Blog Post 15- Amy Spear

This course has taught me a great deal about e-Mental health in general but also more about our delivery of care and how it is changing with our advances in technology. Our models of care are transforming from in-person therapies to hybrid models involving technology use to deliver treatment. I have become familiar with many online tools for delivery of these treatments as well as the advantages and disadvantages of these portals when delivering care.

When we normally think of treatment or attending a doctor's’ visit we thinking of the conventional methods of in person therapy. However, with our recent advancements in technology we have developed a new integrated model of care. Utilizing online or web-based technologies in conjunction with in-person therapy has been shown to be effective in treating mental health disorders. Over the course of this course we have discussed many applications that can be used in addition to these conventional therapies. We discussed many applications such as Pacifica, PTSD Coach, Virtual Hope Box these app vary in the disorders they are specialized for such as anxiety and PTSD. Many of these applications have universal advantages and disadvantages. These applications increase access to care and are typically very cost-effective. Many applications are also able to provide these therapies to hard to reach populations as well as eliminating the stigma that follows getting help for mental health disorders. However, we have had many discussions of how these technologies can impact the doctor-patient relationship. With these new models of care there are many boundaries that must be established between the physician and patient. Therefore, with the utilization of these applications we see many benefits for patients and physicians. Overall, I have learned a great deal about not just e-Mental health but many aspects of the mental health field in general. I have also developed a greater understanding for mental health disorders and various treatments. With this knowledge I believe as a future clinician I use these techniques in my practices.

Blog Post 15-Abbi Herrold

This class has helped to expand my knowledge on healthcare from the patient/consumer's perspective in addition to showing me all the possibilities and capabilities technology has brought to the field of mental health. I have learned about many smartphone apps and websites I had no clue existed prior to this class. Additionally, I have thought more thoroughly about the barriers to healthcare as a part of this class.

No matter what technologies we create there will always remain two barriers: cost and stigma. Even if therapy or healthcare is free one must still have viable transportation and time to get to said therapy. Additionally, regardless of treatment having a mental illness is stigmatizing and is something those who live with mental illness have no choice but to recognize. We cannot socially reconstruct a society that has been condemning mental illness for years through the use of an app, there is much more of a social reform needed. 

Through the duration of this class I have noticed that while these technologies help healthcare be more inclusive, we are still leaving the most vulnerable out: the poor. What about those who do not have access to a smart phone or internet? What about those in third world countries who do not have the means to access mental healthcare? Etc. I am astonished by how far these innovations have reached to help under-served populations, but there is still a long way to go. 

This class has increased my passion as an advocate for mental health awareness and has increased my knowledge of the barriers of the healthcare system. As a future clinician I hope I will be able to serve those who need it most and be able to provide time and cost efficient care. I must be aware of all the variables that may influence my client's treatment and how I can make access to treatment easier for them. 

Blog Post 14- Abbi Herrold

For this week's discussion I will be reflecting on the process of my presentation and final paper. I have chosen to write about the use of the mobile-phone based app Pacifica as an intervention for anxiety disorders in college students. I chose anxiety as it is a very prevalent issues among college students and young adults that up until recently people did not consider. Throughout the process of creating my presentation and writing my paper I have found there to be able sources that say the prevalence of anxiety disorders is high in college students and people in "emerging adulthood". However, I have found little research to find out why that is. Finding appropriate resources and research to back up my thoughts and claims has by far been the most difficult aspect of writing this paper. There is ample amounts of research on anxiety in general and cognitive behavioral therapy as a treatment, although the research for the treatment of anxiety via mobile-phone and computed based apps is sparse.

I feel as if this mainly has to do with the fact that the field of mental health is reluctant to use technology in treatment, and understandably so. A significant piece of therapy is focused on the patient-client relationship which ca not successfully be recreated through the use of technology and the internet. Although, I feel as is more research and treatment needs to focus on the patient as the primary provider of care and the therapist as the secondary provider of care. I would like to see more research done that focuses on self-help for mental illness and how effective they are or what can be done to make them better if found not to be effective. 

Additionally, through writing this paper I've recognized that their seems to be two relatively " hot topics" regarding anxiety in college students: test anxiety and anxiety as result of the college transition. While I recognize that there are important topics it disappoints me that there is not more research on Generalized Anxiety Disorder and other anxiety disorders in college students. Perhaps my search terms are not narrow enough, but I have had great difficulty researching this topic when I know these things exist. I work with NAMI on campus and other mental health organizations and I know based on many anecdotes that Anxiety is an issue for college students, but if it is such a leading issue then why don't we have more answers about its causes and effects? 

Lack of research and lack of time has made this paper rather frustrating to write, but it has also made me ask myself a lot of questions about research and the field of mental health. If nothing else, I hope this paper is able to reflect on the need for more research and increased mental health care for college students. 

Blog Post 14- Amy Spear

This week we did not discuss any presentation material in class. Therefore, I will reflect on our final presentations. My final presentation revolved around the mobile-based application, Virtual Hope Box. This app is designed for use by patients and their behavioral health providers as an accessory to treatment. This application could be helpful for veterans, active military members, families of military members, sexual assault/domestic violence victims. It has shown that this application could be very beneficial as an accessory to in-person therapy and can reduce the amount of medications that need to be used to treat PTSD. VHB is also very different from other therapies because it is portable, and easily accessible so every user always has access to help no matter where they are. This app was specifically designed for those suffering from PTSD that are at a greater risk for self-harm. These patients are able use the app by decreasing these urges for self-harm by use of the app. Users can customize the app based on their specific needs. They can include quotes, their favorite relaxation/distraction techniques, and even pictures and videos of loved ones. Overall, this application could be very helpful for patients with PTSD especially with those who often have urges to harm themselves.

In the development of Virtual Hope Box, the Military Suicide Research Consortium funded a pilot project and a randomized controlled trial to study the potential of the VHB for helping patients at high risk of intentional self-harm. This study is important in the overall understanding and effectiveness of the application and I will be sure to include information regarding this study in the final draft of my research.

The other application we discussed was Pacifica which is a mobile and web-based application used to treat anxiety and depression. This app is based on the principles of Cognitive Behavioral Therapy as well as meditation. We discussed why this app might be useful in college students and why college students suffer from anxiety and depression. This could be the result of the excessive stress that college students experience. Many students are overscheduled and lack the adequate diet, exercise, and sleep schedule. Many of these aspects make us susceptible to developing anxiety and depression. Furthermore, Pacifica makes it possible to track mood and health habits which can be very beneficial to user. Tracking mood over time can allow the user to notice trends and triggers, so that they are prepared for when these things arise again. In addition to mood tracking, Pacifica also lets you track your health habits. This includes aspects such as sleep, exercise, and caffeine intake. Research suggests that self-monitoring of these health behaviors has a positive impact on the user by promoting awareness and self-efficacy. Therefore, it is clear that both of these applications would be very beneficial to users and even beneficial to providers to include in their administration of care. In the future as a clinician, I would most likely incorporate these into methods of care.

Blog Post 13-Abbi Herrold

This week in class we discussed the impact that the internet has in the doctor-patient relationship and the importance of the consultation. The consultation is a key aspect to the doctor patient relationship as first impressions are a crucial point in any relationship. Consultations give the doctor an opportunity to build rapport with the patient, define their reasons for seeking consultation, give a diagnosis, create a management plan, and come up with a contingency plan for the patient. The consultation likely sets the stone how future interactions will be and confirm the patients feeling about the doctor (are they trustworthy, helpful, etc.) The internet often increases the amount of education that patients have and makes better use of the consultation time. However, this increased amount of information also has its disadvantages as patients have more information to sift through and evaluate whether such information is credible or not. Additionally, online forums can make patients more demanding in nature.

As a future clinician I will do my best to educate my clients on credible online resources for mental healthcare. Additionally, I will try to have a list of websites and applications that may help them manage their condition in conjunction with care.

One program which integrates internet usage, online information, and online consultation is known as Jeevom. Jeevom allows patients to search for a doctor online via proximity, availability, prices, experience and testimony. After selecting a doctor the patient is able to pay for the online consultation via the app. After the appointment has selected, and payment has been processed the patient will send their medical records and presenting problems/symptoms online via secure messaging to the doctor they selected. Finally, the doctor will consult with the patient at the selected appointment time. The doctor can then diagnosis, write prescriptions, and request/send lab work all through the internet. The patient is then able to fill select a nearby lab to get the tests done and confirm an appointment with the lab. Once the lab has been processed the results are released via Jeevom to both the patient and the doctor. The patient can then record symptoms for doctor to observe and contact the doctor free of charge for the next seven days. Therefore, virtually everything but the lab work and picking up prescriptions can be done via the internet and use of technology. Jeevom is a prime example of how the internet is changing our healthcare system.

While the use of the internet and technology further enhances healthcare we must consider those who these new models will not work for. For example, while Jeevom may be intended to help those who do not have insurance it is unlikely that they will have an online medical record accessible to them and they may not be able to cover expensive lab charges. Additionally, while majority of the population has a cell phone not all have a smartphone, webcam, or internet access. We must make sure that as we further advance we do not further exclude.

Blog Post 13-Amy Spear

This week we discussed various aspects of the consultation as well as how the internet affects doctor-patient relationship. The consultation is the initial point of connection between doctor and patient. In this setting, the doctor and patient establish initial chemistry and it sets the standard for the rest of the relationship. These consultations are important because it allows the physician to educate the patient as well instruct the patient on what to do next whether this is dealing with a diagnosis or seeking treatment. With our new development with hybrid care models, we also have different types of consultations. There are the in-person of telepsychiatry consultations. These are very similar with the advancements that we have made in these care models; however, some differences do exist. For example, the most beneficial aspect of an in-person consultation is the physical component. In these consultations physicians are able to gather information from the patient’s appearance and more specifically things such as gait or body language. Both of these are very important in monitoring a patient.  Although these aspect lack in videoconferencing consultations, there are also some advantages to this type of consultation. For example, it has been shown that patients feel less anxiety during these online consultations.

We also discussed how increased internet use affects the doctor-patient relationship as well as how it affects simply the patient. It has been shown by physicians that with increased internet use, consultations are often more time consuming because of the complex questions patients have an sometimes misleading information that they have gathered from the internet. However, sometimes patients’ internet research has been shown to enable more complex conversations with physicians during these meetings. Therefore, it is important that when seeking any information, especially medical, that we be very cautious as to what we believe to be true. Often information on the internet can be false or misleading. Although our advancements have made it possible to have information at our fingertips, it is very important that we be cautious with this information and careful not to be mislead.

I do believe that our internet usage has lead to changes in many aspects of the mental health field. Like we have discussed, it has transformed consultation style, patient education, and even our doctor-patient relationships. As a prospective clinician, I believe I will utilize these various technologies but I will do so with caution. These changes with technology can be very beneficial to all of medicine but it is important that we be careful and understand these new innovations in our fields.

Forum 4- Amy Spear

1. There are some differences in tele psychiatry consultation versus in-person consultations. For example, some important cues such as gait and physical aspects of the patient are missing in tele psychiatry consultation. It has been shown that videoconferencing provides an appropriate physical environment for decision-making. Also, nonverbal communication is very important within these consultations. Picking up on these nonverbal cues are somewhat difficult in telepsychiatry consultations. It has been shown that these videoconferencing consultations reduce anxiety within patients while physicians feel increased levels of anxiety. Although these differences exist, both in-person and videoconferencing have been shown to be effective.

2. Doctors have expressed that when patients have done more research on the internet that their consultations have become more time-consuming because patients have more complex questions and often have found misleading information. Although our increased internet usage has impacted the doctor-patient relationship, the increased internet usage by the patient has somewhat enhanced doctor-patient conversations. Patients have gained greater knowledge of their conditions and are able to have more complex conversations with physicians. However, this knowledge can be helpful, anxiety and distrust in the physician can lead the patient to seek help from the internet.

3. However, our increased internet usage can be helpful to us in many ways, it can often provide misleading information to patients. It is hard to find reliable information online and patients often believe that what they see on the internet is entirely true. However, most online sources can be edited by anyone and can even have false information included. Although some information we find on the internet is true, we must be careful with what we do with this information because we often do not know the value of this information.