Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester

There is increasing evidence to support the effectiveness of eTherapies for mental health, although limited data have been reported from community-based services | BMJ Open

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Results: Data indicated baseline differences, with the Breaking Free Online group having higher scores for depression and anxiety than the Living Life to the Full Interactive and Sleepio  groups. Promising improvements in mental health scores were found within all three groups, as were significant reductions in numbers of service users reaching clinical threshold scores for mental health difficulties. Number of days of engagement was not related to change from baseline for the Living Life to the Full or Sleepio programmes but was associated with degree of change for Breaking Free Online.

Conclusion: Data presented provide evidence for feasibility of this eTherapy delivery model in supporting service users with a range of mental health difficulties and suggest that eTherapies may be a useful addition to treatment offering in community-based services.

Full reference: Elison, S. et al. (2017) Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester: repeated-measures and between-groups study of ‘Living Life to the Full Interactive’, ‘Sleepio’ and ‘Breaking Free Online’ at ‘Self Help Services’. BMJ Open. 7:e016392

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New programme will assess how digital therapies can help treat anxiety and depression

NICE is to start assessing new digital therapies that will help treat more people with anxiety and depression.

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Guided self-help, which can track people’s mood or advise on breathing exercises for example, is recommended by NICE guidance to help treat mild to moderate anxiety and depression.

As part of NHS England’s Improving Access to Psychological Therapies (IAPT) programme, NICE has been asked to assess digital applications or computer programmes, which will sit alongside face-to-face, phone and online therapy.

Developers of therapy applications are being invited to submit their product to NICE to see if it meets the criteria to be entered into the new programme. An eligible product will be assessed by NICE for its content, how effective it is at treating anxiety and depression, how cost effective it is and whether it complies with technical NHS standards. NICE will then produce an IAPT assessment briefing (IAB) on the product which will be looked at by an expert panel, made up of mental health clinicians, statisticians, an economist and a patient representative. They will look at NICE’s briefing and make a decision on whether the product can be recommended for real-life testing in selected IAPT services, where further evidence can be collected on its effectiveness.

Over the next two years, NICE’s expert panel will review data from this evaluation in practice and decide if the digital therapy should be adopted for use across the whole of NHS England’s IAPT service. Funding will also be made available from NHS England for digital therapies that are identified by the expert panel as promising, but need further development.

 

Ethics of digital technology for mental health

The potential of digital technology to make the lives of people with mental health difficulties better has never been greater | The Mental Elf

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The advent of the smartphone and mobile internet access has created the conditions for an ever-expanding range of opportunities for the use of technology to influence outcomes in health. However, ethical considerations remain for professionals in suggesting the use of such technologies.

Bauer et al.’s (2017) open access paper Ethical perspectives on recommending digital technology for patients with mental illness reviews some of the major ethical concerns presented to medical professionals by this explosion of technological possibilities and explores some of the ways in which new technologies challenge the boundaries between health, commerce and the private and public uses of data.

Read the full blog post here

Web-Based Mindfulness Intervention for Families Living With Mental Health Problems

Stjernswärd, S. et al. (2017) Health & Social Care in the Community. 25(2) pp.700-709.

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The aim of this study was to explore the participants’ experiences of using an 8-week web-based mindfulness programme in terms of user value and usability.

The programme’s usability was satisfactory and largely corroborated by the surveys. The programme was experienced as a valuable tool to cope with stress in both private and professional contexts, making it a viable option to support families living with mental health problems. Time for self-care, a widened perspective, a less judgmental and more accepting attitude, deterring automatic reactions and setting limits helped the participants to deal with their situation and health. The programme’s ease and flexibility of use were major advantages, although the training requires discipline.

Motivators and barriers to use were illuminated, which should be considered in the development of further online services and study designs.

Read the full abstract here

Digital health for young people with mental health problems: silver bullet or red herring?

Betton, V. | The Mental Elf Blog

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As children and young people (CYP) appear welded to their smartphones at all times of day and night, it seems obvious that when they face mental health difficulties they will turn first to digital health interventions (DHIs). But do young people really prefer DHIs to established services and are they clinically and cost effective?

At mHabitat our discovery work with young people has uncovered surprisingly mixed attitudes towards digital technologies, so I was interested to see how this new systematic and meta-review (Hollis et al, 2017) squares with what we have found in practice.

Read the full blog post here

Read the original research article abstract here

E-therapies in England for stress, anxiety or depression: what is being used in the NHS?

Bennion, M.R. et al. (2017) BMJ Open. 7:e014844.

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Objective: To document the range of web and smartphone apps used and recommended for stress, anxiety or depression by the National Health Service (NHS) in England.

Results: A total of 61 (54.95%) out of the then 111 IAPT service providers responded, accounting for 191 IAPT services, and all 51 of the then NHS Mental Health Trusts responded. The results were that 13 different web apps and 35 different smartphone apps for depression, anxiety or stress were available through either referral services or the online NHS Apps Libraries. The apps used and recommended vary by area and by point of access (online library/IAPT/trust).

Conclusions: Future research is required to establish the evidence base for the apps that are being used in the NHS in England. There is a need for service provision to be based on evidence and established guidelines.

Read the full article here

Gamification for health promotion: systematic review of behaviour change techniques in smartphone apps

Edwards, E.A. et al. BMJ Open. 2016(6) e012447. Published online: 4 October 2016

phone-1537916_960_720Objective: Smartphone games that aim to alter health behaviours are common, but there is uncertainty about how to achieve this. We systematically reviewed health apps containing gaming elements analysing their embedded behaviour change techniques.

Methods: Two trained researchers independently coded apps for behaviour change techniques using a standard taxonomy. We explored associations with user ratings and price.

Data sources: We screened the National Health Service (NHS) Health Apps Library and all top-rated medical, health and wellness and health and fitness apps (defined by Apple and Google Play stores based on revenue and downloads). We included free and paid English language apps using ‘gamification’ (rewards, prizes, avatars, badges, leaderboards, competitions, levelling-up or health-related challenges). We excluded apps targeting health professionals.

Results: 64 of 1680 (4%) health apps included gamification and met inclusion criteria; only 3 of these were in the NHS Library. Behaviour change categories used were: feedback and monitoring (n=60, 94% of apps), reward and threat (n=52, 81%), and goals and planning (n=52, 81%). Individual techniques were: self-monitoring of behaviour (n=55, 86%), non-specific reward (n=49, 82%), social support unspecified (n=48, 75%), non-specific incentive (n=49, 82%) and focus on past success (n=47, 73%). Median number of techniques per app was 14 (range: 5–22). Common combinations were: goal setting, self-monitoring, non-specific reward and non-specific incentive (n=35, 55%); goal setting, self-monitoring and focus on past success (n=33, 52%). There was no correlation between number of techniques and user ratings (p=0.07; rs=0.23) or price (p=0.45; rs=0.10).

Conclusions: Few health apps currently employ gamification and there is a wide variation in the use of behaviour change techniques, which may limit potential to improve health outcomes. We found no correlation between user rating (a possible proxy for health benefits) and game content or price. Further research is required to evaluate effective behaviour change techniques and to assess clinical outcomes.

Read the full article here