Everyone agrees about the potential of mHealth and apps to revolutionize psychiatric care. Yet at the clinical level, we are still waiting for the revolution to arrive. While a complete discussion on why would be too long - let's focus on one key area: sustainability. Sustainability needs to be understood for two perspectives - that of the patient and that of the clinic/healthcare system. We actually know very little about long term use of apps and interest in mHealth for psychiatric patients. How many patients are still using an app at 6 weeks....at 6 months? But we know even less about long term use of apps and interest in mHealth for psychiatric clinics. Why are these clinics not adopting mHealth and offering apps to their patients on a regular basis? Two published articles may give us the first clue.
In May 2014 the prestigious medical journal JAMA Psychiatry published an article entitled "A Smartphone Application to Support Recovery from Alcoholism: A Randomized Clinical Trial" . The paper showed how the app, called A-CHESS, can be effective for patients with alcohol use disorders (see title figure for some of the result). To date this remains one of most scientific efforts to really understand an app and produce valid clinical outcomes data. But what happened to A-CHESS outside of a clinical study and instead in the 'real world.' Thankfully, a second published paper was recently released about this in August 2015. The same team let 14 clinics/agencies use A-CHESS and then checked back in with them two years to see how many were still using the app.  Only 2 of the 14, 21%, of clinics/agencies were still using the app at two years. The article explore various reasons for this low rate of sustainability from a healthcare perspective and identifies many important external and internal barriers. One barriers that stands out is financial. Those two clinics that were able to keep app use sustainable at two years found sources of external funding to support the app program.
At least in this present landscape - mHealth apps for psychiatry may not yet be actually saving clinics money if you look at the story told by the A-CHESS app. A great app with great clinical data still had difficulties being sustainable. But landscapes do change, and this story is more complex that outlined above. There are several more factors important to consider when thinking about the adoption of mHealth in psychiatry; and in future posts I will outline more of them.