Using Telehealth to Improve Psychiatric Symptom Management

The overarching aim of this study is to evaluate whether telehealth leads to better mental
health outcomes and decreased use of acute and crisis-based mental health care services by
randomly assigning 300 people with serious mental illness (SMI) and psychiatric instability
receiving services at 1 of 2 community mental health centers (CMHCs), each of which offers
integrated behavioral and primary health care, to either Health Home Usual Care alone or
telehealth plus Health Home Usual Care for 12 months, with assessments at baseline, 3, 6 and
12 months.

This study will evaluate the effectiveness of an automated, algorithmically-driven,
customizable telehealth platform that provides education, teaches illness self-management,
prompts users to enact coping strategies, and monitors symptoms on a daily basis to remotely
detect early warning signs among people with SMI, moving beyond the existing telehealth
approaches (mainly educational websites and videoconferencing) for assessing and providing
education and therapy to people with SMI.

This study has two specific aims. Aim 1 is to compare the effectiveness of telehealth with
Health Home Usual Care by measuring improvements at 6 and 12 months in illness
self-management, psychiatric symptoms, and health self-efficacy. Aim 2 is to compare the
effectiveness of telehealth with Health Home Usual Care by comparing total cost of emergency
room visits and hospital days during the 12 months prior to baseline to total costs of
emergency room visits and hospital days during the 12 months after baseline.

This study will evaluate a widely used automated telehealth program that has been modified
and upgraded by the research team to incorporate curriculum drawn from illness
self-management interventions for SMI developed by the investigators (i.e., Integrated
Illness Management and Recovery (I-IMR) and HOPES). Unlike other telehealth devices, it does
not require an internet connection and is an efficient and innovative way to provide illness
self-monitoring and self-management education. Responses are entered by the user and
forwarded to a secure server via cellular signal. The telehealth specialist will access the
server daily through a secure website using a username and password.

Inclusion Criteria:

- 18 years of age or older;

- Chart DSM-V Axis I diagnosis of schizophrenia, schizoaffective disorder, bipolar
disorder, post-traumatic stress disorder, or major depression and meet criteria for
serious mental illness;

- Enrolled in treatment at site for at least 3 months;

- Psychiatric instability as indicated by 2 or more emergency room visits or
hospitalizations in the past year, or multiple calls to the psychiatric crisis line
within 3 months (10 or more);

- Expressed willingness to participate in a telehealth program;

- Must be able to read English.

Exclusion Criteria:

- Currently residing in a nursing home or group home;

- Terminal physical illness which is expected to result in death within one year;

- Primary diagnosis of dementia, co-morbid diagnosis of dementia, or significant
cognitive impairment as indicated by a Mini Mental State Examination (MMSE) score <24.