Technology helps young people take control of their mental health

Introduction

MindFresh is a website and an app conceived to give children and young people with mental health problems access to self-support resources, improved communication with mental health professionals and better control over their recovery journey. Designed and developed at North East London Foundation Trust (NELFT), it first went live in September 2017 and has been hailed a revolutionary development in child and adolescent mental health services (CAHMS).

NELFT offers integrated community and mental health services for people living in north-east London (Barking and Dagenham, Havering, Redbridge and Waltham Forest), as well as community health services for people living in south-west Essex (Basildon, Brentwood and Thurrock). It has a catchment area of 2.15 million people, an annual budget of £355 million and 6,000 staff working in 210 locations.

The Waltham Forest CAMHS provides mental health services to 1,500 children every year. However, in 2014, an estimated 5,510 children aged 5-16 years in Waltham Forest had a mental health disorder (Child and Maternal Health Data Atlas, 2012). By applying the average prevalence rate to the local population, it can be estimated that 3,300 children aged 2-5 years in the area have a mental health disorder.

Birth of an idea

We come from different professional backgrounds: Emma is a mental health nurse and Sam a qualified pharmacist. In 2014, Emma joined the Waltham Forest CAMHS team as a community mental health nurse and met Sam, who was working there as a service manager.

In 2016, Emma interviewed young people as part of a parent training postgraduate course offered by the Children and Young People’s Improving Access to Psychological Therapies programme. One finding that emerged from the interviews was that we were using a model of care adapted from an adult model that did not work for children and young people, because it did not take into account factors such as school hours, children’s communication styles and their patterns of mental health difficulties.

After Emma had submitted her essay, we were talking informally about how we could remove barriers preventing young people from accessing mental health support. We knew they did not like talking on the phone and found it difficult to identify online resources. We also knew mental health professionals felt there was too much admin and duplication of tasks.

What if a phone call unanswered for a whole day could be replaced by a smartphone message replied to in seconds? What if an online platform had a messenger function that automatically uploaded communication to a user’s care record? No existing instant messaging app seemed to match our ideal solution so we decided to create one ourselves. The idea behind MindFresh (originally called My Mind) was born.

Experience-based co-design

We took our idea to the NELFT ‘innovation cave’ – a start-up programme for staff – and obtained a £30,000 grant for the development of a working prototype. After a first trial, we received £50,000 from the trust’s emotional wellbeing and mental health service (EWMHS) for children in Essex, Kent and Medway to complete the development of the platform, and Emma was recruited by the EWMHS to roll out the project in all CAMHS across the trust.

A group of young people from the local communities – our ‘youth ambassadors’ – helped us transform the idea into a working solution. Some were service users put forward by mental health professionals, others had responded to a campaign in local schools, youth councils and on Instagram. Initially, 10 young people helped by contributing ideas and designing graphics. Later we had a rolling group of young people from across London and Essex joining our focus group and giving feedback.

“The presenters demonstrated a high level of motivation, exceptional leadership, an impressive collaborative approach and a clear focus” (Judges’ feedback)

The prototype was co-designed with our youth ambassadors and mental health professionals. Once everyone was happy with it, the trust’s IT team developed the first version of the platform in-house. This was followed by eight rounds of testing and refining. After each new version, we went back to our core group of young people and professionals to ensure we were responding to their needs and reflecting their vision – a vision that many of the teams involved came to share.

Two key functions

We knew from talking to young people who felt there was not enough communication with mental health professionals and that they did not know how to find the right online support. In response to these concerns, MindFresh has two key functions:

• A self-help resources section;
• An in-built messenger function.

The resources section lists trustworthy websites, apps or downloadable documents that young people (and their parents, carers or teachers) can access on a wide range of issues from anxiety to sex and relationships. It is searchable using filters such as categories or postcodes, and is available to anyone; they need not sign up or register, regardless of whether they are NELFT service users. The idea is to save young people from having to search online – not knowing where to start or what they can trust – and from having to remember or write down of a lot of web addresses.

The messenger function, for which only NELFT CAMHS users can register, allows them to contact their mental health professionals through instant messaging, either via text message, voice call or video call. All communication is automatically uploaded to the user’s electronic care record within 24 hours. This reduces health professionals’ admin time and ensures that young people’s actual words and voices go on record.

We believe it is the first time CAMHS users’ voices have been captured in this way. Users can create a profile, see their mental health professionals’ profiles, link profiles together, complete their outcome measures, and view their care or crisis plans.

My Mind becomes MindFresh

In September 2017, the My Mind platform was launched for a six-month live trial period. In May 2018, it was relaunched as MindFresh, with a new design, to reflect feedback received during the pilot. Young people felt the name My Mind was too similar to other mental health services. Several also felt it did not promote self-support enough – they wanted the platform’s message to be about self-help and self-recovery.

Youth ambassadors across our network submitted new name ideas and there was a public vote on Twitter; MindFresh won. Youth ambassadors then worked with our in-house communications team on a new design to go with the platform’s key message and new name.

With MindFresh, young people can find out what support exists in their area, be confident that the resources they consult will be helpful, and search for services based on their needs. Those who have gained access to CAMHS can also communicate in new ways with their mental health professionals. Initial feedback showed that users appreciate being able to access resources directly without having to come to CAMHS first.

Digital care pathways

2018 is proving to be another exciting year, in which we plan to expand the reach of MindFresh to cover physical health. The platform is the first step on the road to digital care pathways in all CAMHS run by NELFT, which is committed to providing digital support across its children’s services to build emotionally resilient communities. MindFresh is earmarked to become an integral part of the support offered to the 19,000 children living in the trust’s catchment area.

MindFresh has given our trust a unique opportunity to collaborate with other digital innovators and users. The trust is looking to develop protocols that will help services test digital solutions and provide user feedback to developers. It is also creating its own social media and YouTube channels, populated in collaboration with young people.

Business as usual

New technologies such as MindFresh help to match healthcare delivery with the lifestyles of young people. Ease of access is key: the simpler and less stigmatising the technology, the greater its appeal. Created with young people for young people, MindFresh can empower them to make positive decisions concerning their emotional wellbeing and mental health.

Before winning a Nursing Times Award in November 2017, the team behind MindFresh had won the Digital Innovation category at the 2017 NHS Digital Pioneer Awards; in December 2017, it was commended at the Health Business Awards 2017. The platform has been extremely well received by the profession, which gives us confidence that similar technologies could soon become ‘business as usual’ in CAMHS.

• Acknowledgements – The authors would like to thank our youth ambassadors; NELFT management, IT team and communications teams; Waltham Forest CAMHS team; Waltham Forest Partnership and the EWMHS for their support in developing MindFresh.