering telehealth visits at the same rate as in-person visits, which may make screening and services more accessible for teens needing treatment. With growing awareness of the effects of the pandemic on mental health, it is now even more important that teens experiencing depression and anxiety get timely screening and treatment to improve their outcomes.

Todd W. Mandell, MD, Senior Associate, Addiction Medicine. Todd Mandell is a board-certified Psychiatrist with added qualifications in Addiction Medicine, and more than 30 years of experience in the field of co-occurring psychiatric and substance use disorders with a focus on direct patient service, program development, and administration. (LinkedIn)

Rhonda Waller, PhD, Senior Associate, Maternal and Child Health. Rhonda Waller is a psychologist with more than 25 years of professional experience in public health, education, and human services with an emphasis on program development, leadership development, capacity building, and training and technical assistance. (LinkedIn)

The Bizzell Group (Bizzell) was founded by President & CEO Anton C. Bizzell, M.D., a leading behavioral health expert and former Medical Officer for the U.S. Department of Health and Human Services (HHS). Bizzell’s team of public health experts have created and led comprehensive behavioral health prevention and treatment initiatives and education and training programs. Bizzell’s recent work includes systematic, integrated approaches designed to effect lasting change in health and behavioral health care through work with the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Department of Defense (DOD). Learn more about how Bizzell advances data-driven, research-informed, innovative solutions to solve complex-real-world challenges: https://BizzellUS.com/

Categories Insights, Substance Abuse and Mental Health Services Administration (SAMHSA), Substance Use Disorder Tags Behavioral Health, Center for Behavioral Health Statistics and Quality (CBHSQ), CEO Insights, Health, Opioid Use Disorder (OUD), Special Populations, Substance Abuse and Mental Health Services Administration (SAMHSA), Thought Leadership, Women's Health

Integrated Strategies to Address Opioid Use Disorders in Women

Integrated Strategies to Address Opioid Use Disorders in Women

By: Anton C. Bizzell, M.D.

The opioid crisis has a complex set of contributing factors in women and requires integrated strategies and solutions. The Center for Behavioral Health Statistics and Quality (CBHSQ) of the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 19.5 million females (15.4 percent) age 18 years or older used illegal drugs in the past year, and 8.4 million females misused prescription drugs in the past year (CBHSQ, 2017)Center for Behavioral Health Statistics and Quality. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf. Opioid use and misuse may have a different progression in women as compared to men, due to differences in sex and gender. The National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH) defines differences by sex as pertaining to biological differences, and differences by gender as referring to culturally defined roles for women. Research has shown effects on women who use drugs from hormones, pregnancy, menstrual cycle, and menopause. Women have described reasons for using drugs, such as caregiving, depression and anxiety, fatigue, and coping with pain. Women are also affected by adverse childhood experiences, trauma, post-traumatic stress disorder (PTSD), partner stress, and domestic violence (NIDA, 2019)National Institute on Drug Abuse. (2019). Substance Abuse in Women. Retrieved September 19, 2019, from https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women..

In the past, women were not included in research studies at the same rate as men, or the data was not reported separately by sex. The NIH and other federal agencies have made significant efforts to include women, and to research the biological differences in women that are important to understanding how substance use disorders develop and how to treat them effectively.

Researchers know that there are some differences in how substance use disorders develop in women versus men, and continued research will seek to better understand these differences (NIDA, 2019)National Institute on Drug Abuse. (2019). Substance Abuse in Women. Retrieved September 19, 2019, from https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women.

  • Dependence: Women sometimes become dependent after using smaller amounts of drugs for a shorter time period, as compared to men.
  • Relapse: In addition to developing dependence more quickly, women may experience more cravings and be more likely to relapse following treatment.
  • Biological factors: Science has also shown differences in brain changes, effects on the heart and blood vessels, and increased sensitivity to drugs due to sex hormones. Women may have a higher likelihood of going to the emergency room or dying from an overdose from some substances, as compared to men.
  • Psychosocial factors: Psychosocial stressors can be a significant factor in opioid misuse and opioid use disorders (OUDs). Women who experience changes in relationships due to divorce or loss of child custody, as well as those who are victims of domestic violence, are at increased risk of developing an OUD. Other stressors such as unemployment, housing instability, caregiving, and untreated mental health conditions can play a role as well.

Substance misuse and OUDs affect millions of women, many of whom are of childbearing age. Most drugs, including opioids, can have serious and harmful effects to a pregnant woman and to an unborn baby. Some substances can increase the risk of miscarriage and stillbirth, in addition to causing health complications to the mother such as high blood pressure and seizures, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at NIH (2013)Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2013). Tobacco, drug use in pregnancy can double risk of stillbirth. Retrieved from https://www.nichd.nih.gov/news/releases/Pages/121113-stillbirth-drug-use.aspx. Women who are using may be afraid to get help while pregnant, due to fears that they will lose custody of their children, or due to barriers such as stigma, lack of access to treatment programs, or lack of child care. Babies born to women who misuse drugs, especially opioids, can go through withdrawal after birth, a health condition referred to as Neonatal Abstinence Syndrome (NAS). The Office on Women’s Health (OWH) issued Final Report: Opioid Use, Misuse, and Overdose in Women (2017)Office on Women’s Health. (2017). Final Report: Opioid Use, Misuse, and Overdose in Women. Office on Women’s Health. Retrieved from https://www.womenshealth.gov/files/documents/final-report-opioid-508.pdf detailing how the epidemic affects women, and the key prevention, treatment, and recovery issues for women who misuse opioids and who have OUDs. Stakeholders must collaborate to continue to develop relevant research, effective outreach, and evidence-based intervention targeted to the unique needs of women at risk of and affected by opioid use disorders.

Integrated Strategies to Address OUDs Among Women

Integrated strategies are vital to address the complex causes and effects of OUDs in women. The following is list of suggestions for improving health outcomes for women experiencing an OUD:

Research:  More research and data are needed on women who have substance use disorders, and the treatment strategies that are most effective for women.

Education:  Education should focus on prevention, as well as on early identification and treatment of substance use disorders. Partnerships between organizations such as schools, employers, and community centers are essential to reach women of all ages.

Integration of services:  Substance use disorder screening should be integrated into health care, mental health services, and social services. Screen to identify women who are at risk and who need help, and partner with treatment providers to coordinate care across settings.

Whole person care:  Coordinated assessment is needed of all aspects of women’s lives that may be contributing to a substance use disorder and may be a barrier to care. Treat the underlying contributors to substance use disorder and the barriers to recovery, including chronic pain conditions, pressures of caring for elderly parents plus young children, emotional distress and mental health conditions, relationship stress, domestic violence, under- or unemployment, and housing instability. Partner with social services to provide child care while a woman is undergoing treatment, and to address other social stressors in addition to opioid misuse and addiction.

Bizzell US’s Experience Addressing OUDs Across the Female Population:

Bizzell US (Bizzell) has advanced national and regional efforts over the past decade to improve prevention, identification, and treatment of opioid use disorders in women. The most recent Bizzell projects include:

  • Bizzell partnered with OWH in 2019 to support the meeting Combating Opioid Misuse Among Women and Girls: Prevention Strategies at Work, where 18 grantees and 75 participants discussed projects in 12 states focused on prevention strategies aimed at girls age 10 to 17, women of reproductive age, and older women. Topics included community engagement, pregnant and postpartum women and infants, youth and education, training and capacity building for the clinical workforce, pain management, and health IT and innovation to improve health care delivery.
  • Bizzell partnered with SAMHSA in a multi-year contract to provide technical assistance for approximately 1600 opioid treatment programs nationwide, integrating specific strategies to improve outcomes of women with opioid use disorders.
  • Bizzell partnered with SAMHSA in a multi-year contract to develop and deliver training to over 1500 clinical staff in 16 states through workshops and web-based interactive education, including modules on effective use of medication assisted treatment for pregnant and breastfeeding women.

Are you interested in learning more about Bizzell’s work to improve health outcomes for those affected by the opioid epidemic, including targeted interventions for women and other special populations? At Bizzell, we provide Management Consultation, Technical Assistance, Training, and Subject Matter Expertise in Opioid and other Substance Use Disorders, addressing complex real-world problems with modern, integrated strategies. Visit www.BizzellUS.com or email us: info@bizzellus.com.

 

References

Center for Behavioral Health Statistics and Quality. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from  https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf.

Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2013). Tobacco, drug use in pregnancy can double risk of stillbirth. Retrieved from  https://www.nichd.nih.gov/news/releases/Pages/121113-stillbirth-drug-use.aspx.

National Institute on Drug Abuse. (2019). Substance Abuse in Women. Retrieved September 19, 2019, from https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women.

Office on Women’s Health. (2017). Final Report: Opioid Use, Misuse, and Overdose in Women. Office on Women’s Health. Retrieved from https://www.womenshealth.gov/files/documents/final-report-opioid-508.pdf.

Categories News Tags National Recovery Month, Opioid Use Disorder (OUD), Substance Abuse and Mental Health Services Administration (SAMHSA), Substance Use Disorder (SUD)

National Recovery Month

National Recovery Month

September is Time to Celebrate Individuals in Recovery

In September, the Bizzell Group (Bizzell) encourages everyone to participate in National Recovery Month to increase awareness and understanding of mental and substance abuse use disorders and celebrate the individuals in long-term recovery. Now in its 29th year, Recovery Month is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Recovery Month began in 1989 as Treatment Works! Month, which honored the work of substance use treatment professionals in the field. The observance evolved into National Alcohol and Drug Addiction Recovery Month in 1998, when it expanded to include celebrating the accomplishment of individuals in recovery from substance use disorders. The observance evolved once again in 2011 to National Recovery Month (Recovery Month) to include all aspects of behavioral health.

The 2018 Recovery Month theme is “Join the Voices for Recovery: Invest in Health, Home, Purpose, and Community” and emphasizes that integrated care, a strong community, sense of purpose, and leadership contribute to effective treatments that sustain the recovery of persons with mental and substance use disorders. SAMHSA’s key message is that recovery in all its form is possible and encourages citizens to expand and improve the availability of effective prevention, treatment, and recovery for those in need.

Recovery month encourages us to recognize that mental health and Substance Use Disorders are chronic conditions similar to those who are managing other health conditions such as hypertension, diabetes, asthma, and heart disease. This observance reinforces the positive message that behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover.

According to SAMHSA, in 2016, 20.1 million people aged 12 or older had a substance use disorder in the past year, and 44.7 million adults 18 and older have any mental illness in the past year. In the midst of the crisis, millions of Americans’ lives have been transformed through recovery. The observances of this month are a way for everyone to celebrate these accomplishments since these successes often go unnoticed by the broader population.

Each September, tens of thousands of prevention, treatment, and recovery programs and facilities around the country celebrate Recovery Month. Participants speak about the progress made by those in recovery and share their success stories with their neighbors, friends, and colleagues. In doing so, everyone helps to increase awareness and furthers a greater understanding of the diseases of mental health and substance use disorders.

During this year’s observance, SAMHSA’s website, www.RecoveryMonth.gov and other activities will highlight inspiring stories that help thousands of people from all walks of life find the path to hope, health, and wellness. Advocates, supporters, and people in recovery can also post their stories at http://www.facebook.com/RecoveryMonth/.

People seeking help can reach out to SAMHSA’s National Helpline 1-800-662 HELP (4357) for 24-hour, free, and confidential information and treatment referral, or go online to find other SAMHSA resources for locating services.

This year’s observances highlight the various entities that support recovery within our society, including urban communities, health care providers, members of the media, and policymakers. Resources designed specifically for each of these groups are in the SAMHSA Recovery toolkit at https://recoverymonth.gov/promote/recovery-month-toolkit.

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