Intersection of mhealth and Behavioral Health Co-Chairs: Lisa A. Marsch, PhD, Director, Dartmouth Center for Technology and Behavioral Health Andrew Campbell, PhD, Professor of Computer Science, Dartmouth College
The Application of mhealth to Behavioral Health mhealth tools targeting behavioral health include those used for behavioral self-monitoring, self-management to promote health behavior, and decision support tools They may address a wide array of behavioral health issues (e.g., substance use, mental health, medication-taking, health promotion/wellness). They may include applications for clinical populations as well as prevention/wellness promotion (e.g., quantified self movement of behavioral tracking to increase self-knowledge via data) They may be deployed via integration with health care systems or as standalone, self-directed tools.
The Promise of mhealth for Behavioral Health Research on mhealth tools targeting behavioral health has repeatedly demonstrated that these tools: Can be highly useful and acceptable to diverse populations Have a large impact on health behavior and health outcomes Increase quality, reach, and personalization of care Can be cost-effective Can prevent costly escalation of problems and unnecessary healthcare utilization (via on-demand, just in time therapeutic support) Can be responsive to individuals health behavior trajectory over time
Prevalence and Significance of Behavioral Health Disorders Mental health and substance use disorders are common in the U.S. Approx. 1 in 4 to 1 in 5 adults are diagnosable with one or more mental health disorders Approx. 1 in 10 adults are diagnosable with one or more substance use disorders Persons with behavioral health disorders are among the most frequent and costliest utilizers of health care services. Overall annual economic cost of mental health disorders estimated at over $300 billion (increased from $35 billion in 1996) WHO estimates that mental illness accounts for more disability in developed countries than other groups of illnesses (including cancer and heart disease)
The Role of Behavioral Health in Chronic Disease Management Behavioral Health Disorders are highly prevalent among Clinical Populations with Chronic Physical Health Conditions (approx. 133 million Americans, accounting for over 75% of health care costs) e.g., Persons with diabetes have 40-72% incidence of depression; 50% incidence anxiety Behavioral Health Disorders Typically Complicate and Worsen the Course and Treatment of Chronic Medical Illnesses. Lower quality of life, poorer response to treatment, worse medical and psychiatric outcomes, higher mortality and higher costs of care. e.g., when depression co-occurs with diabetes, health care costs increase by 50-75%.
Integration of Physical and Behavioral Health in evolving U.S. Healthcare System mhealth approaches focused on behavioral health are particularly timely and offer promise for meeting a tremendous need as the healthcare delivery requirements of the Affordable Care Act (ACA) are implemented nationally. e.g., ACA requires that health care settings, which have traditionally focused on physical health conditions, must offer care for substance use and mental health disorders. Providers can no longer refuse to treat or transfer elsewhere individuals with substance use or mental health disorders but are responsible for the entirety of their care. Medicaid eligibility will expand and provide coverage for the first time to an estimated 32 million (many are poor, unemployed, and have disproportionately high rate of behavioral health problems).
Unprecedented Opportunities for Effective and Cost-effective Technology-based Solutions mhealth offers great promise for helping to realize the integration of behavioral and physical health in a manner that increases quality of care while containing costs. Mobile communication technologies that embraces the behavioral dimensions of multiple chronic-condition care can dramatically decrease barriers to successful management Health information and communication technologies may transform health care service delivery models.
Orientation to the Panel David Gustafson, U. of Wisconsin-Madison Sarah Lord Dartmouth College Timothy Bickmore Northeastern University Niels Rosenquist Mass. General Hospital * Panel discussion is being recorded.