A little bit of me and Buddy in The Times

I recently had the pleasure of being interviewed by Phil Robinson for a piece in The Times around mental health apps and my own experience of working for and using Buddy in my own treatment. Here is a short extract from the piece – you can find the full article linked to at the bottom of the post.

Phil Robinson,

I was staying at a five-star hotel in Greece when I broke down. I couldn’t move or speak; I wept for no reason. So I was flown home, diagnosed with depression and sent to a private psychiatric hospital, where therapists began rebuilding my mind.

For weeks, with groups of almost broken, funny, and desperate humans, I attempted to learn the tenets of cognitive behavioural therapy (CBT). I didn’t want to be stuck in a room with a bunch of people who had, like me, flunked life, but it saved me. Beyond anything that was said in that room, I was sure that I wasn’t alone.

For people suffering from depression today, access to therapy is no longer a foregone conclusion. But whatever your problem — paranoia, body dysmorphia, BPD, OCD, PTSD — there’s probably an app for it. And this month, the health and life sciences minister George Freeman launched a £650,000 innovation prize to promote the creation of a new generation of mental health software.

So far there are 26 apps (11 are free) recommended by the NHS as part of a drive to automate healthcare, relieve waiting lists for talking therapies and reduce the £100 billion that it spends on treating mental health patients every year.

One, called Buddy, has been used by 12 NHS trusts and has been used by more than 17,000 people. An SMS and browser-based diary and communication tool, it’s designed to be used in conjunction with seeing a therapist, says Kat Cormack, who is Client Director of Buddy but also uses it “in my own treatment”.

I get a daily text from Buddy,” she says. “‘Hi Kat, Buddy here, how are you doing? Rate your day from 1 to 5 and tell us how you feel!’” As well as rating her state of mind, she can add notes. “It’s connected to my clinician, so I can tell her things that I might not be able to say looking her in the eye. I can confess my darkest secrets.

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By analysing the data, a clinician can monitor a patient’s progress or use it to aid diagnosis. She cites a woman whose long-term depression was revealed to be hormonal after her Buddy data was found to correlate with information from another app tracking her menstrual cycle. “She changed her medication and is now free of depression for the first time in decades.” 

When I was being treated for depression in the Nineties, I saw my therapist once a week, my psychiatrist once a month. I can see that apps present an opportunity to collect evidence to hasten recovery, yet the ability of most apps to deliver a quality service to vulnerable people remains questionable.

Away from the NHS’s recommended apps page, there are thousands of apps dealing with every condition. In most cases their publishers are as obscure as the evidence of their clinical efficacy. At one end of the spectrum you have apps such as MoodKit, the product of the experience of two respected doctors; at the other you have apps such as Fukitol, which is named after a Robin Williams joke.

The industry is still in its infancy and evidence from clinical evaluation trials is scarce. However, in 2013, a study of Viary, a Swedish app for depression, found that 73.5 per cent of patients who used the app were no longer considered depressed after eight weeks and needed half as many therapy sessions as those who engaged in therapy without it.

The result offers a glimpse of why these apps have been seized on as the holy grail of mental healthcare: promoted as a form of triage, they enable health services to push users to take responsibility for themselves and to cut face-to-face therapy.

Cormack is aware that digital tools such as hers are used by people who are frantic for NHS counselling but have not received it.

 The waiting list for an assessment can be up to a year. That’s why people are using apps — they are either a stopgap when you are on a waiting list, or if the NHS has told you that you don’t meet their criteria. People get desperate. We are losing lots of low-cost counselling services because they can’t survive in this financial landscape

When I was at my lowest, between 1998 and 2002, it was always possible to see a counsellor at my local surgery. In 2015, a GP refers people like me to IAPT, an acronym for the suspiciously titled “Improving Access to Psychological Therapies”. It’s a stepped care program that begins with an assessment by phone from a “psychological wellbeing therapist”. Those assessed to have a condition that is interfering moderately with their lives are given a computerised CBT course to complete at home.

If this magic bullet fails, they are given self-help options, or signed up to a 100-person psychoeducation class (like speed awareness courses for people with depression). If you still stubbornly fail to regain your mojo, you can join a year-long waiting list for talking therapies, during which time you can use one of the many apps. The hope throughout this process is that patients simply disappear from the waiting lists as cured, or over the worst of it.

Therapy via healthcare app might seem like treatment purgatory, but anecdotal evidence from practitioners suggests that apps for depression and anxiety work particularly well with certain sectors of the population, such as the military and teenagers, who are notoriously reluctant to talk about emotions.

This is just an extract, the full piece on The Times website (subscription service).

EHI Live 2013

Last week was a busy one, i was at EHI Live 2013 in Birmingham on Tuesday and Wednesday and wisely for once chose to take the rest of the week as leave to recover: i predict many of you that know me just fell off your chairs reading that last part!

I was one of the speakers at the HANDI Health App conference as part of EHI Live 2013 and it was a great experience and quite unlike most big events i’ve been too in the past.

Live-and-HANDI-logos

Now this is really silly but i must confess that at first i had no idea what i was signing up for. I was approached by Ewan Davis to speak at HANDI Health about my experience of working on the WellHappy app. I’m always more than happy to talk about the app (in fact you try and stop me!) so i quickly said yes.

It was only after i said yes and got some more details that i realised i was going to be speaking at EHI, one of the biggest health/tech events in the calendar!

It was nice to know that i was going to be in good company, i found out early on that Sarah Amani who i met in person for the first time recently at the IAYMH Conference in Brighton was speaking the day after me about developing the “My Journey” Early Intervention in Psychosis app. I was also going to get the chance to meet up with an old VIK friend Mark who i don’t get to see often now that the project has ended.

The first person i ran into at the event in fact was Geraldine Strathdee, the National Clinical Director for Mental Health in the NHS & Royal College of Psychiatrist award winner. I had been so busy preparing for my part of EHI that i didn’t even realise there was also a workstream dedicated to Mental Health Informatics.

Being the massive nerd that i am i ended up attending a talk and one of the workshops on mental health informatics and in particular the Mental Health Minimum Data Set produced by the Health & Social Care Information Centre. I won’t go on about this bit as i know it’s niche but if this is your area i strongly recommend you read into the minimum data set. It’s where we get much of our mental health statistics and is only going to grow in terms of the amount of data and it’s importance.

Overall the event was very interesting, a lot more tech based than most of the events i attend so i definitely feel i learnt a lot that i probably wouldn’t have otherwise. It was also a chance to check out some really innovative things like a 3D Printer being used to make artificial limbs and a game you can play with eye movement detection-so completely hands free!

I will leave you with a slightly more off the wall note..the conference was also a good excuse for silly free things..apparently stress balls are out and odd animals are in. I’ve been picking up these oddball things for years now and these are the new additions to what i jokingly call my stress farm! I also have a telephone, sheep, cow and a stress pizza of all things knocking around somewhere..

Yes i know i have weird hobbies..

Yes i know i have weird hobbies..

WellHappy

The last month or so has been pretty hectic, they were always going to be with the restructure of the NHS and the VIK project at YoungMinds coming to an end after four years.

But in the last few weeks i have managed to get a lot done!

After launching the app first at the Healthcare Innovation Expo and then at City Hall i had a few days to finally relax and then bounced right back into work mode.

app launch

Launching the WellHappy app

I attended an iBehave meetup at Google Campus around using tech to increase condom usage in young men. Devika, the winner of the SexFactor2012 awards, came with me and together we worked together with a team of other people from tech, third sector and health backgrounds to come up with solutions. As someone who is much more familiar with the mental health side of the app we developed (plug: download here!) it was good to have an expert and friend with me.

You can watch a short video made about the event here.

I also made a short film for YouthNet and TheSite about mental health and employment. I’ve seen a sneak peek but i’m afraid it has not been released just yet. When it is i will post it so watch this space.

And two last little things i thought i would mention..

Firstly my app was featured in the Guardian today after they interviewed me recently. You can read it here.

Secondly, more for those in London, the WellHappy app will also be featured in the Evening Standard on Thursday so make sure to look out for it!

Mapping mental health

Last year young people from organisations including YoungMinds Very Important Kids (VIK) project, Right Here Newham and the Peer Outreach group at the GLA got together to discuss one of the last taboos: mental health, with a particular focus on how it affects them as Londoners. Their work led to the London State of Mind manifesto, a document put forward to advise decision makers about what is important to young Londoners and what improvements they want to see. This was launched last year at city hall and quickly gained cross-party support.

One point is of particular importance and has led to my job being created. Point five, “tell us where we can go when we need to get help”. I am currently working for YoungMinds on secondment to NHS London and we are working on a very exciting project in response to this.

We have decided to develop an app and online space to help young people find out what help is available in their area.

While this started off at looking purely at mental health services we soon realised this wouldn’t be enough. Mental health is not something experienced in isolation, especially for young people, and has large overlaps and affects areas such as relationships, physical health and substance use. Therefore we decided to embark on a somewhat more challenging task: mapping wellbeing services in the capital and helping young people to find them as well as producing materials to support young people along the way.

Just over two weeks in and we have already accomplished a lot. We have begun mapping services and meeting with young people and organisations from all over London. We will continue to engage with as many young people as we can as I believe participation is key to this being a useful and hopefully successful tool.

We want this to be more than just a wellbeing “Yellow pages” and for that we need your experiences and recommendations of services. Your local knowledge and experiences are invaluable to making this work so tell us about anything you think might be of interest that you know about and let us know what services you use.

So what next?

I will be blogging at YoungMinds and at MyHealthLondon on a fortnightly basis, keeping you up to date with what we’re doing and how you can help.

We will be running consultations with young people, the dates aren’t fixed yet but if you’re interested in getting involved please email me at Katherine.Cormack@london.nhs.uk.

Kat Cormack

 Read the full London State of Mind manifesto here.