Title: Digital solutions for people with severe mental health problems
Funder: Department of Health and Social Care

Abstract: Background: Worldwide, mental health is in crisis: we cannot accommodate the majority of those in need. Psychosis is a severe mental health problem (SMI) and a huge public health challenge with a high burden of disease. Local service structures are under immense pressure to keep up with demand. Management of people with SMI is the focus of NHS mental health providers, yet the Care Quality Commission reports patients feeling uninvolved in their care planning and a one-size-fits-all approach. Long waiting times and reactive care results in delayed, inefficient and imprecise treatment. Conventional methods of treating psychosis involve assessments which rely on patients recalling emotional states over a preceding time period at a scheduled appointment time. This results in reduced precision in treatment planning, which is problematic in a condition that requires precise, time-sensitive treatment. Digital technology offers a potential solution: we have an unprecedented opportunity to drive improvements in quality, efficiency, cost and access to care. The NHS has a clear digital agenda for addressing mental health challenges, and self-management in long-term conditions is a cornerstone of NHS policy. Many digital health interventions are being developed and show benefit, but there are few examples of successful implementation and many challenges in closing the innovation-translation gap. Aim: To improve health outcomes in psychosis by delivering the right treatment, at the right time, in the right context. We will co-produce a contextually responsive digital health intervention within re-designed digital care pathways to improve quality and efficiency of care in psychosis, delivered by a digitally confident and capable workforce. Methods: This programme will be delivered over five years with four interlinked workstreams:1) synthesising the evidence and identifying, through qualitative methods, barriers to digital uptake;2) building a theory that describes the underpinning mechanisms of digital health interventions, translated into good practice guidelines;3) advancing current digital health interventions through the application of advanced statistics and machine learning to make them more personalised and tailored, and testing this in a feasibility study;4) implementation research on translating digital health interventions into clinical practice with a focus on redesigning digital care pathways.Patient and public involvement: Ideas for this research programme were identified by patients and clinicians who have already used some of our digital interventions. People said they would like to see a more intelligent and interactive system that is tailored and personalised to patient and service needs. With support from the McPin Foundation, consultations with our advisory group will ensure our co-produced work is relevant and meaningful. Impact and dissemination: We will be recognised as a world-leading digital mental health research group with a successful programme of funded research, high-quality outputs and translational impact. Findings from this work will be shared with clinicians, patient groups, professional societies, media channels, at academic and industry conferences and clinical services. The promise of this programme of work is a critical mass of interdisciplinary digital mental health researchers developing co-produced tools that are implemented into routine practice, delivered by a confident and digitally-enabled mental health workforce.

Lay abstract: Background: Worldwide, mental health is in crisis. We cannot help the majority of those in need. Psychosis is a severe mental health problem (SMI) and a life-changing condition for those affected by it. Local services are under a lot of pressure to support people with SMI. Many of those who seek help describe feeling uninvolved in the way their care is managed and say that the care they do receive feels like a one-size-fits-all approach. Other problems include long waiting times for appointments. These problems can lead to significant delays in help being offered, which can affect the quality of care a patient receives. Access to psychological therapy is also problematic. The widespread use of 'digital technology', through devices that provide personal access to the internet, offers a solution to help tackle the overwhelming demand on services and opens up access to mental health support at a time when someone needs it most. The NHS supports a move towards using digital technology in healthcare. Emerging methods of helping people through the use of digital technology shows benefit, but challenges exist in bringing these approaches into clinical practice. Aim: To improve health outcomes in psychosis by delivering the right treatment, at the right time, in the right context. With the help of service users/stakeholders, we will co-produce a digital health intervention to improve the quality and efficiency of care in psychosis, delivered by a well-trained, digitally confident and capable workforce. Methods: This is a five-year programme of work with four inter-connected workstreams:i) reviewing the literature to understand the benefits of digital health interventions and identifying barriers to using digital interventions in mental health; ii) developing an understanding about how digital health interventions work and using this information to produce a set of practical guidelines for developers and services; iii) using statistics and computer science methods to develop a digital health intervention that is individually tailored, which we will then test to evaluate the extent to which patients engage with it. We will ask for feedback after people have used the digital intervention to find out how they felt about using it; iv) encouraging clinicians to use digital health interventions in their day-to-day clinical practice and helping them feel confident in doing so. Patient and public involvement: Ideas for this research programme were informed by patients and clinicians who have used some of the digital health interventions we have already developed. People said they would like to see a more intelligent and interactive system that is personalised to their needs. Throughout this programme, we will hold regular consultations with advisory groups to make sure that the work we produce is relevant and meaningful. Dissemination: We will build a world-leading group of researchers dedicated to increasing access to mental health support using digital technology. Findings from our work will be shared widely through public and academic reports, scientific conferences and the media. We will influence clinical practice by giving talks to staff and clinicians who work with SMI patients.

Research activity codes: 6.3 MEDICAL DEVICES
Health categories: MENTAL HEALTH