Smart Homes: Supporting Community Integration for Clients with Severe Mental Illness

Background and Importance

The majority of people with mental illness prefer independent living situations (Nelson, Hall & Forchuk, 2003, 2011). However, for those with more functional and cognitive limitations related to organization, memory and problem solving, supports are needed in order to maintain housing. This population is vulnerable to unstable housing situations due to their distinct needs. The technology being offered may provide necessary supports to allow people to live independently in affordable stable homes in order to increase community integration. The community housing is permanent, reducing the risk of homelessness and allowing participants to continue living in the smart homes after the project’s completion. Our goal is to provide a replicable solution for housing instability among people living with severe mental illnesses.

The objective of this demonstration study is to establish and evaluate smart homes in the community to assist people with mood and psychotic disorders. We will be outfitting eight affordable housing units at Canadian Mental Health Association Middlesex (CMHA) and London Middlesex Housing Corporation (LMHC) with smart home technology in order to support the tenants’ community integration, increase housing stability, decrease health and social service utilization, and improve overall health.

This study will evaluate the use of smart technologies within community housing units in London, Ontario. These technologies will assist with self-assessment of symptoms, appointment and medication reminders, as well as increase communication with HCPs. Examples of the types of technologies that will be used in this study include smartphones, touch-screen monitors, and wireless-enabled health monitoring devices (where appropriate) such as heart rate activity tracking smartwatches and weigh scales. These health monitoring devices account for comorbidities that may be present and will support chronic illness management. This is crucial given that the risk of cardiovascular disease is 2-3 times higher among people with mood and schizoaffective disorders than the general population (De Hert et al., 2011). Clients will be offered the opportunity to choose which devices they want/need and can add or change devices during their time in the apartment.

Methods

The primary outcome measure is the Community Integration Questionnaire - Revised (CIQ-R). The CIQ-R can be divided into four integration subscales corresponding to: home (housework/childcare/meal preparation), social (socializing/leisure activities/shopping), productivity (employment/schooling/volunteering) and Electronic Social Networking, allowing for a more detailed analysis within specific domains of integration. Secondary quantitative outcomes will include the SOFAS to assess the client’s current social and occupational functioning independently of psychiatric symptoms. Short Form 36 (SF-36) and EQ5D will measure the client’s health status. The Housing, Social, Justice Service Use questionnaire will assess service utilization, and the Housing History Form will observe housing stability. A questionnaire examining the usability and helpfulness of the technology will also be administered (Perception of Smart Technology). Effectiveness, economic, ethical, and policy analyses will be used to evaluate the study.

Outcomes

The primary quantitative outcome for this study will be the total score from the Community Integration Questionnaire, which measures an individual’s level of integration into the home and community. Quantitative analysis will also assess previous housing history (Housing History Survey), self-reported health status (EQ-5D, and Short Form-36), and use of health, social, and justice services (Health, Social, and Justice Service Utilization tool). Effectiveness, economic, ethical, and policy analyses will be used to evaluate the study.

Technologies

Using their smartphone, clients will be able to access the Collaborative Health Record (CHR), an online electronic medical record that allows for both synchronous and asynchronous communication between clients and HCPs. Clients will be able to conduct video-conferences (Virtual Visits), send instant messages, and send self-completed questionnaires (Qnaires) and mood monitors to their HCPS through the CHR. Likewise, HCPs will be able to send questionnaires, schedule virtual visits, and monitor client progress on their Qnaires.

In addition to the screen devices, the intervention will include adjunct health monitors dependent on individual need. The health monitoring devices on offer will include a weigh scale, a heart rate activity tracker smartwatch, and a medication dispenser. The medication dispenser developed by AceAge will administer the client’s correct medication at the prescribed time and is locked to enhance security (versus a blister pack or bottle). The pouches containing medication are pre-cut and easier to open, which may prove useful for seniors with arthritis or motor difficulties.

Data from the CHR and health monitoring devices will be exported and backed-up to the Lawson Integrated DataBase (LIDB). The LIDB is an information management platform that collates and manages client health information collected from multiple community agencies and HCPs. The LIDB is currently based on Lawson Health Research Institute's informatics platform, behind the St. Joseph’s Health Care hospital firewall. HCPs will be able to log-in to the LIDB through a secure portal and will be able to see all the data in one place; allowing for ease of access to all the collected data as well as greater monitoring of the client’s physical and mental health.

In addition, the LIDB can be programmed to transmit prompts and reminders (e.g. take medication at 8am) that coincide with the client’s care plan directly to the client via SMS text messaging.

Future Directions

At present, Smart Technology is not included in the Assistive Devices Program in Ontario. We hope this study and the subsequent Community Phase will be able to revise that so that individuals in the community will receive the support they need at little cost to them.

Furthermore, this study could enable mental health care strategies and inform health policy & decision makers to adopt more smart technologies into mental health care and/or treatment plans. Additional funding has been sought to establish “smart apartments” throughout London to implement the intervention in 128 community homes.

Funder

This project received funding from the National Housing Strategy under the NHS Demonstrations Initiative, however, the views expressed are the personal views of the author and CMHC accept no responsibility for them/ Ce project a reçu du financement dans le cadre de l’Initiative de démonstrations de la Stratégie nationale sur le logement. Cependant, les opinions exprimées sont les opinions personnelles de l'auteur et la SCHL n’accepte aucune responsabilité à l’égard de telles opinions

Demonstration NHS webpage (ENG) / Initiative de démonstrations de la Stratégie nationale sur le logement (FR)

Press

Lawson study will examine how smart technology can serve those with mental illness (Global News, May 2019)
‘Smart home’ technology may change life for those with severe mental illnesses: Local researchers (London Free Press, May 2019)
Study testing smart technologies to support people with severe mental illness (CBC Radio, May 2019)
Tech brings home insight into mental health (Western University, May 2019)
How ‘smart homes’ could help Ontarians with mental illness (TVO London, July 2019)

Partners

  • London and Middlesex Housing Corporation
  • Canadian Mental Health Association (London Branch)
  • InputHealth Systems Inc. (Vancouver, BC)
  • AceAge Inc. (Toronto, ON)
  • Thunder Bay Regional Health Sciences Center (Thunder Bay, ON)
  • Institute for Clinical Evaluative Sciences – Toronto
  • St. Joseph’s Health Care London – Parkwood Institute
  • St. Michael’s Hospital (Toronto)
  • Universite de Sherbrooke (Quebec)

Contributors

  • Cheryl Forchuk
  • Abraham Rudnick
  • Bessam Abdulrazak
  • Richard Booth
  • Deb Corring
  • Lorie Donelle
  • Jeff Hoch
  • Wanrudee Isaranuwatchai
  • Dan Lizotte
  • Jeffrey Reiss
  • Puneet Seth
  • Xianbin Wang
  • Dariusz Gozdzik
  • Rupinder Mann
  • Naghmeh Mokhber
  • Sujata Ojha
  • Jodi Younger

Principal Investigator

Cheryl Forchuk, RN, PhD

The Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery, Parkwood Institute Research;
Distinguished University Professor, Arthur Labatt School of Nursing, Faculty of Health Sciences, Western University;
Assistant Director and Scientist, Lawson Health Research Institute

Mental Health Nursing Research Alliance
Lawson Health Research Institute
Parkwood Institute – Main Building
550 Wellington Road, B3-110C
P.O. Box 5777, STN B
N6A 4V2

Tel: (519) 685-8500, ext. 77034
Email: cforchuk@uwo.ca

Research Coordinators

Jonathan Serrato, MSc

Mental Health Nursing Research Alliance
Lawson Health Research Institute
Parkwood Institute – Main Building
550 Wellington Road, B3-110
P.O. Box 5777, STN B
N6A 4V2

Tel: (519) 685-8500, ext. 75802
Email: jonathan.serrato@lhsc.on.ca

Fatima Bukair, MSc

Mental Health Nursing Research Alliance
Lawson Health Research Institute
Parkwood Institute – Main Building
550 Wellington Road, B3-110
P.O. Box 5777, STN B
N6A 4V2

Tel: (519) 685-8500, ext. 75719
Email: fatima.bukair@lhsc.on.ca