Case study: An example of using technology to amplify mental health treatment provision

Stephanie RuskinFebruary 2016

Mental Health is a Global Problem

1 in 4 adultsexperience at least one

diagnosable mental health problem in any one year

• 16m pa UK

~80% of these

conditions go undiagnosed and

untreated

The economic impact of mental illness is estimated at

more than £100bn in the UK alone

Sources: The Office for National Statistics; World Health Organisation; National Survey on Drug Use and Health (NSDUH).

Cognitive Behavioural Therapy (CBT) is the most effective treatmentBut… Stigma and Embarrassment prevent people from seeking helpAccess to qualified therapists is limitedQuality is variable

£100Bn+

Improved Access• Discreet method tackles stigma• Available anytime and anywhere• Access from any connected device

Greater Efficiency• Freelance network of therapists• No infrastructure overhead• Improved productivity

Quality Controlled• Data from therapy transcripts used to improve outcomes and quality

Clinically Effective• Excellent clinical outcomes validated by published clinical trial and NHS service

Unique Written Conversation CBT MethodProprietary web-based platform optimised for online therapyTherapy delivered in real time by real therapistsClinically validatedQuality controlled

Service Development

2000 2001 2007 2008 2009

Founded by two Psychologists

300 patient RCTNHS GP referrals Bristol and London

Lancet publication– clinical evidence

1st investment round

Early NHS pilot projects

v2.0 software release

100 patient pilot project in Surrey

v1.0 software

Clinical Need Evidence Operational Phase

Commissioned by NHS in Surrey

2nd investment round

Kessler et al, 2009, Lancet, 374, 628

Multiple new NHS contracts

Launch of Ieso Digital Health

2011 2012 2013 2014 2015

Live therapy session

Out-of-session messaging

Goal setting

Questionnaires

Questionnaire display

Evidence based

300 patient randomised control trial

• 2007-2009• Patients allocated online CBT or standard care• At 4 months 38% recovery (Beck Depression Inventory <10) in intervention group vs. 24% in control group• Effect maintained at eight months – 42% vs. 26%• Median of six sessions needed for benefit• Severely depressed benefited most• Many patients found it easier to talk when not face-to-face with a therapist

2009; 374: 628–34

Proven effective by peer-reviewed research

More patients complete treatment and recover

These data have been collated from monthly IAPT Reports published on the HSCIC website http://hscic.gov.uk/iaptreports (all published Jan-September 2015), and Ieso monthly IAPT Reports all of 2015

Completed Treatment Recovery Sessions missed0%

10%

20%

30%

40%

50%

60%

42%46%

16%

56%51%

10%

All IAPT Providers Ieso Digital Health

98% of patient evaluation responses rate the Ieso service as “good” or better (60% return compared to 11% nationally)

Online therapy

• Increased access to services• Reduce waiting lists• Anytime, anywhere• Evenings and weekends• Easy access to specialisms• No travel

• Discreet

• Relative anonymity

• Reduced pressure

• Speed of disclosure leads to faster

recovery

• Forces order and logic

• Documents a narrative

• Embedded & reinforced learning

• Transcripts available

Online therapy provided via written conversation

Benefits

Who?

Amplifying the provision of Cognitive Behavioral Therapy

More patients complete treatment and recover

These data have been collated from monthly IAPT Reports published on the HSCIC website http://hscic.gov.uk/iaptreports (all published Jan-September 2015), and Ieso monthly IAPT Reports all of 2015

Completed Treatment Recovery DNA0%

10%

20%

30%

40%

50%

60%

42%46%

17%

56%51%

10%

All IAPT Providers Ieso Digital Health

98% of patient evaluation responses rate the Ieso service as “good” or better (60% return compared to 11% nationally)

Access to data enables accountability in care:

Focused Professional Development

Ieso’s data analytics allow therapist performance data to be continually monitored

✔

Personalised support and training based upon individual therapist data can be delivered

✔ Filter to show all in

a group

Drill down to show an individual

or

Therapist A

Therapist B Therapist D Therapist E Therapist F Therapist G Therapist H Therapist I Therapist J Therapist K Therapist L Therapist M Therapist N Therapist O Therapist P Therapist Q Therapist R Therapist S Therapist T Therapist U

Therapists and supervisors can visualise their performance

✔

Using Transcripts to Inform Practice

Consolidated learning

Patients revisiting therapy sessions when it is convenient for them

Quality Control Of therapy and clinical outcomes. Analysis of therapist fidelity to the CBT model

Amplifying expertise

Using Natural Language Processing to detect ‘language signatures’ of common mental health conditions and suggesting actions

NLPIESO Therapist Quality Control and Clinical Vigilance

Linguistic Indicators of Therapeutic Model Adherence and SafetyDr Matthew PurverDr Christine HowesProfessor Rose McCabeDr Ann Hayes

BackgroundMost mental health therapy takes place behind closed doors and is unmonitored. Therapy delivery is not quality controlled.This puts both the therapist, the patient and the healthcare system at risk. The ability to automatically monitor therapist performance and detection signals of clinical risk (e.g. suicidal ideation) has multiple applications within and beyond the IESO platform

MethodLinguistic Analysis of IESO transcript data using:• Topic Modelling• Machine Learning• Sentiment Detection

ResultsPatient textMore positive sentiment better symptoms, progressMore variable sentiment worse progressMore/more variable anger worse symptoms

TherapistAdherence to CBT model detectable and associate with clinical outcomes esp. Progress review, feedback, goal-setting

Benefits to patient during therapy

• Relative anonymity• Anytime, anywhere• Transcripts for revision• In a location of choice• Discretion• Reduced embarrassment

• Benchmarking to national standards

• Identifying needs based on outcome measures

• Tailored training programmes for clinical staff

• Natural Language Processing• Fidelity to the model control

Using therapy data to improve future services

Internet-enabled CBT amplifying treatment through:

Improving access to evidence-based mental health therapy

www.iesohealth.com

Stephanie Ruskin

t 07986 616 451

e steph@iesohealth.com