Page last updated at 08:19 GMT, Wednesday, 31 December 2008

Monitoring mental health by text

By Jane Elliott
Health reporter, BBC News

Phone texting
The text monitoring is being expanded
Every morning at precisely 10 am Joe (not his real name) gets a text message from his clinician, asking how he is feeling.

From the data received the medical team can plot his mood swings, monitor how his medication is working and assess when he needs his next face-to-face appointment.

Joe, aged 23 and from Sussex, said that for him the system has been brilliant and has cut down the amount of time he needs to spent with the doctors for his bipolar disorder.

"For me it has fortunately proved to be extremely effective. Whereas before I would be going to see the doctors once a month or more now I only need to see them every three months to check that all is well," said Joe.

Mood monitoring

"From my perspective the phone texting has been a godsend."

Each patient using the scheme is given two small cards, marked with mood variations from A to E, which allow them to plot their moods for the previous week - depression and euphoria. They then select which feeling most closely matches theirs and text over the corresponding letter.

It has made recovery relatively painless

Joe said the system provided an excellent support network.

"It is a simple thing, but because it is so regular it gives you a structure and giving the strong impression that someone at the other end is taking your data," said Joe.

"So often with depression you feel cut off from everything and with this there is a strange reassurance that things are being processed. You really do benefit when you go for your next appointment with whoever is treating you and they bring up all your data.

"If there is a blip or hiccup they can check against medication you can tell what effect taking a pill or adding a pill can cause.

"And if they see an anomaly in your results they will contact you.

"It has been a massive support for me," he said.

Pain free recovery

Joe's treatment has been so successful he has been able to return to university to complete his degree.

"That is thanks to the service, because without it the treatment could have taken twice as long. It has made recovery relatively painless," he added.

Art work depicting depression. Pic caption: Paul Brown/SPL
The service can plot mood changes

The system, a collaboration with Oxfordshire and Buckinghamshire Mental Health and Oxford University's Department of Psychiatry, has been such a success that it is now being expanded across the trust later in the new year.

Professor John Geddes at Oxford University said that over 150 patients now self-monitor and that they also collect data from patients elsewhere in the UK and in Colorado, the US, for use by their own clinicians.

Professor Geddes said the mood monitoring was vital.

"When you try to work out how their mood has been there are real problems trying to do that retrospectively," said Professor Geddes.

"What people tend to do is either miss really important mood variability or just look at the average or very severe.

"We knew we needed a way of monitoring it. A lot of people use mood diaries or computer systems. The problem with the paper system is that only patients have access to that and the more sophisticated computer systems have problems because you need access to a computer.

"We wanted to create a system that was pretty low-tech and was very easy for patients and not too burdensome."

System successes

The software catches the message and then imports it automatically into spreadsheets and graphs.

"So when I see the patient in clinic I pretty much know how they have been," said Professor Geddes.

"Before I would spend quite a lot of time trying to find out how the patient had been and if the patient was depressed it could be quite hard for them to remember.

"Basically, with this system we would hit the ground running and we can focus on trying to help them and their treatment."

Professor Geddes said the system could probably be adapted to monitor people with other mental health disorders, such as less severe schizophrenia.

The system won the NHS Live award in 2008. Jo Godman, of the NHS Institute for Innovation and Improvement, said the system was an inspiration.

"This project has opened the eyes of many staff across the NHS. We want to encourage more of this type of innovation."

Neil Tinning, from the MDF Bi-Polar Organisation, agreed the system offered hope.

"Monitoring your mood on a daily basis is a foundation of self management of the illness," he said.

"To have a mood mapping text messaging service to a health professional will provide a window into your illness. This could lead to early intervention and potentiality head off serious episodes of this mood disorder."

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