People with a physical chronic condition often also face mental health symptoms associated with their illness. They are more likely to develop anxiety symptoms or depression. And coping with their illness also takes mental strength. Frank Snoek, head of Medical Psychology at University Hospital Amsterdam UMC, wants to support these people with online interventions. This has resulted in the tool MyDiaMate, which has received a grant from Breakthrough T1D (prior: JDRF), to be rolled out in the UK, as well as the Netherlands, Spain and Germany.
Frank Snoek, picture: Amsterdam UMC
Diabetes and depression
Over 10 years ago, Frank Snoek's research group was the first to publish a study on an online intervention for people with diabetes, suffering from depression. For this, they collaborated with the Dutch Trimbos Institute, a mental health research centre. Under the banner of the National Diabetes Action Programme, they started a project to market the online programme. Through a Trimbos Institute social venture - MentalShare - and in consultation with health insurers, theory was translated into practice, in order to enthuse GPs in particular about the digital tool.
Unfortunately, MentalShare did not make it - an important lesson according to Snoek – and a reason to look for a reliable party with a digital platform that was solid in the market. Snoek: "We found that in Minddistrict. They had been working for years on a portfolio for digital mental health care. Together, we could convert the platform to make it usable for chronic patients with mental health disorders."
Broadening the scope of medical psychology
The medical psychology department in the hospital focuses on the mental aspect of physical complaints. But the number of people referred to medical psychology is limited. A large group of patients remains under the radar, for many different reasons. For example, because they do not see their practitioner often, because there is insufficient attention on mental health, or because people do not want or dare to talk to their doctor about mental health issues.
Snoek: "We see in the increasing maturity of ehealth an opportunity to broaden the scope of our profession. On the platform, you can develop an intervention in a research setting, tailor-made for chronic patients. On a small scale, we have tried out interventions in practice - for people with diabetes, skin diseases and cancer - to see what works and what does not. What is acceptable to patients, what they use and value."
Mental health often remains undiscussed and untreated in hospitals
The research setting at Amsterdam UMC reveals, among other things, that for many patients in an outpatient setting, it proves valuable to get digital support for the more mental problems they face with their illness and treatment. Snoek: "That side too often remains undiscussed and untreated. The online tools we provide for them help with that."
MyDiaMate
An eye-catching example is MyDiaMate, a self-help app for people with type 1 diabetes. A fairly large group of people with milder psychological complaints receive little or no counselling but want to work on their mental health. Currently, most use a generic wellness or mindfulness app. These can help, but there is a need for a disease-specific tool, says Snoek.
"Why not pour our knowledge and experience into a self-help app for this group of people? We did that in collaboration with the patients themselves and then shaped it in Minddistrict. A national implementation project is now underway, to see what people themselves can do for their mental health, but also to engage and deepen the conversation about the mental side of diabetes with your healthcare provider."
The app is constantly being improved. Version two has now been released, with new content and patient videos. And further thought is already underway, such as the development of an additional online peer support programme for patients with type 1 diabetes. This will start soon, in close cooperation with Diabetes Plu, an active patient community. The roll-out of MyDiaMate in other countries is also being considered. With the Breakthrough T1D (JDRF) grant, MyDiaMate is being rolled out in the United Kingdom, Germany and Spain as well.
A division of roles
Medical psychologists and the other practitioners treating people with chronic conditions are not technicians, Snoek stresses. "We remain in our role as healthcare providers and researchers. Working with Minddistrict as an ehealth provider, we can shape our wishes and those of patient-users on their platform, without having to develop an app or set up a business ourselves."
Hybrid approach
The online tools continue to evolve, with help from user feedback. Snoek also takes the feedback back to Minddistrict to further refine and develop the tools. "The future calls for hybrid models, in which we integrate mental and physiological data," he says. In diabetes, for example, blood glucose regulation can have a strong influence on mental well-being, and vice versa.
According to Snoek, the hybrid, integrated approach is badly needed: "In medical treatment, the focus is mainly on the physical side, less on the mental side of a disease. But for patients, it all works together. By combining both sides in a digital tool, you can better support the patient and optimise treatment outcomes."
Physical health or mental health: for patients, it all works together.
Not mainstream
During the Covid period, the need for and acceptance of digital assistance increased. But despite Covid, supporting treatments digitally is still far from mainstream. Snoek: "It is accepted but still constitutes a minority of interventions. You do see it growing in breadth. And people's expectations are changing. People more often ask themselves if there is an online programme for them. And as healthcare is increasingly offered outside the walls of the hospital, patients’ and care providers’ demand for a platform that can be used anywhere will grow."
Financing digital innovations also remains a tricky issue, says Snoek, and an integrated care model does not make this any easier. "It costs healthcare providers money to use tools like Minddistrict. But we don't have a clear reimbursement model with health insurance providers. The programme is now financed with the somatic reimbursement of medical psychology." For Snoek, it is no reason to hold back. "With the upward push towards structural digital care, I hope we will end up with more logical funding for hybrid, integrated care models."
More optimism
Snoek says he is a lot more optimistic about structural funding and solutions than he was a decade ago. He believes, the range of digital healthcare platforms is starting to mature. "They have shown themselves to be solid, reliable partners. And hospitals simply do not have the capacity or budgets to develop and arrange digital care on their own: collaboration with technology partners is a must."
Let's look at digital care that already works and use it
Especially with common chronic conditions, governments need to develop a strategy to help the medical mental health field with digitalisation in areas such as scale-up, regulation and funding. "Specialised care centres in the field of chronic diseases have a responsibility too. Digital care has taken a long time, and many interventions are only used on a small scale, but now it is time to scale up. Above all, let's look at what already works and deploy it."
Read more
Read more on MyDiaMate and the MyRemedy-study on the websites of King's College London, MyRemedy research (in Dutch), or read the MyDiaMate study protocol.
Want to know more about other studies and research projects with Minddistrict? Navigate to Research partners and projects, or discover our vision on validation.
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