A digital tool that prompts users to share their daily thoughts is helping to strengthen links between therapists and clients.
Sarah's depression had been going for several months before she started therapy with a clinical psychologist at the local community mental health trust. She found the sessions useful, but explaining how she felt in the periods between appointments was difficult and was taking up valuable time during the meetings. Then her therapist introduced her to a new digital tool, Buddy, to help with her treatment.
Using simple text messaging, the tool allows service users to keep a daily diary of what they are doing and how they are feeling, and helps to identify and reinforce positive behaviours to aid their recovery. Their texts are then used to compile an online diary that records patients' daily moods and activities over a week or month.
"Buddy helped me communicate better with my therapist, and it helped me to spot patterns and see what I was doing or not doing," says Sarah, 36. "Buddy really felt like a friend checking up on me at the end of the day. Sometimes it was the only contact I would have throughout the day. It's something that helped point me in the direction of change, and which I then felt better able to act on."
The digital tool linking therapists and people with mental health problems has been piloted in four London boroughs since early last year. In Lambeth, Southwark, Lewisham and Croydon Buddy was made available to a range of different users, including people with depression and anxiety disorders and military veterans with mental health difficulties. It is now being rolled out in mental health services in north-east Essex, Pennine and the Five Boroughs' Partnership, in north-west England.
The tool was developed through a collaboration between South London and Maudsley NHS trust - the biggest provider of mental health services in the UK - and design and innovation company Sidekick Studios.
Eric Morris, a consultant clinical psychologist at South London and Maudsley NHS trust, started using Buddy to support service users being treated through early intervention in psychosis. "We had used written mood diaries in the past, but for many service users with literacy problems or limited education, this could prove difficult to maintain," says Morris.
"With the Buddy approach, they have much more ownership of their treatment and it's very immediate." He explains that the client receives two texts or SMS messages - "How are you feeling?" and "What have you been doing?" - at 5pm every day. These act as prompts for a reply in which clients describe their mood and give some details about their day. All the information is then sent automatically to the patient's personal online account and the day before their appointment they are prompted to review their week online. "This helps them to focus on how they've been feeling and to set the agenda for the next meeting," says Morris.
"It also helps to avoid generalised questions about their mood, because as the therapist I can look at their texted replies before the meeting, which gives an insight into their week.
"The idea of Buddy is to put the person's goals at the centre of their treatment. I've noticed that the ones who are using it have become more focused in what they want to get out of our meetings. Early intervention service users usually have problems with depression and anxiety and Buddy gives them support during the week when they're not seeing a therapist."
Adil Abrar, lead developer of Buddy at Sidekick Studios, says he approached South London and Maudsley NHS trust in 2010 with the idea and the software was then developed with a panel of six service users. "The tool is a web app rather than a mobile phone app, as they can see their 'diary' online. One of the main advantages is that, as it encourages more participation in their treatment, they are more likely to attend their appointments, which saves the NHS money. 'Did not attends', or DNAs, can be as high as 50% in community mental health services," says Abrar. "In the three-month trial in Lambeth the DNA rates fell markedly."
A six-month evaluation of the tool by researchers at South London and Maudsley trust last year found a 40% increase in satisfaction with therapy. Around 30% of respondents reported improvements in wellbeing, and there was a compliance rate of 76% in responding to text messages. The number of DNAs also fell by 7%.
Most mental health trusts are paid £2,000-£3,000 per patient by commissioners, according to Abrar, and the South London trust licenses the software from the developers at a rate of £20-£40 per client, depending on how many they use it with, so it is a cost-effective outlay.
Will, 25, has bipolar disorder and has been using Buddy since December. "It's made it easier to see the triggers for my low moods ? it helps to see the pattern through the week. In the case of bipolar disorder, it could also be useful to the therapist for picking up warning signs if someone becomes manic over a week or two weeks, as it can happen fairly quickly."
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