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Case study: An example of using technology to amplify mental health treatment provision
Stephanie RuskinFebruary 2016
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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+
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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
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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
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Live therapy session
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Out-of-session messaging
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Goal setting
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Questionnaires
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Questionnaire display
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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
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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)
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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
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Who?
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Amplifying the provision of Cognitive Behavioral Therapy
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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)
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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
✔
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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
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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
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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:
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Improving access to evidence-based mental health therapy
www.iesohealth.com
Stephanie Ruskin
t 07986 616 451