Transparencies November 2018

November: How Tech is Changing the Face of Mental Health

A Message From Our Board Chair

While there are many challenges in the world of mental health care, technology is proving to have tremendous potential in improving the accessibility, effectiveness, and delivery of mental health care, and worthy of continued exploration. Electronic Health Records (EHRs) and patient portals are allowing more direct communication between health care professionals and patients. They are now expected features when selecting a provider. Websites and apps are using artificial intelligence to help identify possible mental health conditions, and match patients to providers who meet patient needs and treatment preferences. And, online support groups are removing the common obstacles that have historically kept people from participating (such as feeling uncomfortable attending in person, no availability in the community, or needing options after normal business hours).

Integral Care is closely evaluating the various emerging technologies as well as how they may allow us to improve access, measure outcomes, develop best practices, and control costs. How do they work, what’s promising but unproven, and where are the possible drawbacks?

Telemedicine includes the use of such technology as video conferencing, video chat technology, and remote patient monitoring to connect providers to patients. Telemedicine enables healthcare providers to evaluate and treat patients without an in-person visit. The National Institute of Mental Health reports that half of U.S. counties have no mental health professionals. Telemedicine offers increased access and convenience to people who live in areas that have a shortage of providers (such as psychiatrists), or who are unable to leave their home for treatment or evaluation.

Mental health smartphone apps number over 10,000 and are 29% of all health-related apps on the market. Apps are helping people with everything from practicing cognitive behavioral therapy (CBT) to tracking emotions and alcohol consumption to meditation and mindfulness exercises. There are even symptom tracking apps that collect data about a user’s sleep and activity patterns using built-in smartphone sensors. If the app detects atypical behavior, it sends an alert that the user needs additional attention, before a crisis occurs.

These apps hold great promise. However, not all are evidence-based, and while some apps can help improve users’ mental health, others offer potentially harmful advice. The American Psychiatric Association has created an App Evaluation Model to assist clinicians in advising patients on which apps are appropriate for them.

Artificial Intelligence (AI) has allowed the creation of virtual therapists in the form of chatbots, which can serve as triage, or until a human is available. However, a virtual therapist has its technical and legal limitations as a robot, with limited skills and technical glitches. Not to mention the potential to further an individual’s social isolation.

Data Collection is occurring through our smart devices, and being used for mental health studies, which will hopefully increase understanding of conditions and lead to better interventions. The National Institute of Mental Health is tracking and guiding this trend. In 2017, they released a report reviewing the opportunities and challenges of using new information technologies.

Innovative technology can complement and strengthen face-to-face mental health care, but we recognize it cannot replace the evidence-based human interaction between a psychiatrist or therapist and patient. Integral Care is currently using telemedicine technology, a provider portal, and is in the process of launching a more advanced and robust EHR. We have also established a committee to identify other technology opportunities.

Being in a community like Austin, surrounded by technology companies, Integral Care believes it is well situated to identify and understand emerging technologies, and recognizes their potential and importance, if used properly. We will actively monitor and consider incorporating such emerging technologies to ensure Travis County maintains a mental health system with the expected standard of care, and keep you updated on our progress.

Hal Katz

Board Chair

Program Highlight

Telemedicine

Integral Care uses telemedicine to facilitate patient access to a psychiatrist. The Herman Center, which provides short term, emergency psychiatric crisis care through referrals from law enforcement as well as others, requires a psychiatrist 24/7. For individuals who come to Herman Center, intervention is immediate and a treatment plan is in place within a handful of hours. Telemedicine doctors, contracted through JSA Health Telepsychiatry and Iris Telehealth, augment our ability to provide that essential in-the-moment crisis care.

We also offer telemedicine using our own psychiatrists who serve our integrated healthcare clinics throughout our community – both Integral Care and CommUnityCare (CUC). Patients who receive primary care at any of our partner CUC clinics are able to see one of our psychiatrists via telemedicine at their home clinic. This is a convenient service for patients with low to moderate mental health issues. Wendy Salazar, Practice Manager for the program, says:

“Before, patients would have to travel to another clinic to access psychiatry services. They might spend hours on the bus traveling to a half hour appointment. The rate of no shows was higher then. Telemedicine opens up access to no end.”

Technology is imperfect. The internet could go down and what the video conferencing captures is limited. For example, the doctor may be unable to observe all aspects of a patient, such as someone’s hands shaking.

Telemedicine is a great tool to decrease wait times for appointments and increase the efficient use of a limited resource – our doctors – by reducing travel time. Clients come to the clinic and video conference with a doctor either in their home office or at another Integral Care location. Integral Care does not offer in-home telemedicine at this time.

Partner Highlight

Crisis Text Line

Integral Care recently launched a collaboration with Crisis Text Line, a national organization that provides free, 24/7 crisis support via text, increasing access to crisis care for people in our community who prefer texting to talking. Since 75% of texters are under 25, the text line is an additional tool that helps youth and young adults who may be struggling. Here’s how it works:

An individual texts TX to 741741.
A trained Crisis Text Line counselor receives the text and responds quickly – within 5 minutes.
The Crisis Text Line counselor helps the individual stay safe and healthy using active listening and suggested referrals – all through text message, using a secure platform.

Crisis Text Line counselors are volunteers who go through rigorous training. A paid professional with an advanced degree in counseling, psychology or social work closely supervises them, monitoring every conversation. Additionally, supervisors have experience in crisis intervention.

Crisis Text Line is an anonymous service, which means they don’t know the location of the person reaching out for help. However, if a texter is at imminent risk of suicide, including ideation, plans, means or timing within 24 hours, a Crisis Text Line supervisor can activate emergency response and identify the location of the individual. Crisis Text Line will contact local law enforcement or EMS to perform a safety check on the individual. In this situation, local law enforcement or EMS might refer to Integral Care or involve our Mobile Crisis Outreach Team. Nationally, Crisis Text Line contacts law enforcement or EMS an average of 20 times per day.

Integral Care continues to provide immediate crisis support over the phone 24 hours a day, 7 days a week through our 24/7 Crisis Helpline at 512-472-HELP (4357). We are proud to partner with the Text Line, so that people who prefer not to pick up the phone have access to the support they need, when they need it.

TRANSPARENCIES

November: How Tech is Changing the Face of Mental Health

Program Highlight

Partner Highlight

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