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Mental health: The perfect subject for app use
Professor Chris Hollis
www.mindtech.org.uk @NIHR_MindTech
Overview
1. MindTech Healthcare Technology Co-operative (HTC)
2. Potential for apps in mental health
3. Examples of current & emerging mental health apps
4. What should the future look like?
NIHR Healthcare Technology Co-operatives
Nottingham MindTech: Mental Health & Dementia
Sheffield: Devices for Dignity
Cambridge: Brain Injury
Bart’s: Gastrointestinal Disease
Guy’s: Cardiovascular Disease
Leeds: Colorectal Therapies
Bradford: Wound Care
Birmingham: Trauma Management
Catalyst for the development of new technologies
Focusing on areas of high unmet clinical need
Working with NHS, service users, academia & industry
MindTech: Mental Health and Dementia
Institute of Mental Health
Horizon Digital Economy Institute
School of Computer Science
University of Nottingham Innovation Park
Mental health problems affect 1 in 4 people Huge economic cost to UK - £105bn per year Greatest cause of health related disability in UK High unmet need with little technological innovation Subjective clinical assessment dominates practice Lack of historical engagement with SMEs
Why Mental Health?
75% of people with mental illness fail to receive any treatment at all1
60% of people referred to IAPT services fail to take up treatment2
1 CMO Annual Report 2013
2 HSCIC 2014
Treatment Gaps in Mental Health
Apps have great potential in Mental Health
Many evidence-based therapies are ideally suited to digital delivery
• Talking therapies (especially ‘top-up’ between appointments)
• Peer support
• Psychoeducation Regular (self) monitoring particularly useful for mental health: daily
rather than weekly, monthly or yearly – ‘real time’ not retrospective. Many people already use digital technology and social networking to
help manage their condition e.g.: Facebook, #bpd #BigMadChat For mild & moderate conditions digital tools may provide flexibility,
choice, self-management strategies MH user communities are active and include many digital health leaders
Clinical indications: What conditions and severity of symptoms is the app suitable for? Which types of user?
Users of MH apps may be vulnerable (or may become vulnerable) Risks/ harms: Use of an app may increase symptoms or may include
dangerous or unhelpful information ‘Digital Divide’ Equity of access: certain groups are less likely to have
access to devices and internet Sustainability of apps: what if they disappear or change?
Users and services may rely on an app If they disappear or go bust, what happens to the service (and the
data) – e.g. Buddy
But there are also challenges and risks:
App overload?
10,000+ apps aimed at mental health and wellbeing
Some evidence-based, most are not Many free, others require subscription
or in-app purchases Majority focused on self Management
of Anxiety, Depression, Stress Huge potential Rapidly increasing in complexity and
sophistication
MindTech role: responding to our stakeholders
NHS organisations and staff:What apps should we be developing, recommending and commissioning? What’s the evidence? What about safety, privacy and information governance?
Users: Which of the thousands of apps should I use and which are recommended or endorsed by the NHS?
Researchers: What role should apps play in healthcare? Do they offer value for money (to NHS, users, investors)? How should they be evaluated?
Developers: What evidence and information do users & the NHS require? How can I differentiate my ‘quality’ app from the thousands of others.
How are apps being used in Mental Health?
Medication Tracking
Developed by Trust Pharmacy Team
Example of digitising and enhancing an existing tool
Enables patients with bipolar disorders to track their Lithium medication
Also enables sleep/mood tracking and reminders to be set for meds & appointments
Improving Communication & Access to Services
‘ChatHealth’ App and Text Message services linking Secondary school children with
School Nursing service
Developed in response to difficulties in meeting demand:
13% of young people try to hurt themselves at some point
Confidential and anonymous (unless young person chooses to identify themselves:
~50% resolve their issue anonymously
~50% identify themselves and are triaged to other services (app data can be uploaded to PHR)
Not 24/7: Users are signposted to crisis intervention out of hours (police, Samaritans, etc.)
ChatHealth: Outcomes
Service dealing with 50% more contacts for same number of staff
Most enquiries are dealt with with 1 or 2 response and then closed
More serious enquiries escalated more effectively to other services.
One nurse can handle all in-hours messages from across the county
If the user decides to identify themselves info can be added to EPR
Owned by Leicester Partnership Trust – licencing to other trusts
“You can feel judged by someone by talking face to face, so if you can text them it’s private” Young person
“young people want to contact us by social media and it’s easier to answer the questions, you’ve got time to think and speak to colleagues and other
agencies” School Nurse
‘Silver Linings’ Funded by NHS innovation Grant Young people with psychosis: Customisable:
Individual can set personalised recovery metrics
Individual targets, e.g.• Sleep• Paranoia• Mood
Users control their data Decide who to share with (clinicians,
parents, peers)
Enhancing NHS Services
Stand alone interventions and programmes: Peer Support
Online anonymous peer support network: PC (browser) and app
Available and moderated 24/7, anonymous
Guided support courses: anxiety, managing negative thinking, smoking
Commissioned by a number of CCGs, direct sign-up available (£24pm)
MindTech are evaluating the use of BWW in Derbyshire and Nottinghamshire
Does it improve access?
Does it reduce healthcare costs?
Does it improve outcomes
Should it be commissioned? How much should it cost the NHS?
What is the role of these sorts of products in the NHS?
Initial results from our Derbyshire evaluation:
Initial take up is good – 400+ sign ups in 5 months
~50% of users are ‘active contributors’: create bricks, contribute to discussions,
Most users have very low levels of activity, small numbers have extremely high levels
2/3 users are women (although higher engagers include more men & more people with health conditions that affect their day to day lives)
A lot of activity is in the evening
Emerging area, likely to grow: Sleepio
CBT programme for sleep problems & depression or anxiety Links with smart phones, fitness trackers Creates a personalised sleep course Guided by a virtual ‘Sleep Prof’ Partnership: Oxford University & Big Health Commissioned by a small number of CCGs Available for private purchase (12 week course = £60)
Stand alone interventions and programmes: e.g. CBT & Mindfulness
This is a new and rapidly developing area
We need to get to grips with the terminology…
‘Mental Health App’ is not a useful term
Digital Tools, Products and Services for MH
Simple “Supportive”
ToolsBlended Services
Stepping-downMaintaining recovery
ChoiceControl
Design my own care
e.g. mood rating and relaxation apps
Outside the scope of NHS review:
• Low risk• Low cost• Limited impact on
NHS
Similar to self-help books and relaxation tapes – we don’t regulate or evaluate these
Digital Services and Products that ‘aim to treat’
How to rapidly evaluate these more innovative products & services?
Digital Interventions and Services that ‘aim to treat’Blended Digital ServicesFacilitated/ shared with
HCPsStepping-down
Maintaining recoveryChoice, Control
Design my own care
Real choice for Patients, Providers & Commissioners
Access to a variety of evidence-based digital tools and services
Services that blend technology with ‘traditional’ services
User-led engaging products that provide 24/7 and long-term support
A digital (mental) health market that encourages innovation and attracts
creative and talented people
Rapid learning from all of the data that digital makes it so easy to collect
What should the future look like?
Thank you
Visit: www.mindtech.org.ukFollow: @NIHR_MindTech
MindTech 2016 Symposium Save the Date:Thursday 8th DecemberRoyal College of Physicians, London.
