It Started With a Text Message from his Sister; Now Dr. Vincent Agyapong's Text4Mood Program is Fathering Spinoffs

It is winning kudos in Alberta and beyond as an innovative, easy-to-use, technology-based tool to help patients fight the crippling effects of depression and anxiety.

01 February 2019

It is winning kudos in Alberta and beyond as an innovative, easy-to-use, technology-based tool to help patients fight the crippling effects of depression and anxiety.

Since Dr. Vincent Agyapong's Text4Mood program was launched by Alberta Health Services (AHS) in early 2016, the daily supportive text messaging service has attracted tens of thousands of subscribers, and growing praise from mental health professionals worldwide.

AHS subsequently honoured Dr. Agyapong - Clinical Professor and Director, Residents Quality Improvement Projects in the Department of Psychiatry - with its Spirit of Excellence Award in 2016.

The Edmonton Zone Mental Health Staff Association (EZMSA) followed by naming him their Physician Innovator of the Year for 2018.

The Text4Mood program has also won recognition from the Mental Health Innovations Network, which is affiliated with the World Health Organization's (WHO's) Department of Mental Health and Substance Abuse.

"One of the reasons we introduced the Text4Mood program was to offer people support while they were on a waiting list to receive counselling. At the time the wait list to see a therapist in Fort McMurray was about 13 weeks. But we could deliver text messages to people the very next day, after they contacted us for help," says Dr. Agyapong, who also serves as AHS's Edmonton Zone Clinical Section Chief, Community Mental Health.

Patients who subscribe to the program receive regular supportive text messages for six months, starting the day after they subscribe. Individuals can self-subscribe to the program by simply texting the word 'mood' to (760) 670-3130. They can unsubscribe by texting the word 'stop' to the same number.

"Our initial aim was to enroll about 500 people over six months, but within just two months we had about 5,000 people subscribing to the program, and by early 2018 that number had grown to almost 20,000," he says.

The growth of the Text4Mood program is a fascinating example of how technology can be harnessed to deliver mental health and addictions services to those who can't readily access them. But the story behind the birth of the program is almost as fascinating, and it starts not in Alberta, but in Dublin, Ireland.

That's where Dr. Agyapong was posted between 2010 and 2012, prior to his move to Canada in 2013. "I was an Assistant Professor at the University of Dublin and I had a supervisor, Professor Declan McLoughlin, who encouraged me to pursue a Doctorate in Clinical Psychiatry," he says.

"While I was on holiday in Sweden, I received an email from him saying I should have some idea what I would do for my Doctoral project, which I had to submit in six weeks. So I was thinking about that when I received a text message from my sister. It was a motivational thing she forwarded to me. That's when I realized that sending text messages to people who are depressed might be a potential subject for research," he explains.

"So after my holiday I went to the ward where I worked at St. Patrick's University Hospital - it was a dual diagnosis mental health and addictions ward - and I went to the manager, and said what do you think about this idea? If patients are discharged from here, could we send them supportive text messages as part of their follow up care? She thought it was a fantastic idea."

That started the ball rolling, he says.

"I wrote up a proposal, and a review article for publication. Then I did my first Doctorate degree with that and we did a randomized controlled trial where we recruited patients who had completed the dual diagnosis program. We divided them into two groups: half received daily supportive text messages, the other half did not. And we found that the group that received the messages did better. They reported improvements in mood, and they also consumed less alcohol after they had been discharged from their program."

After Dr. Agyapong moved to Alberta in 2013, he was eager to continue that research. So he applied for, and secured a Quality Improvement Grant for the AHS North Zone.

"We wanted to replicate the study we had done in Dublin. So I got a number of stakeholders together and we did two clinical trials. One was in Grande Prairie, focusing on those who had been discharged from the addiction treatment centre. And then we also ran a depression study in Fort McMurray," he explains.

"For the depression study it was very similar to the results we obtained in Dublin. Those who received the daily supportive text messages did much better. There was a statistically significant difference in the reduction of mood symptoms as measured by The Beck Depression Inventory, compared to those who followed their treatment as usual."

As for the Grande Prairie alcohol study, results showed those who received daily supportive text messages took a longer period of time to consume their first alcoholic drink after discharge from the centre, versus those who didn't receive such messages.

"With our results in hand, we then launched the Text4Mood program in 2016 and the number of subscribers has just continued to grow since then. I'm very happy that AHS is sustaining the program. I'm very sure that wouldn't be the case if they didn't find some value with it."

Now that the concept behind the Text4Mood program has proven itself, Dr. Agyapong is exploring other potential targeted applications in which similar supportive text messages might be used as an effective tool for fostering improved mental health.

"We are trying to improve on the Text4Mood program. Since I came to Edmonton I received a grant of $75,000, and we recently obtained another grant of $20,000 from Telus, through the Edmonton Mental Health Foundation. With those funds we've developed the Text4Support program. Unlike Text4Mood, people don't self-subscribe to it. Instead, AHS Addictions and Mental Health inputs patients' numbers into their system, and we've designed buckets of text messages targeting various conditions including anxiety, depression, situational crisis, addiction and psychosis. Depending on the particular problem you have, you get to choose which text messages you want delivered to you."

Text4Menopause is a second targeted application for supportive text messages that is currently being considered, thanks to a donor who contributed funds through the Royal Alexandra Hospital Foundation.

"Elizabeth Lidstone-Black was experiencing menopause and unaware she was living with depression. She died by suicide. Her husband, Ken Black, wants to do something for patients who are going through the same thing," Dr. Agyapong explains.

"So, we are designing the Text4Menopause program to target that group, in conjunction with researchers at the Women and Children's Health Research Institute, the Department of Obstetrics and Gynecology at the University of Alberta, and the Royal Alexandra Hospital Foundation."

A third potential spinoff from the Text4Mood program has been branded Text4Hope. It would target people who have been traumatized or otherwise negatively affected by wildfires, floods and other natural disasters.

"A Regional Health Authority in B.C. has made contact with us and asked us to develop this. Several communities in B.C. have been hit by wildfires or flooding, but they don't have enough mental health therapists to meet the needs of the people who live there. So we held a teleconference and agreed to do a presentation there. Hopefully we can extend the benefits of Text4Mood into the new Text4Hope program."