New Paradigms for Behavioral and Mental Health - Day Two - Patient-Centeredness and Technology

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New Paradigms for Behavioral and Mental Health - Day Two - Patient-Centeredness and Technology

Salzburg Global Fellows consider the importance of shared decision-making and technology in mental health services Thara Rangaswamy’s organization SCARF created one of the world’s first mobile psychiatric treatment buses

“Treat the person in front of you and not the schizophrenic!” – wise words from the floor during a discussion on patient-centeredness on the second day of the Salzburg Global session New Paradigms in Behavioral and Mental Health.

All too often in health care provision, patients are merely seen as their diagnosis, especially when treating mental health issues.

While shared decision making has been embraced in some areas of medicine, especially when considering aggressive treatments versus palliative care for terminal patients, it is poorly applied in mental health care provision. Patients might be the best placed people to determine what would the most effective treatment for them, but they are often assumed to have a diminished sense of responsibility and thus are denied personal agency.

“Every time you relapse, you learn something,” insisted one Fellow who had been diagnosed as bipolar. Another Fellow who is in recovery from a teenage-diagnosis of schizophrenia told the audience, primarily of clinicians, advocates and policy-makers, that over several years, they had come to learn what can trigger their episodes, thus formulating coping mechanisms and better informing their doctors of what medication does and does not work for them.

For many of the service users in the room who generously shared their own experiences, their families and communities had proven to be valuable assets in their recovery. Mental health services in many countries now strongly advocate for “care in the community.” But much like the fact that not all medications work for all people, not all patients are “lucky” enough to have supportive families and communities; in fact for some patients, these people can be a great hindrance to their recovery.

Clinicians need to have the time and resources necessary to adequately consider each of their patients’ individual circumstances – a huge challenge for GPs who might only have ten minutes per consultation.

New Technologies

New technological tools—along with the growing ubiquity of phone access worldwide—are providing both health care practitioners and patients unprecedented abilities.

Doctors can treat people remotely, decreasing costs and allowing them to treat more patients. Meanwhile, some new mobile applications allow patients in-the-moment support, like one self-management tool for schizophrenic patients that provides coping functions that help them avoid the escalation of symptoms.

Thara Rangaswamy’s organization SCARF – Schizophrenia Research Foundation – created one of the world’s first mobile psychiatric treatment buses, which treats patients and dispenses medication remotely. It travels to many poor regions of India and allows psychiatric patients to talk with doctors in Chennai through a video screen. The company also leverages mobile technology with appointment reminders, alarms for taking medication, and provides emergency contact information.

Some concerns about mobile health technology include questions about confidentiality, the potential for mobile apps to replace doctors and nurses, the validity of information, fighting tenuous connectivity in many regions, and the potential for mobile consultations to lead to over-medicating.