Digital Health Age sits down with Dr Derek Richards, director of Clinical Research & Innovation at the online mental health service, SilverCloud Health. Users of SilverCloud Health work through an eight-week course which they can complete at their own pace. Designed to help manage stress, anxiety and depression, SilverCloud Health uses cognitive behavioural therapy (CBT) to help users change the way they think and feel about certain things with a dedicated supporter selecting topics for users and checking in with them every two weeks. The service caters to over 200 health systems across the world and has been adopted onto the NHS’ apps library. More so, a partnership in the US with insurance group, Gallagher Student Health & Special Risk, has seen 26 universities sign on to use the online platform. Here, Dr Richards discusses how online therapies can help people with mental health problems and what the NHS can do to drive mental health services.
Q1. Do you think people are more willing to tackle their mental health problems through digital/online interfaces rather than through face-to-face therapies?
A1. The way people choose to manage their mental health problems is very personal and can vary from person to person. For some people, face-to-face therapies are the most helpful solution – however, for a growing number, a busy lifestyle can mean that regular face-to-face therapy may not be feasible and for some an online approach is preferred. There is also the issue of funding – the need for investment in mental health services is well documented and this can affect how people access services. I think the idea of digital platforms has also become far more accepted, by patients and healthcare professionals alike. Online solutions, like SilverCloud Health, allow access to more patients and enables them to access a safe and secure environment, which can be personalised, so it feels like their own space. Because it is accessible online, it’s available whenever that person needs it most, but has the unique benefit of a supporter for the human touch. People are increasingly turning to the internet in search of mental health support, especially those among younger age groups. As we conduct many aspects of our lives online – banking, movies, social – it is also appropriate to have an expectation that we can access care online too.
Q2. What was it like getting SilverCloud adopted onto the NHS apps library and what can the NHS do more of to drive digital health?
A2. We’re really pleased that SilverCloud Health platforms are included in the NHS app library and we’re delighted to be working with almost 60% of IAPT (Improving Access to Psychological Therapies) programmes across the UK already. The app library helps to distinguish online solutions, like SilverCloud Health, which are built on strong evidence and demonstrate the effectiveness of the intervention. This means that the interventions can be trusted to deliver with the fidelity and care required. Increasingly, as the NHS IAPT services seek to reach higher targets for access, quality and outcomes, digital will see a significant growth, such as evidence based digital solutions – like SilverCloud Health.
Q3. Where do you think mental health is currently tackled the least? (Universities/ workplace, particular industries etc.)
A3. Definitely in the workplace. The majority of the population work in some capacity and are therefore spending much of their lives at work Relationships are sought and made with colleagues (or not in some cases), which can provide a source of support or add to the stresses of work, if relationships are for example strained, or are lacking. All employees will, to some extent, transition through life’s ups and downs during their working life and life events can of course have a massive impact on our physical and mental health. For example, key life events that can really test us include; starting work for the first time, bereavement, family pressures, economic demands, divorce, separation, etc. All of these types of events impact us to a greater or lesser extent at an individual level and will therefore impact us in the workplace. So it makes complete sense to have interventions for mental health available at work, where people spend so much of their time. Employers have a unique opportunity to provide employees with programmes and interventions that not only help them to build resilience in the workplace, but support workers going through tough life events outside of work too.
Q4. Can services like SilverCloud help increase access to mental health treatment across the NHS?
A4. There are so many obstacles to accessing mental health care, from lengthy waiting lists and funding issues, to distance from service locations for people living in rural areas or new mums with limited transport or childcare. There are also those who are living with a disability or long-term condition, which can also make it difficult to get out for appointments. Then there are the ‘social’ barriers to overcome – the continued stigma of mental health and negative perception of treatments. A lot of work has been done to overcome these barriers and offering low-intensity online-internet delivered interventions, particularly through a self-referral pathway, has opened up therapy to far more people.
A growing body of evidence indicates significant cost savings, waiting time reductions and a potential for scalability with online therapy, that cannot be achieved with more traditional and time-intensive interventions. The National Institute for Health and Care Excellence (NICE) guidance suggests a Psychological Wellbeing Practitioner (PWP) working face-to-face, or over the telephone for 30 minutes, can see a maximum of 250 clients per year; with SilverCloud 10-15 minute digital reviews, a PWP has the potential to see more than double the number of patients in a year.
Q5. How can digital interventions help treat mental health problems such as depression and anxiety?
A5. There are numerous research studies reporting positive outcomes for online-delivered treatments for depression and anxiety. CCBT (Computerised Cognitive Behavioural Therapy) is a form of CBT (Cognitive Behavioural) Therapy that is delivered via computer rather than face-to-face with a therapist. It can be delivered in a series of weekly sessions and should be supported by a trained supporter.
CBT is based on the concepts that your thoughts, feelings, physical sensations and behaviours are all connected, and that unhelpful thoughts and behaviours can trap you in a cycle leading to emotional challenges. CBT offers coping skills and strategies to help you change any unhelpful thought patterns to improve the way you feel in the present and has been shown to be an effective treatment for a number of different mental health conditions. The SilverCloud Health programmes’ evidence-based content is based on CBT principles.
Q6. Do you think there is still stigma surrounding mental health or do you see awareness around the topic increasing?
A6. I believe that a great deal has been done to fight the stigma around mental health. During last month’s Mental Health Awareness Week, I was overwhelmed by the volume of conversations around mental health conditions, including anxiety and depression, as well as a focus on stress reduction and building resilience. Recently, numerous celebrities have publicly talked about their own struggles with mental health, and the work of campaigns like the ‘Time To Change’ campaign and ‘#mendthegap’ are doing a great deal to encourage people to get support if they need it. That said, there is still a taboo around mental health, with some people still fearful to seek the help they need, particularly at university or in the workplace. I think it is vital to maintain the momentum of mental health awareness throughout the year.
Q7. What would you like the NHS to do more of to increase and improve mental health services?
A7. Many people with long-term conditions are also living with mental health issues. There is a growing body of evidence to suggest that managing their mental health can also positively impact how they manage their long-term condition, giving better outcomes across the board. NICE has recommended that patients with chronic physical and co-morbid mental health problems can benefit from treatment such as evidence-based computerised CBT programmes to improve their condition. This type of joined-up approach could greatly help reduce the impact on the NHS.
Q8. Are there any limits with digital interventions for mental health compared to face-to-face therapy?
A8. Historically, online delivered interventions have been troubled with a lack of engagement from clients and consequently poor clinical outcomes. However, in recent years, with the development of human-computer interaction (HCI) approaches to engagement, and the recognition that supported delivery of CBT online, yields greatest clinical success, e-therapy interventions have greatly improved. In recent years, attitudes have also changed and more positive attitudes exist towards accessing mental health care online – indeed, this has come with the growth and acceptance of digital in our lives more generally. Like any psychosocial or psychological recovery pathway, any singular intervention is not a panacea, internet delivered solutions are simply to be understood as one step in a journey of care that can change based on the needs of the individual patient.
Q9. Are there any technologies you would recommend for helping people take better care of their mental health?
A9. These days there are a host of mental health tools and apps online, to help support people with their mental wellbeing, from meditation apps to more advanced platforms for diagnosed conditions. Digital interventions are becoming more and more sophisticated and the future of this sector, looking at how AI can be used to recognise and respond to mental health conditions, for example, is really exciting.
For anyone experiencing mental health issues, I’d recommend speaking to your healthcare provider or counsellor to talk about the best options for you.