Wednesday, July 8, 2020

Daily Support Through Texting Potentially Effective for People With Serious Mental Illness

People with serious mental illness (SMI) may benefit from receiving text messages from a member of their assertive community treatment (ACT) team, suggests a report in Psychiatric Services in Advance. ACT is a widely accepted model of team-based care for people with SMI.

“Augmentation of care with [mobile texting] proved to be feasible, acceptable, safe, and clinically promising,” wrote Dror Ben-Zeev, Ph.D., of the University of Washington and colleagues. “When pandemics such as COVID-19 block the possibility of in-person patient-provider contact, evidence-based texting interventions can serve a crucial role in supporting continuity of care.”

A total of 49 patients with schizophrenia, bipolar disorder, or major depression were randomly assigned to receive texts on a regular basis from a trained member of their ACT team (n=37) or “usual care,” which involved ACT without the added intervention (n=12). ACT team members met with each participant receiving the experimental treatment to build rapport and review how the texting intervention would work. Patients also received a training session regarding basic phone functions and texting. After this visit, the ACT team members provided daily support via text messages for 12 weeks during the team’s hours of operation. They were encouraged to add their own “personal touch” so that the texts did not seem bland or robotic.

The intervention proved to be feasible: 95% of participants assigned to the mobile intervention commenced treatment by sending at least one text message. Those who engaged recorded an average of 41 days in which any texts were exchanged, representing approximately 69% of the days in which texting could have occurred. Patients sent an average of four daily messages and received an average of 3.6 daily messages from the ACT team member. A total of 91% of participants reported satisfaction with the intervention, and there were no adverse events reported.

At three months, patients receiving the text intervention showed greater improvement on scales measuring depression, paranoia, and thoughts of being persecuted compared with those who did not receive the intervention. The advantage for the texting condition diminished by the six-month follow-up, suggesting the intervention needs to be sustained to be effective.

“The findings of this study are encouraging given the relative ease of training ACT staff to serve as interventionists and supervising them, the low burden placed on both patients and practitioners over the intervention period, and the simplicity of the technology used,” the researchers wrote. “If future research replicates our findings in larger samples supporting the clinical utility of the intervention, the treatment could be disseminated broadly and rapidly.”

(Image: iStock/milindri)

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