TEXT4SUPPORT

What is Text4Support?

Text4Support is a program and research study looking at the effectiveness of supportive texts to improve mental health outcomes. It is an automated text messaging service that sends daily supportive text messages to patients.

When was Text4Support launched in Nova Scotia?

In September 2022 as a collaboration between Nova Scotia Health’s Mental Health and Addictions Program (MHAP), Nova Scotia Health Innovation Hub and the QEII Foundation.

What involvement does the QEII Foundation have in this work?

The QEII Foundation is funding this research study, covering costs with the text messages delivery and structure.

Who can currently use Text4Support?

As Text4Support is part of a research study, it is currently only available to participants who are included in the trial. These participants are Nova Scotians aged 18+ who are currently accessing mental health services or being discharged from formal mental health services. It is augmenting the care they already receive.

Patients involved in this research are accessing or being discharged from formal mental health services in Nova Scotia – including:

• Community Mental Health and Addictions Clinics (CMHAC)
• Specialty Programs (SP): Mood Disorders Program, Community Outreach Assessment Support and Treatment (COAST), Early Psychosis Program, and Operational Stress Injury Clinic
• Addiction Programs (AP): Withdrawn Management Unit, Recovery Support Centre, and Opioid Dependent Program)
• Transcultural Mental Health Program (TMHP)
• Day Hospital (DH)
• Rapid Access and Stabilization Program (RASP)
• Emergency Departments (EDs) or
• Psychiatric Inpatient Units (PIU) in Nova Scotia

How long will the research study be?

The study will run over three years, with 24 months dedicated to recruitment and delivery of the interventions and an observation period of 12 months for each participant.

Who will lead this work?

This work will be led by Dr. Vincent Agyapong, chief of psychiatry, Nova Scotia Health (Central Zone), department head of psychiatry, Dalhousie University, supported by research students within Dalhousie University.

How many people do you anticipate being involved in the trial?

4,500.

How are participants assessed once they are identified?

First potential participants will be identified from someone within the patient’s circle of care, and they must meet inclusion criteria. From there a QR code will be provided for more information/consent on the Text4Support research initiative. Participants will access the baseline assessment after completing the consent form. Eligibility will be confirmed from the assessment.

Are there plans to expand Text4Support to all Nova Scotians, not just people discharged from MHAP services?

Text4Support is a text messaging program targeting individuals who have been diagnosed with a  mental illness. After evaluating the program's effectiveness, the plan is to implement Text4Support as part of the standard of care in all MHAP across the province. Addressing the mental well-being of all Nova Scotians could be the next step, since the investigators have already developed text messaging programs targeting general populations, such as the awarded wining Text4Hope and Text4Mood, implemented in Alberta.

How will the success of the trial be evaluated?

The success of the trial will be evaluated based on its outcomes. Based on outcomes of previous studies, the research team (led by Dr. Agyapong) expect that participants enrolled in the Text4Support will achieve superior outcomes compared with those enrolled in the treatment-as-usual arm. Specifically, the team predicts that daily supportive text messages will result in a 20 per cent greater reduction in symptoms of depression and anxiety, and a 20 per cent greater increase in recovery and well-being. They also expect a reduction of 10-25 per cent in services utilization (i.e. psychiatric readmissions and ED visits) among participants of the Text4Support arm, compared to the usual care group.

How much will it cost?

This is a free program for participants. Study participants will have no costs for being enrolled in the research study, regardless the group they are assigned to.

Has this been done anywhere else? What was the result?

Since its launch in 2019 in Alberta, over 1,000 patients receiving services from the Alberta Health Services Edmonton zone addiction and mental health program have been enrolled in the Text4Support program. Results from previous research studies have shown that Text4Support was well perceived with a high satisfaction rate either regarding the feedback of the messages or their perceived impact. About two-thirds of respondents agreed that the daily text messages helped them cope with stress and loneliness; remember their goals; feel hopeful that they could manage issues in their life; feel like they know how to stay on track when life or everyday stressors come up; feel like they are making a change and are making better choices; improve their overall mental well-being; and enhance their quality of life. Study findings also indicate that approximately half of the respondents agreed that daily texts helped them monitor their mood, determine where to get help for depression or anxiety, and feel that they could be in charge of managing their depression or anxiety. A total of 57 per cent of respondents reported that the daily Text4Support messages helped them feel like they could bounce back upon making a mistake, and 35 per cent of respondents reported that the messages helped them to manage suicidal thoughts.

Why is a research study needed in Nova Scotia if Text4Support has been successful elsewhere?

The care we provide is impacted by the research we conduct. By doing a trial with Nova Scotians, the program can be designed to meet the needs of people in our community.

How will you accommodate people who don't have a cell phone or plan?

Patients identified as not having a device can be supplied with a mobile phone through the provincial free phone program. A data plan is not required for receiving SMS text messaging, so there will not be any charges for subscribers.

Can text messages really help?

Yes. Previous research suggests that receiving daily cognitive behavioral therapy based supportive messages could help reduce stress, anxiety, depressive symptoms and suicidal ideation, and improve sleep in individuals. Learn more at https://www.resiliencenhope.org/impact.

Will it include all patients discharged from Emergency Departments?

Yes, patients visiting Emergency Departments across the province for mental health issues will be presented to this study at the moment of discharge.

What happens if a Text4Support participant is facing a mental health crisis and responds to the message for support?

Any time a participant responds to a daily text message, the automated system sends a message containing contact information for the Nova Scotia Mental Health and Addictions Crisis Line.

If you or a loved one needs help now, the Provincial Mental Health and Addictions crisis line is always available at 1 888 429 8167.