Smart technologies to support the delivery of mental health care services, such as smartphone applications, have been found to be useful for people living with mental illness in the community (Forchuk et al., 2015). For some individuals with more serious and persistent symptoms of illnesses, such technologies may need to be built into the lived environment rather than portable devices. However, two reviews have revealed that there is a lack of evaluation of smart technology within a health care context (Garafalo & Nathan-Roberts, 2016; Martin et al., 2008). The objective of this exploratory study is to gain insight into the use of a smart homes concept for individuals with mental illness. This study will employ transitional hospital-based apartments for prototype testing and to prepare people for discharge. After a successful previous trial by Corring, Campbell and Rudnick (2012), this study is currently investigating the feasibility of implementing further smart home based technology to determine whether further modifications are required prior to wide-scale community use. This innovative use of technology may be one such strategy in increasing lines of communication between participants and their health care providers, and to provide prompts and reminders related to activities of living particularly for persons with cognitive deficits associated with their mental illness. This study will provide and test smart technology devices to support mental functions such as memory, and enhance independence through self-assessment. In our prior studies, an increase in cognitive functioning and a significant increase in perceptions of community integration were reported by participants provided with mobile devices in residential mental health programs (Corring et al., 2015). In addition, it is hypothesized that the intervention will assist participants nearing discharge into the community with greater support for successful integration by facilitating independence. This has also been supported in previous research after one study provided mobile devices equipped with the Lawson SMART Record to adults with mental illness. The results indicated a 48.6% reduction in hospitalizations and 57% fewer outpatient visits after 18 months. Moreover, the number of arrests and encounters with the judicial system dropped to only 1.1% of the sample at 18 months, compared to 6.8% at baseline (Forchuk et al., 2015).
Methods:
Up to 20 participants (aged 18-85) who are inpatients and requiring a transitional period prior to discharge in order to determine eligibility for independent community living will be recruited. This study will include participants with psychotic or mood disorders. Participants will be provided with screen devices such as smartphones, tablets and smart mirrors which will allow for video-conferencing capabilities. The devices will be installed with the Collaborative Health Record program, developed by InputHealth, which can send self-completed questionnaires and assessments directly to their health care providers. These smart technologies will be linked to the Lawson Integrated DataBase which is programmed to transmit reminders and prompts to the participant in conjunction with their unique care plan. Prompts can include reminders to take medication at the prescribed times, assistance with routines for personal and environmental hygiene, reminders of appointments with health care providers or any other message that the client thinks would be helpful. Health adjunct Bluetooth-enabled monitors such as blood pressure monitors, heart rate monitors, weigh scales, glucometers, medication dispensers, and sensor floor mats will also be made available as required. Participants are allowed to select their preferred screen devices and health adjunct monitors based on their health needs. The research team will use a mixed-methods design consisting of quantitative and qualitative research methods to assess the perceptions and health of the participants, as well as the feasibility of the technology. Upon a one week minimum stay in the apartment, participants will complete a semi-structured interview with research staff. It is anticipated based on previous tenants that participants will average approximately one month in the transitional apartment. This will be followed up with a 6-month interview post-discharge. Focus groups will be conducted with hospital staff to further evaluate the feasibility of the smart technologies.
Results:
The transitional apartments at two psychiatric inpatients facilities will be fully equipped with the smart technology by January 2018. Both of these facilities operate under the same mental health program. Quantitative findings will include an analysis of the Perception of Smart Technology tool, the Housing History Survey Form, the Community Integration Questionnaire, the EQ-5D Health Utilities Index, Short Form-36, and the Health, Social, Justice Service Use Questionnaire. These measures will be analysed to indicate potential changes in self-reported health, perceptions of community integration, experiences with social service and judicial systems. Qualitative findings will be observed using thematic analysis of the open-ended questions from the participant interviews and focus group discussions with hospital staff. Themes identified from these interviews and focus groups will inform the research team of the specific advantages and disadvantages the smart technologies provide.
Conclusion:
This study is being conducted to assess the feasibility and practicability of using smart technology for individuals with mental illness. It is envisaged that this study will provide vital information that will enhance the intervention prior to wide-scale adoption of the technology among participants in the community. The implications of this study could inform health policy and decision makers to adopt smart home concepts into mental health care and/or treatment plans. This study could change how mental health care is delivered and could allow for greater efficiency by allowing health care providers to serve more individuals. It is hoped that providing the smart homes may increase the participants’ autonomy and community tenure as well as allowing earlier interventions to prevent crises such as psychiatric emergency room visits and re-admissions.