A study on the effectiveness of E-Mental Health in the treatment of psychosis: Looking to recovery

Introduction An integrated program (Institutional Psychiatric Open Light Treatment) for psychosis and personality disorder was enriched with audiovisual functions provided through a dedicated website. The aim of the present study was to observe how and if these added functions support the patients in their daily living, influencing the quality of the recovery process. Recent studies highlighted how telemental health services are effective to provide access, improve basic outcome, facilitate empowerment of patients and be well-accepted (Hilty, 2013; Hailey, 2008) and how integrated community-based treatment, such as Community-Based Psychodynamic Treatment Program (Chiesa and Fonagy, 2009) or Assertive Community Treatment (Veldhuizen and Bahler, 2013) are effective in SMI. Telemental health services may become factors improving real-life functioning, integrating community-based treatment for psychosis and bettering social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services, so positively affecting outcomes of psychosis treatment. Methods All patients admitted (May 2010–April 2015) were included. Aged between 18 and 65, with schizophrenia, psychosis, schizoaffective disorder, bipolar disorder, personality disorder. Some troubles with the website use (Voice2Voice) led to a second version, more friendly and simple to use (app2gether). App2gether provided several functions: audio/video conference rooms for patients or family (synchronous virtual space to interact, at scheduled time, with a psychologist, a psychiatrist or a peer support worker, in free groups); chat (asynchronous virtual space for any question or information). We considered primary outcomes proposed by Cochrane Collaboration (Shek, 2010): hospital admissions, days of hospitalization, day-hospital admissions, day-program attendance (e.g. weekly), treatment compliance (voluntary discharge or missing scheduled date). We considered, as secondary outcomes, variables closely associated with real-life functioning (Galderisi, 2015): global functioning (Italian translation of Global Assessment of Functioning Scale), quality of life (Short Form 36 item), social relationships (Personal and Social Performance), internalized stigma (Internalized Stigma Mental Illness Inventory), empowerment (Empowerment Scale). Patients were divided into four cohorts: – 1-using “app2gether” functions in the follow-up, attending day treatment program ( n  = 35); – 2-attending day treatment program ( n  = 52); – 3-attending transitional day-hospital program ( n  = 171); – 4-not included in the IPOLT-program ( n  = 188). Patients were included in the first group only based on their basic computer skills and fast Internet availability. Results At first, we compared (2) and (3) with (4), as control group. For each patient, we considered an identical observation period before and after day-hospital admission (ANOVA, P We found a significant improvement in primary outcomes and global functioning, but not in other secondary outcomes, for the groups (2) and (3) compared with (4). Over 6-months observation, patients using “app2gether” functions in the follow-up showed: – a significantly decrease in hospital admissions and hospitalization length, compared to non-IPOLT-program group; – a reduction in day-hospital admissions and day-hospital attendance, compared to (2) and (3) groups; – a notable effect on secondary outcomes, compared to all other groups. Conclusion A dedicated website in the IPOLT-program supports patients in their living's place, does not interfere with daily activities, decreases social costs, encourages community integration and reduces stigma. Synchronous telepsychiatry allow a professionally modulated intervention in “here and now”; asynchronous contacts with specialists combine professional intervention with chances of autonomy and autoregulation. These services reduce costs, in terms of FTE (Full Time Equivalent), but not the efficacy. Future advances in the websites should be designed, simplifying the contact surface with the treating-team and reducing the social impact of therapeutic practice. A better understanding of the complex variables influencing real-life functioning and new sensitive tools to detect it are needed.