A 2015 pew research study found that 73% of teens have a smartphone,in addition to 58% with tablet access and 87% with computer access. Early teens also have a lot of access with 64% of boys and 73% of girls 13-14 having access to a smartphone. Smartphones aren't just for high income households either, 65% of teens households with less then $30,000 income a year have a smartphone. Racial disparities are reversed when it comes to this as well, with 85% of non-Hispanic black teens having access, compared to 71% of non-Hispanic white teens. Those with mental health conditions have the highest percentage of smartphone ownership at 97%. The study also found that most patients are interested in using a mobile phone application to monitor their mental condition.
Who has a mental illness?
Half of lifetime mental disorders start in the mid teen's and three-quarters by the mid-20's. 52.4% of people age 18-29 experience any disorder and 22.3% are experiencing three or more disorders. Within this group, it was found that anxiety disorders were most common at 30.2%, followed by impulse control disorders at 26.8%.
Mobile Apps VS. Telepsychiatry
This article defines mobile apps as delivering interactive content, collecting information, informing users about insights based on findings, and enabling users to receive assistance when in crisis. Telepsychiatry is defined as linking the patient to a clinician (which is differentiated than a mobile app which doesn't require clinician involvement).
Hard Vs. Soft Benefits
Hard benefits are defined as direct benefits and result from the immediate expenditures and benefits tied to a good or service. Soft benefits are defined as indirect benefits and result from the the activities and changes that are caused by the good or service. Both of these benefits are used to gauge the return on investment for mobile apps and telepsychiatry (summarized in the table above).
Direct Benefits of Mobile Applications
Mobile apps for mental health create savings from the substitution of other forms of care as content delivered through an app is less expensive than the same care delivered in person. Building an app has a high sunk cost, but after that the incremental costs are almost zero. In a multi-site study by the National Institute of Mental Health-funded, it was found that with CBT (cognitive behavior therapy), therapists typically spent 16.6 hours with a patient, but with a combination of a computerized program the same reduction in depression scores could be achieved. By prerecording CBT instructions, it eliminates much of the time therapists need to spend on repetitive tasks. The CBT cost is now reduced to a third.
Another benefit is that high -acuity situations can be prevented because apps provide anonymity and convenience. People who would not normally seek psychiatric help are more willing to complete a diagnostic questionnaire through an app. The US Prevention Services Task Force recommends screening all adults for depression and this app is a good confidential way to get adults the care they need. Early recognition is also helped with mobile apps because adolescents cannot get live therapeutic help and apps bridge this gap.
Self-identification through the app may drive some to seek professional help, which increases the demand for psychiatry services.
Apps are often supported by ad revenue, fees for purchase, or fees for use; all of which provide these app developers and operators a revenue source.
Indirect benefits of Mobile Applications
Poor mental health can lead to poor physical health, which is costly and it can also lead to poor performance at work/school, which is again costly. Early recognition and treatment of mental illness, results in great cost savings due to improved physical health. Mortality is also increased for those with mental health conditions because after a stroke, for example, these conditions lead to an increased rate of mortality.
Mental health affects how adolescents perform in and out of the classroom. Those who score higher on the Children's Depression Inventory, have a higher rate of absenteeism and lower academic performance. This affects university performance because high school performance affects college admissions and college selectivity is found to affect future earnings.
As an adult, depression affects overall output and the productivity loss impacts the individual and surrounding society. Since mobile apps can diagnose and treat, this reduces the impact of present and future financial consequences.
Direct Benefits of Telepsychiatry
Geographic barriers are removed with telepsychiatry, which makes those in rural areas or who are bed bound, able to access these services. The transportation costs is also eliminated with a video conference appointment. This increases access to those with limited time, money, or access to transportation, so that those in rural areas have access to adequate care. For those not in rural areas, this allows continuity of care while traveling.
Telepsychiatry increase the ability of patients to receive care when they need it urgently. A survey found that primary care physicians who referred patients for psychiatric care are satisfied with the telepsychiatry care received. It is useful as a supplement when a patient can't reach his/her primary psychiatrist in a time of need.
Telepsychiatry services expand the market reach of a psychiatrist, which helps fill his/her schedule.Patients are less likely to miss appointment because of the elimination of the transportation barrier and telepsychiatry services allow a psychiatrist to fill in holes for last minute cancellations. Psychiatrists can increase revenues while giving patients access to care at a lower cost.
Indirect Benefits of Telepsychiatry
Telepsychiatry appointments reduce the need for caregivers to assist a patient in getting to an appointment, which lowers costs for patients. This also holds true for children and adolescents that need someone to take them to their psychiatry appointments.
Psychiatrists can save on staff and office space, as telepsychiatry doesn't require a waiting room or physical forms. This also eliminates the insurance required for physical visits, like slips ad falls. In addition, there are savings on utilities,tissues, water, couches, rugs, etc. All that is required for a telepsychiatry appointment is a laptop with a camera, a smartphone,and a broadband connection.
Telepsychiatry produces the same indirect benefits as mobile apps in terms of improved mental health, potential improvements in school as well as present and future earnings since mental illness amplifies costs for physical illness.
Powell, A., PhD, Chen, M., PhD, & Thammachart, C., MA. (2017). The Economic Benefits of Mobile Apps for Mental Health and Telepsychiatry Services When Used by Adolescents. Child and Adolescent Psychiatric Clinics of North America,26(1), 125-133. doi:http://doi.org/10.1016/j.chc.2016.07.013
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I thoroughly enjoyed your guys’ research into the topic of telemedicine. While I was scrolling through your blog earlier I realized that you found a lot more information on different aspects of telemedicine then just what you presented on in class. This just goes to show how in-depth this topic is but you chose a good focus nonetheless. I liked how you downloaded the 3 different telemedicine applications to get a first-hand feel for the different usability characteristics. For me personally, I learned that these mobile doctor applications exist in the first place! In your blog post on the Time magazine article The Doctor Will Skype You Now, the executive director of the IMS institute said that there should be a balance of telemedicine apps and in-person doctor visits. I agree because there’s no reason for these applications to complete eliminate the need for your go-to doctor. They should simply be a great alternative for those times where you just need to get a quick pink eye, or common cold diagnosis to get that antibiotic going. I also like the cost saving aspect of telemedicine. In your table on the sources of indirect and direct benefits resulting from digital tools for mental health, one of the direct benefits is “savings from prevention of higher-acuity situations through early identification and recognition”. With mobile applications, patients would pay closer to the real cost for just seeing a doctor and not any other fees they might see if they ended up in a hospital. Like I said, your presentation was good and informative. If anything it made me want to know more about the topic! It would be interesting to see how telemedicine would work in different regions of the country, like rural areas that are far from hospitals, but also in busy cities where doctor prices are a lot higher! And then what about developing countries with less access to safe healthcare (rural Africa, India, South America), would these telemedicine applications help improve lives there as well? Hopefully we all keep an eye on the future of our classmates topics because there was just so much to learn! Thanks again Kathryn and Juwen for the great research and presentation.
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