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.

IMAG1101-01

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).

Advertisements

The problem with IAPT

I’ve just been referred to IAPT when i really shouldn’t have been, i will explain..

A bit of background: most of you know that i have struggled with various mental health issues for the majority of my life. I’ve also used mental health services on and off for the past decade to try and move towards that elusive “recovery” we hear so much about. I’m also a very well-informed service user with 5 years of  experience working with organisations like YoungMinds-basically i know what i’m talking about when it comes to mental health and in particular what is best for me.

I recently went back to my GP in a very distressed state. My anxiety recently has been through the roof and it’s had a crippling knock on effect on my mood and several other conditions which in turn has lead to a sharp deterioration in both my mental and physical health. Basically i was not in a good way-another bad downspike in what for me is a severe and enduring problem.

This one GP in particular is one i try to avoid as we have had several clashes over my treatment in the past. After refusing to prescribe me more medication she offered to refer me back for CBT (which i have had previously & has been relatively effective). I agreed but pointed out it would probably be at least a year until i was seen and that i would need to continue medication in the meantime (which she was not happy about). She told me that several of her patients had only waited a month or two.

This struck me as odd-i look back and want to kick myself; i should have known why.

She was not referring me back to the adult CMHT who have seen me before and know me. She was referring me to IAPT.

I have since been back to the surgery to see a different clinician who confirmed exactly what i already knew: i should never have been referred to IAPT and my local IAPT service won’t take me-i am too severe a case with far more than mild-moderate Depression/Anxiety.

It’s very frustrating to continually have to educate clinicians myself about things they should know about-mental health and services in particular. I often have to explain mental health conditions to GPs (who do not need to have any training on mental health to qualify by the way) or tell them about third sector services in the area that they could refer people to.

I am exhausted from having to constantly and almost aggressively self advocate in order to get any treatment at all.

Oh the irony..

For me this is actually almost painfully ironic.

You see while i was a VIK at YoungMinds i was part of several consultations on IAPT before it was up and running and i even facilitated group workshops for other young people on the subject. I liked the idea in principle, after all it would offer therapy to so many people who usually wouldn’t be considered “ill enough” or would have ended up of the bottom of the average 18 month waiting list of adult mental health services. It would also bring in a self referral element often lacking from statutory mental health services and the waiting lists they suggested were much better too.

But i did argue one point very strongly:

My concern was that the implementation of IAPT might lead to cuts in other psychological therapies on offer and that we ran the risk of IAPT becoming the be-all and end-all. This is because IAPT is quicker and also therefore cheaper than more traditional talking therapies making it more attractive to commissioners and cash-strapped trusts.

I said repeatedly that there must be safeguards put in place and that clinicians and patients needed to be fully aware that IAPT is not appropriate for everyone, especially not those with more severe issues. Especially as IAPT often offers just 6-12 CBT sessions which are not appropriate for every condition and often not enough (i’ve had about 30 sessions over the years so far and i’m still painfully ill).

Sadly it seems my fears have been realised.

From January-March 2012/2013 259,016 people were referred to IAPT but only 154,722 entered treatment which suggests to me that i am not alone in being wrongly referred to the service. (Source: Health & Social Care Information Centre IAPT data set).

I have also spoken to a large number of people, especially in the 18-25 age range who have been referred to IAPT when they should not have been.

I would be very interested to hear of anyone else’s experiences of being wrongly referred and will be voicing my concerns on this matter to the NHS and YoungMinds.

What is IAPT?

IAPT stands for “Improving Access to Psychological Therapies” and is an NHS program to extend access to talking therapies for over 18s in England (there is also CYPIAPT for children and young people). It is usually offered to people with mild-moderate Depression, Anxiety or Stress.