This document discusses the potential for mobile apps in mental healthcare. It notes that mental health issues affect 1 in 4 people in the UK and cost the economy £105 billion per year. Apps have potential to help close treatment gaps by providing evidence-based therapies digitally like CBT. However, there are challenges around evaluating the thousands of existing mental health apps and ensuring user safety. The document outlines examples of current NHS apps for medication tracking, peer support, and improving access to services. It envisions a future with more user-led digital tools that blend technology with traditional care to provide long-term support and rapid learning.

1. Mental health:
The perfect subject for app use
Professor Chris Hollis
www.mindtech.org.uk @NIHR_MindTech

2. 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?

3. 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

4. MindTech: Mental Health and Dementia
Institute
of Mental
Health
Horizon
Digital
Economy
Institute
School of
Computer
Science
University of Nottingham Innovation Park

5.  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?

6.  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

7. 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

8.  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:

9. 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

10. 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.

11. How are apps being used in Mental Health?

12. 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

13. 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.)

14. 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

15. ‘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

16. 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?

17. 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

18. 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

19. This is a new and rapidly developing area
We need to get to grips with the terminology…

20. ‘Mental Health App’ is not a useful term

21. Digital Tools, Products and Services for MH
Simple
“Supportive”
Tools
Blended Services
Stepping-down
Maintaining recovery
Choice
Control
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’

22. How to rapidly evaluate these more
innovative products & services?
Digital Interventions and Services that ‘aim to
treat’
Blended Digital Services
Facilitated/ shared with
HCPs
Stepping-down
Maintaining recovery
Choice, Control
Design my own care

23.  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?

24. Thank you
Visit: www.mindtech.org.uk
Follow: @NIHR_MindTech
chris.hollis@nottingham.ac.uk
MindTech 2016 Symposium Save the Date:
Thursday 8th December
Royal College of Physicians, London.