Article title: Development of a Smart Mental Health Support System: IoT based system for Smart Mental Health

Support
Authors: Nazmul Hassan[1]
Affiliations: north south university[1]
Orcid ids: 0000-0001-6116-017X[1]
Contact e-mail: iam.najib16@gmail.com
License information: This work has been published open access under Creative Commons Attribution License
http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at
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Preprint statement: This article is a preprint and has not been peer-reviewed, under consideration and submitted to
ScienceOpen Preprints for open peer review.
DOI: 10.14293/S2199-1006.1.SOR-.PPND4JU.v1
Preprint first posted online: 08 March 2023
Keywords: depression, anxiety, tension, stress, mental health support, smart system, mHealth, web application,
therapist
 Development of a
Smart Mental Health Support System
IoT based system for Smart Mental Health Support
Nazmul Hassan Najib,
Maksudul Islam Chowdhury,
Kamrujjaman
Department of Electrical and
Computer Engineering
North South University
Dhaka, Bangladesh
iam.najib16@gmail.com
Abstract— we know that many people suffer from
depression, anxiety, stress, hypertension, and many more
mental illnesses in this pandemic situation. As a result, the
condition of their mental health is getting bad to worse.
However, very few of them can consult a psychiatrist,
therapist, or professional who'll guide them properly to get rid
of their problems. Keeping that in mind, we came up with an
idea to build an intelligent web app that will help people
suffering from mental health but not consult a
doctor/psychiatrist. This system allows professionals to check
and follow up on their patients from remote areas. Both
patients and professionals can communicate through audio,
video, voice, and text messages. Users, as a patient, can also
directly search for professional psychiatrists/ doctors or
consultants and request appointments through the app to get
guidelines. Professionals can check patients' history, review
appointments, accept them, schedule them, and provide
guidelines for improvement. Patients will also have the facility
to get a quick in-app therapy to improve their mindset if they
feel they're not okay, which includes breathing exercise, some
cardio exercise, a short audio clip on a motivational story, and
a feature that will allow expressing user's hidden thoughts or
some words they can share with our live chat agent. This
system can play a significant role in the life of the people who
are introverts, shy from sharing their mental health issues, and
the people who don't have the opportunity to consult a mental
health professional from their position directly. The overall
system has been tested in a lab environment to ensure the best
user experience, including a very user-friendly interface. It
shows more efficiency in its service to help people countrywide
who are suffering from mental illness.
Keywords— depression; anxiety; tension; stress; mental
health support; smart system; mHealth; web application; video
calls; audio call; voice message; physiatrist; therapist; payment
gateway, twilio
I. INTRODUCTION
An intelligent system is always effective in creating a
platform where professionals can help and provide services
to their clients remotely with the blessing of technology.
Using the smart mental health support system, a professional
can ensure all the benefits. It includes maintaining
appointments, daily check-up, regular follow-up, providing
advice and guidelines, and almost everything a person needs
when suffering from mental illness without having an in-
person visit. This system provided both audio and video
communication with voice and text message facilities. In this
Covid-19 situation, this web application will be helpful to an
enormous amount of people as they can take the service from
anywhere anytime and avoid the unwanted crowd.
Most commonly known as an app, a web application is a
software intended to operate on a mobile device, such as a
smartphone or tablet computer. These apps typically function
to give users comparable features to those available on PCs
[1]. It is a collection of demand-side and supply scripts that
manage how data is saved, retrieved, and shown to the user
[2].
Mental health is vital for a healthy and prosperous life;
however, mental health problems do not typically get
appropriate scientific attention and are not treated as a severe
public health concern in Bangladesh.
II. LITERATURE REVIEW
Mental healthcare in Bangladesh is tremendously poor
due to a shortage of public mental health services, shortage
of competent mental health practitioners, poor financial
resource distribution, and social stigma. The lack of
intelligent management reinforces these deficiencies to
implement appropriate mental health policies [3].
Considering little documentation of the mental disease cases
and problems in improving mental healthcare, there's not
been a good and detailed analysis of the country's present
mental health situation nationally. The first nationwide
survey on the mental health of adults in Bangladesh was
done in 2003–2005 [3]. Then another survey was conducted
in 2018-2019 [4]. The table below shows the rate of adults
who suffer from mental health-related problems [4].
1974 2005 2019
All Adults 31.4% 16.1% 18.7%
Men Not reported 12.9% 12.5%
Women Not reported 19.0% 18.8%
 Table 1: Rate of suffering from mental health-related
issues among adults
The COVID-19 has impacted negatively on the mental
health of the Bangladeshi people. One research has indicated
that the prevalence of depression (57.9 %), stress (59.7 %),
and anxiety (33.7 %) symptoms in the adult population is
currently substantially greater than pre-pandemic rates [5].
Some other analyses showed that 28.5 %, 33.3 %, and 46.92
% of home-quarantined kids suffered from stress, anxiety,
and depressed symptoms accordingly [6].
Of about 7000 students each year from medical colleges
around the nation, only a handful prefer to study psychiatry
[7]. Psychiatrists, psychiatric nurses, and clinical
psychologists conduct any Mental health support programs
with almost no interdisciplinary interaction. It is difficult for
rural communities to get psychiatrists and other mental
health support providers [8]. Mental health care is frequently
confined to a divisional tertiary level when psychiatrists
operate at public medical college hospitals situated inside
cities. With just 260 psychiatrists serving a nation of 162
million, most of the population cannot get mental health
treatments [9]. The limited public care facilities for mentally
ill patients present all over the nation are highly stressed in
terms of financial and human resources. There is now just
one national-level mental health institution in the country,
the National Institute of Mental Health (NIMH), in Dhaka
[10].
As Bangladesh is still an underdeveloped country with a
vast population, there is insufficient funding for mental
health service-related sectors. Mental health expenses by the
Bangladeshi government are 0.44 % of the overall healthcare
budget [11]. Very few medical professionals in Bangladesh
are specialized in delivering mental health treatments (0.49
%), and there are even fewer psychiatrists [9]. Most of these
experts operate in the metropolitan areas of the nation.
Approximately 62 % of the professionals, including
psychologists, counselors, health workers, and therapists,
work for the government. Of mental health facilities, 26 %
work for NGOs or in private sectors, and 12 % work for
public and remote areas. The allocation of human resources
between city and rural areas of the country is unequal [12,
13]. The number of mental health professionals in the city
areas is almost five times larger than the number of
professions operating in the rest of the nation [3]. But not
only the urban people suffer from mental health-related
issues, but people all over the country, including rural areas,
suffer from the same problem. Current research across
university students indicated a substantial relationship
between students' self-observed physical health problems and
feelings of depression and anxiety [14]. Another mental
health problem sufferer class of Bangladesh includes gender-
based violence. Nearly 60 % of the married women in
Bangladesh reported abuse from a sexual and physical
intimate partner, a subject that stays unacknowledged by the
government. Almost nothing is said about violence against
unmarried female teens [15]. Domestic violence, dowry-
related acid assaults, rape, forced abortion, and trafficking
for prostitution are frequent gender-based abuse concerns,
and these victims frequently suffer from psychological
problems [16]. This group of people is the most helpless as
most of them cannot share their issues without consulting
with any mental health professionals. As a result, they keep
suffering from mental illness, which is alarming and affects
their physical health because mental health problems can
cause physical conditions and lead to unhealthy habits [17].
Considering all of these factors, we can say an intelligent
mental health support app can play a vital role for people
who are not directly consulted with any mental health
professionals. People of all races can easily use this
intelligent application anytime and from anywhere whenever
they feel the necessity of mental health support or counseling
from a professional regarding their hidden mental health-
related problem that is almost impossible for many of them
to share with anyone. This application presents a valuable
contribution to boosting the availability and quality of mental
health care services. By providing proper guidelines and total
follow-up by experts, this system ensures patients' problems.
Mental health apps encompass all phases of medical
healthcare, including emergency case management,
prevention, diagnosis, supportive care, a complement to in-
person therapy, and after-treatment follow-up and
management [18]. Mobile applications are a suitable option
for psychological therapy distribution than the other
platforms because of (I) freedom of habit, (II) less effort
expectation, and (III) strong behavioral motive [19].
The world has already realized the necessity of an
innovative mental health support system, especially the
developed countries. There are already some renowned apps
that are used by people all over the world. Some of the apps
have a good review of their service and support system and
user experience. Especially the western and European
countries have introduced some of this system to the world,
and they have successfully implemented such services to
help their patients nationwide.
What's up is an excellent free app that employs Cognitive
Behavioural Therapy (CBT) and Acceptance Commitment
Therapy (ACT) approaches to help users manage their
Depression, Anxiety, Stress, and more. There is a positive
and negative habit tracker to preserve users' excellent
behaviors and break unproductive ones [20].
MoodKit employs the basis of Cognitive Behavioural
Therapy (CBT) and offers users over 200 different mood
enhancement exercises. Developed by two clinical
psychologists, MoodKit helps users understand how to
improve their thinking and build self-awareness and positive
influence [21].
MindShift is one of the most significant mental health
applications built exclusively for kids and young people with
anxiety. Rather than attempting to escape anxious sensations,
Mind Shift highlights the significance of altering how you
think about worry [22].
SAM could be excellent for a user if they're interested in
self-help but not interested in meditating. Users are invited to
develop their 24-hour anxiety toolbox to monitor anxious
thoughts and behavior over time and learn 25 various self-
help tactics [23].
IMoodJournal may be used to record anything from
mood and symptoms, to sleep, medicines, and energy cycles.
By registering these many aspects, users can examine their
everyday sentiments using summary charts revealing their
stress levels peak and decline [24].
eMoods is a mood monitoring tool intended exclusively
for persons with bipolar illness. Throughout the day, users
may monitor depressed and psychotic symptoms, heightened application. For the backend, we've used Django, which is a
mood, and irritability and estimate the severity of their high-level Python web framework.
symptoms. Users may then examine their mood fluctuations
on a color-coded monthly calendar and generate a monthly 3.1 Block Diagram
summary report to discover critical triggers and better
understand their shifting moods [25].
Happify app, with its psychologist-approved mood-
training program, fast-tracks to a pleasant mood of its users.
Users may attempt numerous entertaining games, exercise
ideas, thankfulness prompts, and more to train their brain as
if it were a muscle, to fight negative thoughts [26].
MoodTools seeks to help persons with clinical depression
by facilitating the journey to recovery. Discover helpful
movies that may improve your mood and behavior, track and
analyze your thoughts using Cognitive Behavioural Therapy
(CBT) principles, construct a suicide safety plan, and more
with this free app [27].
nOCD was established with the cooperation of OCD
doctors and patients to include two treatments: mindfulness Figure 1: Block diagram of the intelligent mental health
and Exposure Response Prevention Treatment. Users may support system
get rapid, clinically-supported assistance when an OCD
episode occurs, complete weekly tests to measure the Fig. 1 shows the block diagram for the intelligent mental
severity of their OCD, and have motivational support along health support system. The principal parts and functions are
the way. One user considers nOCD "a free therapist in your represented in the block diagram. Users have to register to
pocket!" [28]. the app, and if they're an existing user, they can directly log
in. After logging in user will take a quick therapy session
PTSD Coach is designed by the VA's National Center for guided by the app, which includes breathing exercises, some
Post-Traumatic Stress Disorder (PTSD), includes everything cardio exercises, a short audio clip on a motivational story,
from a self-assessment for PTSD to chances to find support, and a feature that will allow expressing user's hidden
positive self-talk, and anger control. What's fantastic about thoughts or some words they can share with our live chat
this software is that users can modify tools depending on agent. Users can also directly search for professional
their specific requirements and tastes and incorporate users' psychiatrists/ doctors or consultants and request
contacts, photographs, and music [29]. appointments through the app to get guidelines. Professionals
can review appointments, accept them, schedule them and
Moner Bondhu is a platform to offer support for mental
provide guidelines for improvement. Users can apply for
health and well-being service. We have their present activity
both online or in-person sessions with professionals. For both
in three industries. 1) offering care and support to mental
online and in-person sessions, the user will get a receipt for
distress through hotline numbers, online and offline therapy
payment. Users will have the facility to choose a payment
assistance. 2) conducting seminars and training on stress
method, online (debit/credit/mobile finance) or in person.
management, awareness development on mental healthcare,
Admin will have access to all the databases, Fix
etc. 3) presenting 'Amar Moner Kotha,' a weekly radio
appointments (approve/deny), check user details, add/delete
program on Color's FM 101.6 devoted to promoting topics
data, monitor the sessions details and report from the
on mental healthcare [30]
professionals.
Calm is a fantastic app gradually being considered one of
3.2 Entity Relationship Diagram
the best mental wellness applications available. Calm
supports those facing stress and anxiety with guided
meditations, sleep tales, breathing routines, and calming
music [31].

III. METHODOLOGY
Twilio's APIs (Application Programming Interfaces)
enable its system for communications. Behind these APIs is
a software layer linking and enhancing communications
networks throughout the web to allow clients to contact
through audio and video calls and messages with anybody
worldwide [32]. For the payment gateway, we've used the
SSLCOMMERZ API. SSLCOMMERZ is a payment
gateway in Bangladesh offering services for businesses to
collect payments online. Customers of these companies will
be able to pay online using their credit/debit cards, internet Figure 2: Entity Relationship diagram of the smart mental
banking, and mobile financial services [33]. For the front end health support system
of the app, we have used XML and java. SQL and PHP with
The ER diagram is a conceptual schema with many tables
laravel are used for databases and connecting them with the
and columns represented by entities and attributes having a
relationship and one primary key, shown in Fig. 2. It portraits
the structure of the existing system database. Here the
entities are user, login, register, admin, therapy session,
payment, in person, online, appointment, doctor. The 3.4 Use Case Diagram
relationship: take, do, with, do1, search, make, check data,
make. The primary keys are name, ID, RID, name, PID,
time, ID, OID, Anum, Dname.

3.3 Class Diagram

Figure 3: Class diagram of the smart mental health

support system

Figure 4: Use Case diagram of the smart mental health

The class diagram shown in Fig. 3 identifies the system's
classes, attributes, operations, and relationships among
objects. In total, there are 14 classes. Multiplicity between
classes are shown below:
1. There is a 1:1 multiplicity between the User class and
Register class
2. There is an M:1 multiplicity between Payment class
and user class
3. There is an M:1 multiplicity between Doctor class and
User class
4. There is a 1:M multiplicity between Doctor class and
Appointment class
5. There is a 1:M multiplicity between the User class and
Therapy_Session class
6. There is an M:1 multiplicity between Admin class and
Register class
7. There is a 1:M multiplicity between the User class and
Appointment class
support system
The use case diagram shown in Fig. 4 summarizes the
details of the system and the users within the system.
3.4.1 Use Case Diagram for Patients
In this app, patients suffering from mental health-related
issues can consult with professionals from any area across
the country. They can take in-app therapy, search for mental
health professionals for appointments. Get consultancy
through video/voice call or in-person and get guidelines to
follow. Users can request emergency consultancy that is free
of cost.
3.4.2 Use Case Diagram for Professionals
Here, professionals can review appointments, accept
them, schedule them and provide guidelines for
improvement. They can check user history and follow up on
them. Through this app, the professionals will take their
sessions by voice/video calls or text message.
3.4.3 Use Case Diagram for Admin
Admin will be able to fix appointments manually, check
on the user details, including patient and professionals,
add/delete data, monitor sessions, and check the report from
the professionals.
 To have access to all the features of the application user
has to create an account. They can easily sign in by using
their Facebook or Google accounts. They can also manually
3.5 Sequence Diagram sign up. If users forget their password, they can easily
recover their account with forget password option, just like it
is shown in Fig. 7

Figure 5: Sequence diagram of the smart mental health

support system
Figure 6: User interface
Fig. 5 shows the sequence diagram of the system. The
diagram shows how and in what order the system, along with
its objects, works together. Users can log in/register to the
design and start taking in-app therapy sessions. After the
admin verifies the user account, they can search all the listed
doctors/professionals, make an appointment request. The
therapy session will be confirmed after the approval/
verification of the appointment by the doctor. The system
will send a confirmation notification to the user after the
payment has been made. Admin will have access to review
it.

IV. APPLICATION & SYSTEM DESIGN

4.1 Database
The system has an organized database that contains a lot
of tables to store data and connect with the app. The security
of data will be ensured, and all the data, including patient's
information, professional's information, user history, session
record, and provided individual guidelines. These data will
be reserved in the database accessible only by the admin.
Registered users can only view their profile data and
previous history. Doctors will have access to their session
and guideline-related data along with their patient's records.
SQL and PHP with laravel are used for databases and
connecting them with the application.
4.2 Application Functionalities
The application has been developed with XML and java
for the front end, SQL and PHP with laravel are used for
database and connecting them with the application. For the
backend, we've used Django, which is a high-level Python
web framework.
4.2.1 The User Interface Figure 7: Sign In/ Sign Up Page for users
As we don't have any particular group of people as our
targeted users, but the app is for people from all over the
country, we tried to build a simple user interface that will 4.2.3 Patient User Interface
help our users to understand all the functionalities and After signing In, patients will be able to get all the
features very quickly. Fig. 6 gives an idea of the overall UI services that they want. As shown in Fig. 7, they don't have
and the features. Details will be described step by step. to sign in every time they check on the " remember me " box.
4.2.2 Sign In/ Sign Up All the features step by step are shown below for the patient-
user interface.
 4.2.3.1 User Home Page
The patient will first be redirected to the home page in
the application, shown in Fig. 8. They'll see all the services
like in-app therapy, including breathing and cardio exercise,
watching short motivation, and inspiring videos. They will
be able to search for mental health professionals for
appointments, request appointments. They can also check the
task list and follow up on the guidelines.

Figure 9: Text and voice messaging system

Figure 8: Home page UI for the patient

4.2.3.2 Communication
Communication is the primary and critical feature of our
application. Users can communicate with professionals by
text message or voice message (shown in Fig. 9) and voice
call and video call (shown in Fig. 10). For smooth and
uninterrupted communication from both ends, we have used
the Twilio API. It allows all the online appointments and
sessions to run smoothly. Users can experience and get the
online consultancy very quickly by using the applications
communication facilities anytime and from anywhere, which
is one of the core facilities and goals of the system.

Figure 10: Audio and video calling system

 4.2.3.3 Subscription and Packages
In the app, a patient can subscribe to monthly therapy
plans and choose professionals by their own choice besides
the typical fixed appointment system, as shown in Fig. 11.
They'll also be offered some weekly and monthly exclusive
packages, which will allow them unlimited access to check
with doctors within that period, shown in Fig. 12. These
features will allow them to customize their check-up plans. If
a user is not satisfied with one professional, the central
facility will make appointments with other professionals
without paying any additional fee. Basically, under one
package, the patient will be facilitated with multiple
consultations with the mental health professional that will
help to increase the user's satisfaction with the service.

Figure 12: Exclusive weekly and monthly packages

4.2.3.4 Notification and Reminder

The app will be sending notifications to the user
regarding every update. If users missed any important
notification, they could check that from the notification
history, as shown in Fig. 13. It's will also work as a reminder
from upcoming appointments and sessions. Users can click
on the notification, and the notification details will pop up to
help users check both forthcoming and past updates in detail,
including the payment information.

Figure 11: Monthly subscription plan with selected

professionals
 Figure 14: Notification page Figure 16: Improvement analysis
4.2.3.5 Improvement Analysis and Tracking
One of the most advanced features of the system is the 4.2.4 Doctor User Interface
improvement analysis and daily tracking of their
Professionals or doctors can review appointments, accept
performance based on their treatment and follow-up
them (shown in Fig. 17), schedule them, and provide
program, as shown in Fig. 15 and Fig. 16. This feature will
guidelines for improvement. They can check patients' history
help users check their own improvement on a daily, weekly,
and follow up on them. Through this app, the professionals
and monthly basis. The analysis will be done by
will take their sessions by voice/video calls or text message.
professionals depending on the patient's improvement. As
From their profile, they can check for scheduled and
patients will be able to track down their live performance, it
upcoming appointments (shown in Fig. 18), immediately
will motivate and push them to improve their mental health
respond to their patient through chat (shown in Fig. 19),
problems.
approve the payment, and check their total earned credit and
points (shown in Fig. 20). They'll have access to create or
update general guidelines for the patients to improve on
mental health-related problems.

Figure 15: Performance record Figure 17: UI for the request of appointment to the
professionals
 Figure 20: Doctor profile
Figure 18: Appointment history page
4.2.5 Admin User Interface
Admin will have access to almost all the features of the
system. Admin will be able to fix appointments manually,
check on the user details, including patient and professionals,
add/delete/verify data, monitor sessions and check the report
from the professionals, and edit payment-related issues. The
admin will manage user data from the administration panel
interface. The admin UI is shown in Fig. 21

Figure 19: Responding patients over chat

Fig 21: Admin User Interface

 4.2.6 Payment Gateway
The payment gateway is shown in Fig. 22. The patient
can confirm any consultation, buy any package or subscribe
to plans after completing the required payment successfully.
Users can make online payments using a debit card, credit
card, or mobile finance system. If they're booking an in-
person session, only then can they select the cash payment.
The consultation fee varies and depends on the consultant's
specialization. As mentioned previously, we've used the
SSLCOMMERZ API to develop the payment option.
Figure 22: Payment Gateway.
V. CONCLUSION
There is currently little research for mental health
applications that promise remedies for depression, anxiety,
stress, and mental disorder-related issues in Bangladesh. The
smart mental health support system that is presented in this
paper can help in numerous ways to improve this problem. It
can initially allow more doctors/psychiatrists to be involved
in the investigation. A centralized database may be
developed in which doctors, psychiatrists and researchers can
provide information and statistics on the use of mental health
applications by adopting a defined process on which this
research is based. A database of mental health information
would provide an ever-growing knowledge base for doctors,
therapists, researchers, government agencies, and academic
institutions. This system can be updated and be more
decorative in the future with the involvement of both
professionals and patients, and researchers. New methods of
treatments and situations can be discovered by analyzing the
data. As the system can provide service remotely, it will be
beneficial for the people of rural areas who seek help or
support regarding their mental health problems.
ACKNOWLEDGMENT
We want to thank the Department of Electrical and
Computer Engineering of North South University,
Bangladesh.
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