E-mental health is revolutionizing and reshaping mental health practice worldwide

Online resources, smartphone applications, social media and videoconferencing support and improve mental health care and practice worldwide. They also enable the global exchange of expertise and knowledge.

At an intellectually stimulating symposium at EPA 2018, speakers from the US, UK and South America, shared their experiences and understanding of the opportunities and challenges provided by these new technologies.

E-mental health technologies have huge potential to support and improve mental health care and practice worldwide

The presentations highlighted the application of e-mental health to individualize and improve quality of care for patients, and to provide psychoeducational resources for patients, care givers and health care professionals.

The use of social media by health care professionals to support and improve everyday clinical practice was also explored.

Telepsychiatry in the US addresses a shortage of psychiatric expertise and community-based services

In the US, the Department of Veterans Affairs, which provides healthcare cover for nearly 5% of the insured population, has been a leader in the development of telepsychiatry, explained Sofia Frangou, Professor of Psychiatry at the Icahn School of Medicine, Mount Sinai, New York.

The Department of Veterans Affairs serves current and former members of the US Military, and plays a central role in helping those members of the military with mental health problems. With over 4000 areas in the US, defined as areas with a shortage of psychiatric expertise and services, telepsychiatry can play a significant role in filling an existing need for the military and civilian populations. This shortage of coverage has been addressed by the provision of telepsychiatry using videoconferencing technology in “clinically supervised settings,” usually in local clinics or hospitals.

Telepsychiatry in the US is carried out via videoconferencing technology in “clinically supervised settings,” usually in local clinics or hospitals

On the other hand, psychiatrists providing this type of care face many challenges. They must hold a medical license in the state and be credentialed by each organization where thepatient is located during the interaction, or have “privilege by proxy”. In addition, some states require the presence of medical staff with the patient and face-to-face visits.

Protection of privacy is critical, yet presents challenges in telepsychiatry: the Health Insurance Portability and Accountability Act (HIPAA) requires that videoconferencing systems encrypt all health information, and state laws may pose further requirements to ensure patient privacy.

Apps are increasingly available, popular and effective e-mental health interventions

Smartphone applications (apps) are used to assess symptoms, provide education, locate resources and track treatment progress, said Olivier Andlauer, consultant psychiatrist from London.

Dr Andlauer described the work of the e-Mental Health Section of EPA. Its wide remit includes demonstrating the efficacy of e-mental health applications, improving knowledge about the opportunities they provide, and promoting regulatory guidelines and standards.

Apps for patients provide opportunities for monitoring lifestyle factors and early detection of adverse events

mPivas (mHealth Psychoeducational Intervention Versus Antipsychotic-Induced Side Effects) is an e-mental health Android app developed by the EPA for patients. It was financed by a European Union grant and provides opportunities for monitoring lifestyle factors and adverse events. The group found the app particularly valuable for early identification of adverse events enabling an early appropriate change in medication

Professor Frangou highlighted academic-initiated e-mental health hybrid models in which apps are used for passive monitoring and data collection, which then enables big data analysis. She cautioned, however, that many thousands of e-mental health apps are available to people worldwide, and at the moment there is no regulation to ensure the content is accurate and safe to use.

E-mental health resources for psychoeducation

Many e-mental health educational resources are available worldwide for mental health professionals, though Dr Olivier advised using resources that have been accredited by an authoritative organization.

Professor Rodrigo Cordoba Rojas of the University of Bogata, Columbia and Former President of the Latin American Psychiatric Association described how the 18 countries and 25,000 psychiatrists within the Latin American Psychiatric Association have developed an on-line resource on bipolar disease.

E-mental health resources provide valuable education for mental health professionals, patients and caregivers

Similarly, e-mental health educational resources and peer-support groups are available for patients and caregivers worldwide, but not all are accurate or helpful. Dr Olivier suggested providing advice for patients and their families to guide them in their use of these resources.

Challenges for the use of e-mental health technologies include a lack of broadband internet in rural and remote areas and their use by older patients, who may have difficulty operating digital solutions, said Professor Frangou.

Closed social media groups provide invaluable support for healthcare professionals

Finally, Dr Olivier discussed the use of social media to inform care and provide peer support for healthcare professionals.

He described how, in his experience, the use of closed social media  groups has enabled health care professionals to exchange images and anonymous case histories for advice on management.

In addition, these groups also provide positive emotional and logistic support for their members.

All communications within closed social media groups among physicians must protect patient privacy and images should only be shared with permission from patients and their families

Dr Olivier cautioned that all communications within these groups must protect patient privacy and that images should only be shared with permission from patients and their families.