A digital self-monitoring tool for Personality Disorders
A Public-Private Innovation Partnership between Region Zealand and Monsenso tested a smartphone app for self-monitoring. The app is used in the treatment of patients with Borderline Personality Disorder (BPD) undergoing Dialectical Behavior Therapy (DBT).
Traditionally, patients needed to fill in daily, paper-based self-assessments that indicate their thoughts, feelings, and behavior. However, several patients did not get this done, which was a problem for the clinicians. The content of the self-assessments is the starting point of DBT, which is a type of therapy that helps patients to regulate their feelings and emotions which can result in self-harming behavior.
In a Public-Private Innovation Partnership, Monsenso together with Psychiatry South, the Psychiatry District of Naestved Vordingborg, Psychiatry West, the Psychiatric Research Unit in Slagelse and the Unit of Production, Research and Innovation in Region Zealand have customised the Monsenso mHealth solution into a smartphone app, which digitalises the daily self-assessments for skill-training in DBT.
The collaboration which initially took place from January 2016 to January 2017, was the first time the healthcare region implemented an mHealth solution in psychiatry.
It was a big step for some of the clinicians since they had no previous experience using mHealth solutions. The project revealed the importance of a thorough training for the staff when introducing a new technology.
- MHealth solutions are still not used broadly in psychiatry, but they have a great potential, says Jesper Lakman, Consultant of Production, Research, and Innovation in Region Zealand.
Although the technology was a challenge to the staff, in the beginning, the 30 patients rapidly embraced the app. After a year, when the pilot was completed they had no wish whatsoever to return to the paper-based self-assessments. For this reason, Region Zealand chose to extend the agreement with Monsenso for an additional year, even though the project had not been fully evaluated.
- It demands an entirely different setup than for somatic illnesses because patients somehow “get addicted” to the tool, and that requires some considerations when completing a clinical testing in the middle of a process with a patient, says Jesper Lakman.
Research and evaluation in Public-Private Innovation Partnership
The partnership between Monsenso and Region Zealand involved the first psychiatry project in the healthcare region, that’s why they chose to pursue an Innovation Partnership instead of purchasing a solution.
- There were many things that we needed to customise to match our exact type of DBT. At the same time, we also needed evidence and research data on how to ensure that patients and clinicians obtain the best value possible. We wanted to collect experience before a large-scale investment in a system, says Jesper Lakman.
For Monsenso the partnership was a good way to establish cooperation with the healthcare region, and subsequently, it evolved into a long-term business arrangement.
- The collaboration with Region Zealand has been excellent. This sort of partnership is of great importance to a young innovation company like Monsenso. The feedback received from patients and clinicians has not only lead to an extension of the agreement, but it has also initiated a further collaboration to develop an mHealth solution that includes Cognitive Behavioral Therapy (CBT) and psychoeducation for individuals with schizophrenia, says Thomas Lethenborg, CEO at Monsenso.
According to Jesper Lakman the relatively short test phase of the project did not allow clinicians to exploit all the features of the system. As always, in a Public-Private Innovation Partnership, it is essential that the organisation has a plan on the outcome. If a pilot is positive, how is the technology going to be implemented on a large scale?
The final evaluation, which will be conducted by the Psychiatric Unit of Research of Region Zealand in Slagelse and the Consolidated Unit of Production, Research and Innovation is set to be concluded in early 2017.
The final evaluation includes a round of interviews with patients and staff, who have been testing the Monsenso solution.
There were also certain ethical consequences that were discussed during the partnership.
- Even though the tool is primarily to enable patients to manage their illness, they know that the clinicians have access to their data. This demands ethical considerations, for instance, if one of the patients registers suicidal thoughts for four days in a row, should the clinician intervene? Even though there is a pre-established agreement, that there will not be clinician intervention in between the scheduled sessions, says Jesper Lakman.
Watch a short video about the project (In Danish with English subtitles):
Monsenso is member of Welfare Tech.