WELCOME
E-Mental Health:
Harnessing the Power of Digital for
Better Mental Health
NHS South of England (East)
Monday 18th March 2013

House Keeping
#ementalhealth

Time Speaker & Topic
10:00 Chair
Welcome
10:20 Ali Mousa
Why Use Digital Technology in Mental Health?
10:40 Paul Irwin – Director, TryLife
The Role of Technology in Youth Services
11:00 Jenny Hyatt – CEO, The Big White Wall
Delivering Best Practice in E-Mental Health
11:30 Refreshments and e-Mental Health Exhibition
11:50 Rebecca Cotton -Deputy Director, Mental Health Network, NHS
Confederation
The Policy Context & Future of E-Mental Health
12:10 James Seward – Managing Director, Buddy App
Psychological therapies in the Digital World: The Buddy App
12:30 Buffet Lunch in Main Foyer

Time
13:00 E-Mental Health Exhibition, Live Computer-based Demonstrations
Opportunity to View & Create Your E-Mental Health Videos
13:45 Interactive Workshop Session (6 Questions on 6 Tables)
15:00 Feedback & Postcard Pledges
15:15 Question Time Debate with:
Ali Mousa
James Seward
Paul Irwin
Jenny Hyatt
Rebecca Cotton
16:00 Sarah Amani & Katrina Lake
Closing Comments
16:15 Closing

‘My Journey’ Mobile App
Early Intervention in Psychosis Service

“Following a wide eyed collective gasp of realization, we
were quickly swept up in a heady conversation about
how useful it would be to have a designated EIIP mobile
app that could help people manage their mental health
through reminders and trackers.”
Sarah Amani
DH Maps & Apps Competition – 7th out of 500
ideas submitted for health apps

77%
of people have a mobile device
or 5.3 billion at the end of 2010 – U.N. Telecommunications Agency, http://www.itu.int

This was ‘portable’...
<10 years...
Released: 1998 Released: 2007
CPU: 233 MHz CPU: 412 MHz
RAM: 32 MB (512 MB max) RAM: 128 MB
Storage: 4 GB (+ optical drive) Storage: 4 GB (8 GB max)
Display: 38.1 cm Millions of colours Display: 8.9 cm Millions of colours
Dimensions: 40.1 x 38.6 x 44.7 cm Dimensions: 11.4 x 6.1 x 1.2 cm
Weight: 17.3 kgs Weight: 135 g

Your mobile phone has
more computing power than
all of NASA in 1969.
http://www.flickr.com/photos/43533334@N07/5153726732

“For kids like my 13 year-old, the
boundaries between the internet
and life are so porous as to be
meaningless.“
Comment on the Guardian web site
most will grow up connected
http://www.flickr.com/photos/tocaboca/5523598823

London 2
1 3
Smartphone penetration is 47%...

Public space
distractions
limited attention
mobile usage can be this...
glanceable?
onehand simple?
tedious input
personal
http://www.flickr.com/photos/oimax/3800475934

1hr train ride Focused user privacy
reliable
network? comfy
Unlimited wifi?
chair
two
hands
Reliable power source?
or this...

comfy
chair privacy
One hand prone to
Reliable power interruptions
source
gravity
...or this?
http://www.flickr.com/photos/joeshlabotnik/2359224681

“ The most profound technologies are those
that disappear. They weave themselves
into the fabric of everyday life until they are
indistinguishable from it…. Mark Weiser
http://www.flickr.com/photos/armaggeusa/3176297283

Our behaviour is changing, because devices are changing...

Mobile Opportunities
touch
screen
tiny hybrid
screen +
keypad large
input touch
navipad
screen
many of these are now <£50
yesterday today

A big screen...
web browser
+
application is now a highly customisable
layer always on, always connected
+ blank canvas...
APIs
With a button or two!

camera
a big screen...
work communication
play
sharing
web browser
learning
+
enabling users to choose
application
layer music their own experience
+
chat
APIs navigation
With a button or two!
discovery
Health
creativity
video

Mobile App Costs, Benefits, Build vs. Buy
Gauge the Opportunity Business Drivers
Examples ROI Decision
Compare Mobile Platforms Mobile Market Overview Platform Analysis and Selection
Focus Business Application
Goals and Objectives Security and Privacy
Requirements Requirements
Development and
Develop the Application Keys to Success Required Resources
Testing
Launch, Measure,
Launch and Promotion Feedback and Metrics Future Releases
Iterate

PHASE 1 – February 2012
P

PHASE 2 – September 2012

My Journey
times have
changed
Person
motivation
Ce n’est pas unIntuitive
al phone Usabl
Responsi al
Customiz eHelpf
ve
able ul

• 47 Adolescents & 6 clinicians
• Outpatient Clinic
• Self Reported Mental Health Outcomes for 4 weeks
• First week - 91% entries completed
• 88% said data reflected actual experiences
• 92% adolescents found app ‘helpful’ in understanding
their condition + collaborating with clinician in
managing their health
1. Reid et al (2011) A mobile phone application for the assessment and management of youth
mental health problems in primary care: a randomised controlled trial.
2. Reid et al (2012) Using a Mobile Application in Youth Mental Healh
Journal of Australian Family Physician http://www.ncbi.nlm.nih.gov/pubmed/22962650

http://speirs.org/blog/2011/4/1/stop-lying.html
This is the world we are living in and we can either
lie to ourselves about it or we can dive headlong
into the new forms and effects that it produces.
– James Bridle
http://www.flickr.com/photos/tijanav/4885088185

Thank You
Questions?
Sarah.amani@sabp.nhs.uk
@S_Amani

Big White Wall
Reflections on Good Practice

Without people
it’s just a pile
of s…

….stuff

There’s a lot of choice….
Text and listening services
Moodtrackers and buddy systems
Social networks
Self management programmes
(often CBT)
Online therapy
Integrated systems

…… but how do
I know what
works?

For a moment
nothing
happened.
Then, after a
second or so,…

….nothing
continued to
happen
Douglas Adams

help choice ……share results

Safety isn't just a slogan …..

…..it’s a way of life

Dr Who?

Safety
Privacy PEOPLE Evidence
Professional
re-
imagined

The Policy Context and Future of E-Mental Health
Rebecca Cotton
Acting Deputy Director, Mental Health Network

Today’s session
• About the Mental Health Network.
• Outline our work on e-mental health.
• Outline some of the policy and strategic drivers that
may help drive spread innovation in e-mental health.
• Opportunity to get involved in future work.
• Q&A

About the Mental Health Network
• Part of the NHS Confederation – the membership
body for all organisations that commission and
provide NHS services.
• We represent 70 providers of mental health services
in England – including NHS Trusts, Foundation
Trusts, voluntary sector and independent sector
providers.
• Governed by a board of members – including Chief
Executives, Chairs, Clinicians and service user and
carer representatives.

What we do
• We help shape and challenge
national policy and legislation
affecting our members.
• We provide members with up to
date news and analysis,
through briefings and events.
• We also work to identify and
spread good practice and
innovation in the mental health
sector, plus carry out original
research.

Work over the last 12 months
• Social media
• Payment by Results in mental health
• Measuring outcomes in mental health
• Suicide prevention
• Housing and mental health
• Mental health and homelessness
• Effectiveness of psychological
interventions for patients with long-term
conditions and MUS
• Race equality in mental health

E-mental health – what’s all the fuss about?
• Discussion paper launched 30th
January
• Asks how can the mental health
sector make the most of
opportunities offered by e-mental
health to not only improve
efficiency, but also to transform the
nature of mental healthcare itself?
• Asserts a national framework for e-
mental health should be developed
to provide a platform for change.

Policy context
No Health Without Mental Health
• Number of objectives are relevant
to e-mental health, inc improving
access, recovery rates and
experience of using services.
• Implementation framework highlights e-mental health.
Information strategy
• Published May 2012. Sets a ten-year framework for
transforming information for the NHS, public health and
social care.

Policy context
Innovation, health and wealth
• Published December 2011. Sets out eight principles
that could help frame a strategy for e-mental health.
Choice, personalisation and Any Qualified Provider
• Making choice work – in terms of choice of provider
and choice of treatment – will depend on access to
high-quality, comparable information.
NHS Mandate
• Sets an objective around increasing in the use of
technology to help people manage their health and
care.

Where do we go from here?
1. How can we build momentum and support real
change, in partnership with service users?
2. How can providers make sense of what is a rapidly
evolving marketplace and make informed choices
about which programmes and applications to use?
3. How do we determine what „quality‟ looks like?
4. How can we ensure that innovations in this field are
developed within appropriate governance
frameworks?
5. At a national level, how can we help spread
knowledge and good practice about what works?

A national framework for e-mental health
• In our view, a two-stage process is needed,
culminating in the development of a national
framework for e-mental health.
Stage one: Comprehensive mapping exercise.
• What are people already doing with technology –
including service users, carers, members of the
public, professionals (including clinicians, managers
and informatics specialists), providers and
commissioners?

A national framework for e-mental health
Stage two: Designing the framework
• Building on the mapping exercise, this would lead to
a shared vision for what people would like to be able
to do with technology, and set out clear actions for
different parts of the system to enable that change to
be brought about.
• Broad engagement process – involving service
users, carers, members of the public, professionals,
providers and commissioners.

What happens next?
• We have secured funding from the SHA mental
health leads group to undertake the first stage of
work – the mapping exercise.
• Scoping work on this is currently underway – we
would very much welcome input and involvement
from MHN members, including any examples of
current work in this area.
• We will continue discussions with DH, NHSCB and
others about future development of a framework for
e-mental health.

Any questions?
rebecca.cotton@nhsconfed.org
www.nhsconfed.org/mhn

Therapy services in a digital world

THE VISION

BUDDY APP: SIMPLE PROPOSITION
To use ubiquitous text-messaging
to give users a tool for taking
more control of their recovery and
as a resource for collaborating
with professionals to achieve their
goals

BUDDY APP PROVIDES
Buddy is a digital tool to support therapy services.
It enables clients to:
– Keep a daily diary via SMS
– Spot patterns via a website
– Be reminded about session appointments via SMS
– Create their own session plans in advance
– Set and receive behavioural activation goals via SMS

PLAY FILM
Only 3 minutes!

BENEFITS
SERVICE USERS PROFESSIONALS MANAGERS
Spot Patterns Rich Insight Improved DNA rate
Improved Communication Make Time in Therapy Caseload management
Create Control Focus on Goals
Appointment reminders
Happier users, enabled clinicians, and more
efficient services

SLaM Service
SERVICE USERS PROFESSIONALS MANAGERS
Improved quality of life in 63% Compliance 7% DNA decrease
87.5% of users
(from previous trial)
57.1% of users reported 71% users felt it allowed
decrease in CORE-10 for more open and
honest discussion
100% of users said
they would use again
* Published data from the SLaM EIS 100 week trial

USER FEEDBACK
“Buddy helped me communicate
better with my therapist, and it
helped me to spot patterns and see
what I was doing or not doing.
Buddy really felt like a friend
checking up on me at the end of
the day. Sometimes it was the only
contact I would have throughout
the day. It's something that helped
point me in the direction of
change, and which I then felt better
able to act on."
Helena, Service user

CLINICIAN FEEDBACK
Eric Morris, Clinical Director, EIS, SLaM
"The idea of Buddy is to put the person's goals at the centre of their treatment. I've
noticed that the ones who are using it have become more focused in what they want
to get out of our meetings. Early intervention service users usually have problems
with depression and anxiety and Buddy gives them support during the week when
they're not seeing a therapist."

Stockport IAPT, Self Help Services
SERVICE USERS PROFESSIONALS MANAGERS
100% of users satisfied 100% clinicians would
use again in the future 4.5% DNA decrease
with care received
63.8% reported 83% felt it allowed 4% canc. decrease
decrease in PHQ9 and for more open and
GAD7 scores honest discussion
500 additional clinical hours
Improved quality of life
in 89.2% of users
£25k additional income (PbR)
* Published data from the SHS Buddy Trial Outcome report
* All data over historic baseline

CEO FEEDBACK
Nicky Lidbetter, Chief Officer, Self Help Services
“With the increasing demand for providers of mental health services to
deliver more for less, Buddy contributes to system efficiency and enhances
patient experience by promoting the collaborative nature of therapy sessions.
This enables patients to feel more in control of their interaction with the
service. ”

RETURN ON INVESTMENT
• For service providers moving towards PbR, Buddy
offers increased:
– Throughput
– Efficiency
– Outcomes

CLINICAL FEEDBACK
“Buddy is being used in a variety of
ways in addition to routine activity
and mood monitoring. These
include: pain diary, alcohol
diary, monitoring
flashbacks, monitoring for
dissociation, promoting grounding
techniques and mindfulness such
as 'remember to notice where you
are‟ and „what you are doing right
now?” Regarding impact on DNA
and CNA rates, it‟s also having a
positive effect of reducing DNA's”
Dr Alan Barrett, Clinical Lead

SUMMARY
• Buddy has been designed to specifically support mental health
pathways
• Built to improve user engagement
• Designed around everyday lives, and everyday technology
• Improves the relationship between professional and service user
• Empowering and non-stigmatising

ABOUT US
• Incubated by Sidekick Studios, Buddy Enterprises Ltd brings together
business, design, digital and mental health professionals
• Developed in collaboration with SLaM‟s CMHTs & Early Intervention in
Psychosis service & Rethink‟s NE Essex Health in Mind IAPT service
• Current clients:
– NW Regional IAPT for Military Veterans service (Pennine Healthcare
NHS Trust)
– Nottingham Healthcare NHS Trust
– Self Help Services Stockport
– Kent & Medway NHS Trust
– West London Mental Health Trust
– Sheffield Health and Social Care NHS Trust
– Derbyshire Healthcare NHS Trust
– Mental Health Matters

Awards / Recognition
Gold Award Winner 2012 Finalist 2012
Community & Social Mobile App Innovation in Mental Health
www.lovieawards.eu

james@buddyapp.co.uk
syed@buddyapp.co.uk
www.buddyapp.co.uk

Thank You
E-Mental Health:
Harnessing the Power of Digital for
Better Mental Health
NHS South of England (East)
Monday 18th March 2013