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).

Talking & Walking Out Of Darkness

The following post is a write up of the speech I gave on Saturday at the first ever Walking Out of Darkness event. Some of it may be slightly different from what was actually said on the day; mostly because I got the most emotional I have ever been giving a speech!

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Hi everyone,

My name is Kat and I’m here today because when I heard what Kenny was trying to achieve this weekend, I had to get involved.

These days I’m very open about my mental health, so I’m happy to share with you that I’m not okay and in fact I haven’t been okay for a very long time.

I’ve used mental health services on and off for a decade and probably have enough labels to keep the post-it note industry alive. I’ve also come far too close to the edge myself and there were times, certainly, when I couldn’t bear the thought of being here for another day.

Looking around today, I can see a fair few familiar faces and, given what we’re all here for, I’m pretty sure I may be preaching to the converted, but let’s give it a go anyway.

Even for me this has not been an easy speech to write which these days is a novel experience for me. Over the last six years I have dedicated a large amount of my life to campaigning around mental health issues including Suicide.

I have spoken to countless individuals, and at events around the country about my experiences and those of my peers. Hell I even took on Jeremy Paxman live on Newsnight earlier this year to talk candidly about my experience of Self Harm and what I think needs to be done to help other young people suffering in silence.

But Suicide, even now, is something of a taboo within a taboo and not something that I can easily find words for.

You’ve probably all heard the statistic, that one in four of us will be affected by mental health issues. However I’ve often argued that it’s four in four. Because one in four doesn’t take into account the distress and despair felt by friends and family when a loved one is struggling. And yet many do not, cannot talk about it.

I used to be one of them. Even though I’ve been ill most of my life it wasn’t until six years ago, aged 19 that I “came out of the mental health closet”.

I was lucky enough to stumble across an amazing charity who changed, if not saved my life. The charity in question was YoungMinds and without their support there is no way I would be here today giving this talk. YoungMinds helped me to find my voice and start standing up to stigma. I joke that they gave me the activism bug, but more seriously, they helped me express the injustice I had long felt and gave me a platform to actually do something proactive.

In fact some of my friends from YoungMinds are here today so if you see anyone wearing our tshirts come up and say hello. I’d also urge you to sign up to our mass movement for change, YoungMinds Vs as we attempt to fight the pressures faced by young people across the UK.

I now work for a mental health start-up called BuddyApp. We’re a small team and we work with NHS services up and down the country to help people of all ages have a better experience of treatment using something strikingly simple and accessible; a text message.

Because I am so open I am often seen as one of the more visible advocates for service user voice in the mental health community. Because of this a lot of people reach out to me. It happens, sometimes several times a week and the sad thing is the conversation always starts the same way:

I’m really sorry but I don’t know who else to talk to

Now I’m glad that people reach out to me, don’t get me wrong. However it saddens me that, even in 2014 in a supposedly enlightened culture, there aren’t more of us willing to stand up and speak out. I wish my friends and the acquaintances and strangers that message me don’t have more options.

So everyday, sadly, I see the human cost of distress, of mental illness and of suicide. And sometimes it feels to me as though it’s everywhere, just hidden behind a thin veil. Perhaps if we stopped and looked around the crowds we would see that not everyone manages to keep their mask on, perhaps we could take a bit more time to carry out some random acts of kindness.

Be kind, for everyone you meet is fighting a hard battle.

When it comes to Suicide, we can talk about statistics until the proverbial cows come home. I could rattle off numbers and tell you how many thousands died last year.

I could tell you that the biggest killer of men aged 20-49 is not road traffic accidents, it’s not Cancer and it’s not Heart Disease..it’s Suicide.

But I guess, and I can’t believe i’m quoting, or rather misquoting this person, but as Stalin almost said:

The death of millions is a statistic. The death of one man is a tragedy.

What makes us sit up ad think, what really pulls our heart strings and makes the numbers feel more human, what we sadly often lose, is the individual tragedy.

I’m guessing that many of you, like me, are here today because you have lost someone you love or have come too close to taking those final steps for yourself. There is no pain like it, I know.

I was 18 when I first lost someone to suicide. Her name is Casey Brooks. She was a charming, funny, caring girl with friends all over the world (we met through an online support group). Although I never met her she provided me, and many others with support in our darkest hours. And yet, in hers, that last time, she didn’t reach out.

Casey Brooks

Casey didn’t think much of herself, a common problem for people like us with mental health issues. I wish she had truly understood the love and the laughter she brought to people’s lives and what the absence would mean. I wish could see the effect her leaving had. I don’t think she could have guessed that all these years on her online memorial would have almost a thousand members. I wish she knew that her parents never stop talking about her, or about the work they’ve done in the last few years to help save other young lives. Her dad has also written this book which I would recommend.

Since that fateful day I have come far too close, far too often to losing far too many others.

Three weeks ago I received a text that made my blood run cold. It was one of my dearest friends, who I have known and cared about for years and she was saying goodbye. I think my heart stopped beating as I read those words.

I know she’s come close before, I’ve held her as she wept, whispered supportive words down the phone at 4am when everyone around me was asleep, I’d do anything for this girl. But this time felt different. I guess after all these years being involved in the mental health community, and all my safeguarding experience, you start cultivating a pretty accurate gut reaction. It didn’t help that I was also several hundred miles away and couldn’t do what I desperately wanted to, which was to hold her and keep her safe until the storm passed.

I’m so happy to be able to say that she’s still with us but it breaks my heart knowing how close she came and how little she felt she had left to live for.

And i’m proud of her for telling me, I am so grateful I didn’t lose her that night.

When we are struggling and feel alone, we need the courage to reach out, to say this is not how my story ends. And appropriately for today, if we see that hand reach out, we must have the courage to clasp it and hold on, as long as it takes.

I want to thank you all for joining us today Walking Out Of Darkness; blessed are the cracked for we let in the light. I’d also like to think Kenny, the CEO of CLASP, who has worked so incredibly hard to bring us all together today.

And I will leave you with this quote from Ben Okri, which struck me as apt for today;

The most authentic thing about us is our capacity to create, to overcome, to endure, to transform, to love and be greater than our suffering.

Thank you