Navigating mental illness is a challenge for anyone but especially for young adults, who often don’t know how or where to seek help. And even if young people find a trained health care provider, they often don’t know how to talk to them effectively.
Nurse researcher Melissa Pinto decided to address this issue by meeting young people on their home turf — on the computer, online and on electronic mobile devices. Working with a team of researchers, Pinto, Ph.D., RN, helped devise an avatar-based program that immerses young people in a virtual health care office to empower them to take an active role in their own care.
In September, she was invited to present her research at the White House as part of a conference about technology innovations for substance use and mental health disorders.
“If you had told me that I’d be using technology-based interventions to help young adults with mental health issues when I started my nursing career, I wouldn’t have believed you,” said Pinto, an assistant professor at Emory University’s Nell Hodgson Woodruff School of Nursing.
“I guess you could say I put my boots on the ground while earning my doctorate at the University of Louisville in 2005,” she said.
With degree in hand, Pinto accepted a four-year fellowship at Case Western Reserve University funded by the National Institutes of Health. When she was in Cleveland, Pinto began working in the community with young adults who had symptoms of depression.
“I was hearing their voices and seeing their frustrations. One young girl asked me if there was nothing else I could do for her. It was heartbreaking,” she said.
It would also serve as a catalyst for the focus of Pinto’s research.
“According to the National Alliance on Mental Illness and other research, 20 (percent) to 25 percent of the population will experience a mental illness across their life span. These disorders are often chronic and start young. Fifty percent of people diagnosed with a mental health disorder have symptoms before age 15; 75 percent by age 25,” Pinto said.
Yet it takes most people 10 years to get treatment. Meanwhile, the illness (most often depression in young adults) affects every function of young people’s lives, including their ability to form relationships, get an education and become productive citizens.
Most people wouldn’t wait 10 years to treat a physical illness, but the stigma associated with mental illness often creates barriers to getting care.
“A lot of young people are struggling and the younger they get help the better. We are missing a critical window of opportunity,” she said.
Pinto’s program — the Electronic Self-Management Resource Training for Mental Health (eSMART-MH) — has a basis in eSMART models that fellow researchers created to use with patients who have chronic illnesses. Pinto adapted the software to create a useful application for young adults who have mental health issues.
With Pinto’s eSMART-MH program, a participant enters a virtual health care office and interacts with a receptionist, a medical assistant and a health care provider. A virtual coach, who can be summoned when needed, is there to offer advice.
The participants are taught a SBAR3 communication strategy that helps them:
S – Share their story.
B – Bring their background (sleep or mood diary if they have it).
A – Ask for what they want.
R – Review the provider's plan.
R – Ask themselves if the plan is right for them. Can they comply? If not, come up with a workable plan.
R – Repeat the plan so that both provider and client are on the same page.
“We give them a structure to follow and a nonthreatening virtual environment in which to practice office visits, so that they can get the most out of them. We want them to be engaged and feel empowered,” she said.
Pinto’s first study of 28 participants who had prevalent depressive symptoms showed some positive results. Those who used the eSMART-MH system for three months showed a statistically and clinically significant reduction in their depressive symptoms, while those in the control group showed no change.
“In the absence of medication or treatment, we’re not sure how they could look like they were doing better,” she said. “Clearly, we want to do larger studies to see if we get the same good results.”
Pinto brought her work to Emory University’s Nell Hodgson Woodruff School of Nursing when she relocated from Case Western Reserve in July. She will continue to study the mental health intervention and is tweaking the program to make it smarter, more realistic and more individually responsive.
Pinto has no idea how her research came to the attention of the Substance Use and Mental Health Disorders Agency, but she enjoyed her experience at the White House.
“It was wonderful to be in a room with other professionals working on mental health issues. There’s a lot of work to be done,” she said.
Pinto has found her niche in helping young people.
“So much research has been done on infant and child development, but not enough on adolescents and mental health,” she said. “I consider this my life’s work.”
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