Connecting with help
University of Manchester Clinical Psychologist and Senior Lecturer Dr Sandra Bucci tells us about a Smartphone app her team are developing for the self-management of psychosis, and how it could particularly help younger ‘digital natives’.
Severe mental health problems such as schizophrenia affect 24 million people worldwide, with an estimated annual cost to society of nearly £12bn in England alone. People with psychosis tend to misinterpret or confuse what is going on around them. For example, they may experience hallucinations (in which they see or hear things that are not real), delusions (unusual beliefs not usually held by others) or confused thinking.
Connecting the disconnected
Feelings of isolation are common for people experiencing psychosis. Psychotic experiences usually begin to appear in adolescence and young adulthood – a critical time in life when we find our identity, complete our education and start out on our careers. Feeling disconnected from others during that time can have really serious knock-on effects, not only on the trajectory of the rest of your life but for your family, and for society more broadly.
Psychosis can be treated effectively with a combination of medication and psychosocial interventions, such as talking therapies. But there are times when patients start showing signs of relapse before their scheduled appointment or they can end up getting treatment too late.
As the treatment of psychosis is time-sensitive, we had the idea of using Smartphone technology to improve the speed and quality of recovery in psychosis, over and above conventional drug and psychosocial treatments. The NHS shares this aim to harness the recent revolution in information technology; self-management of long-term problems is now a cornerstone of NHS policy.
Young people can particularly benefit from this approach. Technology is so much a part of their day-to-day life and way of communicating with others. We wanted to make support for mental health more accessible, modernise it, and try to connect people in a way that is now second nature.
With the support of the MRC Developmental Pathway Funding Scheme, we have developed a personalised, smartphone app, called Actissist, that has been co-designed with the input of users and other stakeholders. The app delivers a theory-driven psychological intervention that can be used anywhere, at any time.
Mental health problems happen around the clock, and people can’t necessarily get the care and support they need at the time that they need it. But an app is available 24 hours a day; you can carry a Smartphone with you wherever you go and you don’t have to wait for your appointment with your clinician or doctor.
So how does it work? Psychosis doesn’t happen out of the blue: there are usually some early warning signs, such as feeling low or anxious, sleep problems, feeling unusually suspicious, hearing voices that start to bother you or experiencing confused thinking. Our app focuses on specific psychotic experiences many people find upsetting and aims to offer people the tools and support for these experiences as and when they need it.
For example, when someone recognises these warning signs, they can choose from a menu of these trigger points in the app and work through a series of question-answer exchanges. Actissist then gives them some tips and strategies on how they might manage the distressing experiences that they have had.
The app also emits an alarm prompting users to engage with it, whether or not they are distressed at the time. If they are not distressed they can use the app to consolidate some of the learning, and then draw on the coping strategies when they need them at a later date.
Giving patients choice
Recently, we secured more MRC funding to conduct a larger trial to test how effective the Actissist app is in improving people’s symptoms, recovery and quality of care.
Ultimately, my hope is that Actissist will become another option within the care packages that clinicians prescribe to people. I would like to see a digital stream of ‘prescription’ that occurs in services to give people different options about how they receive healthcare – whether that’s a face-to-face session with a clinician, or an app, or both.
People with mental health problems have historically been disempowered in their healthcare choices. If we show that Actissist supports recovery and improves well-being, my hope is that it will be adopted by the NHS so that patients have more control and choice about how they receive help and support from healthcare services.