LONDON — The apartment in the Parkwood Institute for Mental Health is beige and clinical — not surprising for a living space in a hospital. On the table sit devices that could reshape the way we treat mental health: a wafer-thin electronic scale, a smart watch, an electronic blood-pressure monitor, and a glucose meter. All things that can be found in a regular doctor’s office, but with one major difference: each one is connected to the internet.
Jonathan Serrato, a research coordinator with the Lawson Health Research Institute, adjusts the blood-pressure monitor’s strap around his wrist. “It’s already trying to take my blood pressure,” he says, pointing to a green light. He presses a button, and the reading begins. He then gestures to a desk, where a smartphone and tablet lie beneath a mounted touch-screen monitor, ready to display the results and send them to the relevant care providers.
For the past year, patients have been using this “smart home” setup here and at an apartment in a St. Thomas mental-health facility. Now, researchers are working on the project’s final stage: bringing it outside the hospital. Through a $400,000 pilot — the first of its kind in Canada — funded by various non-profits, agencies, and research centres, eight patients with severe mental illness will use the technology at home for 12 months.
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Participants will have access to a medication dispenser that administers doses at prescribed times. They will also be able to use their tablet, smartphone, or computer monitor to fill out mood questionnaires, video conference with doctors and nurses, and organize day-to-day activities.
Devices will use cloud-computing software to relay heart-rate, sleep, and physical-activity information to a database housed on hospital servers. Both the participants and the care providers will have access to results, and the system will alert clinicians to any irregularities.
The plan is to engage participants living on their own, in supportive housing, or with family or roommates. Four of the eight participants are now set up, says Cheryl Forchuk, the assistant director at Lawson, which is leading the project.
For Paula Rawlinson, chair of the family-advisory council and regular member of the patients' council at St. Joseph’s Parkwood Mental Health Institute, the benefits are obvious. More than 20 years ago, she was hospitalized for severe depression. In 1997, she moved from Guelph to London to seek further treatment. “I isolated myself a lot from anyone in my apartment building,” she says. “I even was in a group home at one point because I needed that much care.”
She’s convinced that immediate access to internet assistance would have helped. “Having some sort of device right there … I can only see it as being a positive.”
Forchuk says the project is a continuation of research that the institute has been engaged in since 2012, when it began looking at how smartphone apps could be used to help people monitor their own conditions. The data, released in 2015, was encouraging: outpatient visits dropped 44 per cent among study participants, psychiatric-care admissions dropped 20 per cent, and police encounters dropped 5 per cent.
Patients with severe mental illnesses such as schizophrenia or bipolar disorder need more comprehensive supports, Forchuk says, as their treatment regimens are often complex, and their conditions can affect memory and make organizing, self-monitoring, and problem-solving difficult. In London and the surrounding area, such support is usually provided through home visits from care providers. Waiting lists, though, are long. According to Forchuk, smart homes would increase “the capacity to see more people.”
As the pilot involves sharing personal medical data over the internet, keeping data safe is crucial. Aleksander Essex, a Western University software-engineering professor who specializes in cyber security, says it’s up to health-care providers “to demonstrate to the person they’re going to plug this device into … that they’ve done everything that they could [to ensure security].”
Forchuk agrees that “there are huge privacy and ethical issues” but emphasizes that they’re taking various measures: internet connections are secured and encrypted; the Wi-Fi in participants’ homes is secured. To mitigate the threat of hacking, Lawson will manually control software and firmware updates, use unique, encrypted usernames and passwords for all devices, and secure the various IP addresses.
“Best of all, there will not be any identifiable information,” she says, explaining that “we are matching the data in our database based on the time [and dates],” she says. “We know who lives in the given apartment, so we can match the data from the cloud with our participants.”
Each pilot participant will receive a customized technology package. Their packages will be covered, Forchuk says, but cost could be an issue for other Ontarians going forward. The equipment ranges in price from about $50 for a weigh scale to $300 for a tablet; patients require high-speed internet, which, like the pill dispenser, involves monthly payments. The Ontario Assistive Devices Program, administered by the Ministry of Health and Long-Term Care, does not fund mental-health supports, and Forchuk says that patients often can’t afford such supports on their own. “People living with mental illness are twice as likely as the general population to be living in poverty,” she says. (Currently, the Ontario Disability Support Program’s basic-needs allowance is $672 a month.)
She hopes that the OADP will be expanded to cover the devices, which she says lead to cost savings. Indeed, in 2017, Doris Grinspun, CEO of the Registered Nurses Association of Ontario, sent then-minister of health Eric Hoskins a letter regarding the earlier smartphone trial: the total per-person cost over 18 months had been $1,350, she wrote. By contrast, an average stay in a Canadian psychiatric hospital costs roughly $9,000. “If just those costs were avoided in the case of this trial, the savings to the system (over $700,000) would cover the technology costs of the trial,” she wrote.
Mark Nesbitt, a spokesperson with the Ministry of Health and Long-Term Care, told TVO.org by email that the OADP is designated for Ontario residents with long-term physical disabilities who need assistive devices for six months or more. The devices — such as wheelchairs, respiratory equipment, and insulin pumps — compensate for a missing body part or “a particular function they can no longer perform,” he wrote.
Rawlinson says the smart-home approach has the potential to save lives. “A lot of people do not have anyone to rely on except themselves, due to poor family connections, poor socialization skills, even poor self-esteem that prevents them from having developed a proper network of support,” she says.
“This pilot is an attempt to fill that gap in services.”
Correction: An earlier version of this article stated that Paula Rawlinson is the chair of the patients' council at St. Joseph’s Parkwood Mental Health Institute; she is in fact a regular member of the council. TVO.org regrets the error.
This is one in a series of stories about issues affecting southwestern Ontario. It's brought to you with the assistance of faculty and students from Western University’s Faculty of Information and Media Studies.
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