Digital Engagement Healthcare Healthcare Apps Research Technology

Mental Health Apps in the NHS in England

A company that has developed a fantastic mental health app asked for my advice last year on how they could introduce their app into the NHS. The following is the advice that I gave them. I thought I would share it here as it may be useful to others. Please bear in mind this was written in Feb 2017.

Which online mental health therapies are currently recommended by the NHS?

Below is a list of online mental health therapies currently recommended on the NHS Choices website:

Service Name

Demographic

Problems

Big White Wall

Anyone aged 16 or over.

Common mental health problems.

FearFighter

Anyone aged 16 or over.

Panic and Phobias.

Ieso

Anyone aged 18 or over.

Common mental health problems.

Kooth

Those aged 11 to 19 (25 in some areas).

Common mental health problems.

SilverCloud

Anyone aged 16 or over.

Common mental health problems.

Sleepio

Adults

Sleep issues.

However, other mental health apps and websites are being used in the NHS, and researchers found that 35 different smartphone apps for depression, anxiety or stress were available through either referral services or the online NHS Apps Libraries (see the full list here, pages 5-6). The NHS Apps Library has now been shut down as an evaluation revealed that only 4 out of the 14 apps reviewed from this library were able to provide any evidence of efficacy.

Which NHS services would consider purchasing copies of your app?

Local Clinical Commissioning Groups (CCGs) are assigned the task to commission health services in each borough in England. CCGs commission IAPT (Improving Access to Psychological Therapies) services to treat adult anxiety disorders and depression. Sometimes a CCG may invest in a specific e-therapy directly, or IAPTs can choose to buy specific e-therapies. So the purchaser of a mental health app could be the CCG or the IAPT service. If you think your app is to be used in conjunction with therapy, I’d be inclined to contact the IAPT directly; otherwise if it is a stand-alone programme like Big White Wall or Kooth, then it is best to contact the CCG directly (as an example, details for the South London and Maudsley IAPT service can be found here).

Why is there a need to evaluate mental health apps for clinical effectiveness?

Users’ reviews and the number of downloads are not sufficient to evaluate the efficacy of a digital health app. In fact some research has shown that downloads are inversely correlated with effectiveness. The NHS also claims to have become a little stricter now in promoting apps that have no evidence of clinical effectiveness.

How do you evaluate a mental health app for clinical effectiveness?

There is considerable interest in evaluating mental health apps, and there appears to be a major challenge to close the gap and measure the accessibility, usability and reliability of healthcare apps, as well as safety.

NICE (The National Institute for Health and Care Excellence – the organisation that is responsible for providing all evidence base for the NHS) and organisations such as MindTech and MHabitat are currently exploring ways that digital mental health products can be evaluated. There are a few researchers and academics working in this area too (see the next section and have a look at this fantastic academic conference on mental health apps too). For example, academics at Nottingham university have set up a randomised controlled study to evaluate whether an online peer support website “Big White Wall” is more or less effective in helping people if they are experiencing symptoms of depression and anxiety, compared to freely available online information from the NHS (Moodzone) (further information here; and initial results are here). Another example is a less academic approach to evaluation used for the WorkGuru app (details here).

Who could you approach or commission to evaluate your mental health app?

There are two organisations that I know of in England that are specialists in this area. Both are run by academics and researchers (I have also learnt that both organisations are working together to develop a common set of criteria for evaluating digital mental health apps and websites):

  1. MindTech – This organisation is run by academics and researchers mainly based outside of the NHS.
  2. MHabitat – This organisation is run by academics and researchers within Leeds and York NHS Foundation Trust.

My advice would be to contact both organisations and see how they respond to your request.

1 Source: http://www.nhs.uk/Conditions/online-mental-health-services/Pages/introduction.aspx

2 Example of concerns about safety: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0444-y

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