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mmm-Health

Introduction

It's not an established and defined area nor academic discipline, and so is not in any phone directory. You need networking and contacts. This page is my personal node for this, largely about and for Glasgow-based people.

One general argument (only one of the possible ones) implies that this IS an area, whether it has a name or not:

• There is now a mental health epidemic.
• This can never be solved using 1:1 professional help: that is hopelessly uneconomic under all conceivable budget increases.
• So we must go to a public health approach: using prevention and self-help, not expensive emergency treatment (repairs after disaster).
• Using ICT and modern gadgets for whatever they can contribute to doing this faster, better, cheaper, to new "audiences".
• What applies to mental health also applies to other areas such as obesity, diabetes; exercise, diet, ....

  In fact, moreover, the WHO definition of health has always been (since WHO's founding in 1946): "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Thus, for this "area" even to count as being about health, must deal with physical and social issues, not only psychiatric i.e. "mental" ones.

If we feel like using the tag "mmmHealth", then "m" stands for all of:

• mental
• mobile
• mass (as in population-wide roll-out)
• my (as in self-care, and personalised care)
• mindful ?

But CompSci use "pervasive health"; and some medics use "e-health".

A possible structure for this area

1. The aim: medical cure or life enhancement?
   A clinically diagnosable condition should, when possible, be remediated: thus increasing well-being from negative to zero. But the Positive Psychology attitude is that people who are not diagnosably ill can (should) further increase their well-being from zero to plus. (This means reaching almost everybody: how could this be done?)

   Thus while the disease model divides the population into two parts, sick and healthy; the PosPsy view might be taken to divide the population into three: the sick, the normally unhappy, and those with good well-being. A possible argument is that PosPsy operates in and on the second gap, and that it is largely the re-invention of methods for a secular society that will again restore high well-being, but not raise it above those of highly spiritual people.

   A2. Similarly, in considering what samples of people to study, consider samples of all these groups for a given pathology:

   1. The sick: clinically diagnosed
   2. The average in the population ("near zero")
   3. The exceptionally healthy (well above the clinical threshold), because we may be able to learn from them what are the characteristics, and the standard behaviours, from the unusually healthy and robust.

   A3. Another facet of the same issue is whether to "pathologise" the condition, apply a simplistic medical model to the condition, .. i.e label it as abnormal, less than zero. Issues can be framed (or reframed) as one of these:

   • Fully healthy
   • Resistance factors, Brown & Harris, protective factors.
   • Hygene procedures (active things done, which tend to protect)
   • Coping strategies
   • Pathology, requiring things to be done to the patient by outside agents.

   But part of this is whether to separate pathologising (recognising a problem as a problem, a pathology) from the distinct question of who is responsible for (and in control of) the solution. Recognising (admitting to yourself) that you have a problem and what its nature is, is not necessarily identical to having control taken away from you. You can't take control of your own issue until you admit to yourself you have one. Then the control issue (see also [B] below) would be about ...

2. Agency: Active/passive; who takes the initiative?
   (Interventions) The alternative modes of help are:
   • Self-help. The individual seeks out practices, exercises, solutions themselves, and implements them. E.g. self-help for depression.
   • First aid: basic training to allow a person to recognise and help others. Training for mental health first aid.
   • Public health approach: designing mass campaigns to help people, especially with preventative practices (rather than remedies after problems surface). Another way of looking at this, is that this is about the mass education of people who aren't (initially at least) looking to be taught anything. E.g. an impressive campaign that cut the suicide rate by 33% in its target group can be found through this page.
   • Community care: ...
   • Treatment by medics: Someone hospitalises you, and extremely expensive 1:1 treatment is applied. Actually not 1:1 but M:1 i.e. big team → one patient.
3. Time of intervention:
   This is about the time at which the intervention is made, relative to the condition. E.g.
   • Prevention e.g vaccination, washing your hands, ...
   • Early intervention e.g. rushing to a doctor not waiting for a cancer to be so big it's painful (and inoperable).
   • Late (emergency?) intervention: hospital after the appendix has burst.
   • Palliative medicine: a cure is no longer possible, but some repair to quality of life is possible: as in cancer care for the inoperable, gerontology.
4. Delivery mode:
   How can each of the things above be delivered?
   • One to one personal trainer.
   • Classes, say 1:20. Personal, face to face, with in addition peer support / pressure e.g. exercise classes, traditional mindfulness training classes.
   • ICT: using modern internet technology to deliver it remotely; using mobile apps so it is there when needed; and "gadgets" i.e. new sensors, often in mobile phones etc.
   • We probably want to be exploring "blends" of face to face and ICT. E.g. local groups, run by leaders who have done some basic training; but supported by experts over the internet.
5. Types of (mHealth app) intervention: In the overall field of mHealth, there are at least these kinds of app; and anyone working on a given problem has to think which type of intervention / intrusion might be best.
   • Major homework e.g. mindfulness training, CCBT: things which require the user to take significant amounts of time repeatedly, and probably to find a quiet place as well as time for this.
   • Body sensors: which take no time and attention at all, but just operate during other activities and record things for later attention; or like a wrist watch may be looked at when but only when the user likes.
   • Like a diary: require the user to take a moment, but only a moment, to record things themselves. Classics would be a food diary.
   • About as brief, but again requiring user attention if only briefly, might be a quick consultation to guide behaviour.
   To see why this can be important, consider a project to address a kind of social anxiety where people are unhappy with their own behaviour in social situations (a kind of shyness), and discuss it endlessly but unproductively with their friends afterwards (rumination). Should this be addressed by a) major remedial activity away from both the situation and from friends e.g. by mindfulness, CBT style reflection etc. b) By a "coach in the ear" prompting alternative behaviour in the social situation itself. c) By a "coach in the ear" during ruminative discussion with friends to bring it to a halt. Some helplines have a rule to terminate calls after a fixed time, because generally by that time the conersation is becoming repetitive and unproductive.

Individuals I know personally who are related to this

Petr Slovak: Protective factor boosting, ...   #petr

Petr Slovak has degrees in both psychology and computer science; and uses both as illustrated by a list of his publications found by Google Scholar.

Siobhan Lynch: positive effects on education

First up, Siobhan Lynch has done important work on Mindfulness training and its direct educational (besides well-being) benefits for learners. I have another whole sketchy page on this.

Rohan Gunatillake: Mindfulness, designing apps, and more   #rohan

About Rohan

21awake

Buddhify

Buddhist geeks

Gunatillake, Rohan (2016) This is Happening. Redesigning mindfulness for our very modern lives (Macmillan)

• Link to publisher's page on the book
• Link to a blog by Rohan on deciding to do the book.

NHS Scotland spiritual care division and report

Naomi Clark: Mindfulness   #nclark

Mindfulness scholar.
Planning for calm

Some (more) people

  #cmcc First and most important is Claire McCallum   (dcs page).   (SocSci page). She started (Sept. 2014) a PhD funded for this area. Naturally it is fundamentally interdisciplinary.

Lucy Gunatillake worked on Ginsberg in the past. She has just completed an MSc project, which I supervised, on whether people's feelings for their personal device affect how effective mHealth-related apps on it are. (Yes, they can. App designers need to take this into account.)

Cara Wilson (←) has just completed an MSc project (which I supervised) that showed that an app delivering CBT (Cognitive Behavioural Therapy) with proven effectiveness for patients also significantly increases well-being in non-clinical users. She is now moving to postgraduate work at QUT (Queensland University of Technology, Brisbane, Queensland, Australia) with Margot Brereton (→); although she is interested in staying in touch. (Requests for the report to: carawilson21 AT gmail.com)

  #jclarke   Joe Clarke did an MSc project (which I supervised) on actual student use of a mindfulness app, and subsequently got it published:
Joseph Clarke & Steve Draper (2020) "Intermittent mindfulness practice can be beneficial, and daily practice can be harmful. An in depth, mixed methods study of the Calm app's (mostly positive) effects" Internet Interventions Vol.19, 100293 doi: 10.1016/j.invent.2019.100293
This study showed that:

• The app "Calm" produced definite benefits (most mindfulness apps have no published tests on their benefits);
• Intermittent practice was effective, contrary to the advice of almost all academic studies which assert without evidence that regular practice for at least 8 weeks is the only approach to consider, and so ignore the most common practice at least amongst students;
• Some participants report negative effects, which few studies look for and so do not report (in contrast to almost all other medical studies).

He has recently been working on the topic of suicide interventions; and has been accepted for a clinical psychology doctorate at Exeter University.

Ginsberg: a project by the Scottish government to help people improve mental wellbeing.     Use for free

Mel McKendrick lives in Glasgow, works in Edinburgh. Her main connection to this page is that in the past, she founded and ran a support group for the families of the mentally ill, and started research in this area before switching PhD topics.   Action on depression.

Mark Charters has experience with mental health first aid (and shares an office with a mad woman, or so she says).

Academic subjects

There is not a single discipline for this area. Here are a few academic areas, each with their own angle on it, which you could check out. For these, you can follow links to people or sites to explore further.

Computer Science (gadgets for this area)

• mHealth. N.B. you might well read the "m" in "mHealth" as either "mobile" or "mental", or even "mass" meaning population-wide roll-out.
  

• Mark Dunlop   papers
  

• Matthew Chalmers   papers
  

• Social/Ubiquitous/Mobile research group.
• UBICOMP conferences. You can see what kinds of work it deals with by browsing past proceedings e.g. UBICOMP 2013 proceedings
• MobileHCI conferences. You can see what kinds of work it deals with by browsing there or in the past papers of the Personal and Ubiquitous Computing journal.
• A networking grant: EPSRC - NIHR HTC Partnership Award: Social Computing And Mental Health Research Network
• Social networking research centre at Lincoln university.
• A future special journal issue: Designing for Mental Health and Emotional Wellbeing

John Rooksby.   Blog   Eurofit project (Social innovation to improve physical activity and sedentary behaviour through elite European football. His part is about the app.s)   Digital health, CSCW, mobile technologies, ...

Well-being, Positive Psychology, and the Institute for Health and Well-being

The Glasgow University Institute for Health and Well-being. It is a virtual institute because it has no buildings, and no degree programmes. But it does have a long list of interested people, many of whom are actively researching in this area.

Cindy Gray (staff page)     ffit project (football fans in training)

UK Network for Mindfulness-Based Teacher Training Organisations

Carol Craig's Centre for confidence and well-being in Glasgow

Video Phil Hanlon's Society, Health, and well-being "Afternow" website   Starter video   Papers

Esther Papies works the School of Psychology, in the field of Health Psychology, particularly in connection with cognitions around eating behaviour.   Her Healthy Cognition Lab.

Positive psychology; and academic courses on it

Positive psychology is a (or is a wannabe) sub-area of academic psychology. There are a few university courses on it (and doubtless more arriving).

General page of mine on PosPsy.

My course (final year undergraduate) on PosPsy at University of Glasgow.

Tal D. Ben-Shahar's former Harvard course (first year undergraduate) on PosPsy   His current website

UC Berkeley's PosPsy course (module). It is free, open to all, but can count for up to 16 credit hours of CPD for professionals such as therapists.

Positive psychology center at University of Pennsylvania (Seligman's base)

Links to the UPenn course, and to other universities' courses (postgraduate degree programmes)

Medicine

Mindfulness as a cure.

Greenspace effects

Gadgets to help deliver multiple things: not only mental health but diet etc.

Counselling: this tends to publish entirely separately from academic psychology; to be based on practical experience and concerns, and on case studies not experiments. Thus even when tackling exactly the same topic (what is "well-being"), there are two literatures to check.

Chris Williams.   His websites:   Five Areas ltd.   Living life to the full

Michael Smith   profile 2

Rory O'Connor.       #rory
Mental health and wellbeing research group   Suicidal behaviour research lab   His Integrated Motivational-Volitional (IMV) Model of Suicidal Behaviour   His 11 minute video introducing the IMV model.

The staple cures.

Forty years ago, a friend of mine training to be a GP remarked that all he really needed to know about was: Aspirin, Penicillin, and Valium. These were interventions that were effective, and each addressed a wide range of common problems.

In this mHealth area, there are two:

• Physical exercise
• Mindfulness training / exercises.

Both these are even safer than aspirin, penicillin and valium; and are continually being shown to be effective for ever more different problems. Consequently, they are more and more attractive to employ: If they don't do you good for one thing, they will for another.

NHS, university services, volunteer organisations

The NHS, university services, volunteer organisations etc. have not been slow in starting to look at this area ....

NHS Scotland spiritual care division and report

Action on depression.

Ginsberg: a project by the Scottish government to help people improve mental wellbeing.     Use for free

Glasgow University Counselling & Psychological Services

• Mindfulness training group (course)
• List of online self-help resources

Glasgow Association for Mental Health: community based support.

Big White Wall - The support network for emotional health [Support]

Mindfulness Scotland

Everyday Mindfulness Scotland

Scottish Recovery Network: to raise awareness of recovery from mental health problems.

Techno Wellness Center Encouraging Balance through Activities [preventative]

Self-help for depression [self-help]

Titles: possible titles for this area and web page

Public approaches to well-being
Mental improvement for all
New mass approaches to health and well-being
The nameless area
Mass strategies for coping
Mind improvements (solo and social; medical and hobbyist; community and professional)
New tactics for mass health
Mass, mobile, mental well-being.

Misc. links: still to be placed somewhere in the above sections

"Mindfulness" journal (Not on the library list of journals, but free access anyway).

Summer School on mindfulness -- University of Amsterdam 1-20 July 2018

ICM -- Int. conference on mindfulness 2018; Amsterdam 10-13 July 2018

Mhealth apps, New Scientist 7 Nov 2015. This touches on: evidence that apps work much less well (for depression) than previous studies suggested; that the prompting and human interaction around therapy and/or apps may be a big part of any effectiveness; mass computer analysis of online text can indicate various mental disorders; social networking applied to support for mental disorders.

Simon Gilbody has published evidence that CCBT worked much less well for depression than previous studies indicated.
However it compared GP treatment for depression with that plus one of two CCBT apps: so it doesn't address the effectiveness of an app alone which might save resources by not involving a qualified human in the treatment. It also doesn't show any preference by patients for a human contact, since all had to use the human contact.

• BMJ paper presenting the evidence.
  Gilbody,S. et al. (2015) "Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial" BMJ doi: http://dx.doi.org/10.1136/bmj.h5627
• Depressed? Look For Help From A Human, Not A Computer: a popular article
• Another comment on the trial
• Sherry Turkle on the benefits of human face to face in general.
  See also her new book: Reclaiming Conversation Sherry Turkle (2015) (Penguin Press) review / interview

James Laurie, Ann Blandford (2016) "Making time for mindfulness" International Journal of Medical Informatics Vol.96 pp.38-50 doi:10.1016/j.ijmedinf.2016.02.010 (http://www.sciencedirect.com/science/article/pii/S1386505616300302) [Blandford study on a mindfulness app] Blog comments on it

NHS approved mhealth apps     new NHS Health apps library     old NHS Health apps library

Notes on mHealth /digital health workshop at GU, 23-4 July 2015.

Call for funding proposals on separate evaluation studies on well-being. Deadline 21 Jan. A pot of money for multiple projects collecting evidence about what works with well-being.     Spec. for the new ESRC centre

Positive Technology: article about how PosPsy gives Pos Technology.

Positive Technology Just a web development company.

New project page? Data science for health.

New project page? ATUP

"NHS game-changers: Rise of the data-empowered patient" also titled "Wearable technology could revolutionise how we monitor health". A New Scientist article (March 2015). It mentions "data analytics" for scanning data collected for other reasons.

This article contains:
'To get to this point, independent trials will be needed to establish the efficiency of each one. "We need to know what the benefits are of the apps and devices," says Lowe, who wants an app-testing equivalent to the randomised clinical trials used to assess drugs.' [ignoring the writer's mistake, where she meant 'efficacy']

This of course is a relevant perspective for framing projects and contains the crucial distinction between a project on the user interface's issues and one on the end effect on users.

NICE blanket approval of CCBT. (Blay Whitby argues that this is madness: just because one bit of software worked in a trial says nothing about whether another bit of software would.)

Funding application call for 6 Oct 2015.

Alex Stobart alexATmydex.org www.actionondepression.org/

Mel/Gary links.

• Phys.org
• Science News
• Mario Beuregard Home: http://drmariobeauregard.com/

Student projects contributing

Cara Wilson: see above.

Lucy Gunatillake: see above.

Hannah Lyall: has shown that exam anxiety can be improved by use of Mindfulness apps (significant pre/post improvement on exam anxiety scale).

Amy McDonald is the chief person in Headtorch: e-learning training for improving attitudes and behaviour at work towards mental health.

"Study Protocol on Ecological Momentary Assessment of Health-Related Quality of Life Using a Smartphone Application" Frontiers in psychology doi:10.3389/fpsyg.2016.01086

PhD studentships related to digital health, deadline 20 Jan 2017: PhD studentships   related details

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