Over the past two-years the ARC East of England Mental Health Over the Life Course theme has received two awards from the University of Cambridge, COVID-19 response and ESRC Social Science Impact Acceleration award schemes, to further develop their digital mental health platform- How are you?
The ARC East of England (EoE) has been investing in developing new methods of measuring mental health based on computerised adaptive testing (CAT) to provide rapid, precise, real-time assessment of mental distress and wellbeing - ‘digital thermometers for the mind’. Led by Dr Jan Stochl and Professor Peter Jones, the work has been making considerable progress with the prospect, thanks to support from Cambridge Enterprise and Eastern Academic Health Science Network, of sustaining a community interest company or other spin-out business.
The Mental health over the life course theme has been working with schools over the past two years to develop Artemis, a CAT platform co-produced with students, parents and teachers. A Medical Research Council (MRC) confidence in concept award supported early development, and recent funding from the NIHR i4i scheme supports Drs Jo Anderson and Anne-Marie Burn working with Professor Tamsin Ford, Jan and Peter is calibrating Artemis against conventional diagnostic approaches. Recent Government policy to embed mental health support workers in schools means that an accessible and acceptable measurement tool is eagerly awaited.
Working with Dr Adam Coutts who recently joined the Applied Research Collaboration as lead for mental health and care research capacity building, the team received two awards from the University of Cambridge, COVID-19 response and Economic and Social Research Council, Impact Acceleration award schemes, to further develop their digital mental health platform – How are you? and bring in Dr Ursula Balderson as research support.
Policy engagement and impact
Over the past year the team have been consulting a range of policy and civil society stakeholders to tailor and calibrate the platform to work across a range of health and non-health settings and workplaces; from frontline public services such as primary healthcare, A&E departments, schools, universities, Job Centres, employment providers, food banks, housing associations, third-sector mental health care and support groups to private sector corporate organisations and workplaces. These frontline public services and non-health care organisations are vital settings by which to identify, signpost and refer vulnerable people to appropriate support services before their mental health deteriorates further.
The research has several significant policy impacts. Embedding mental health surveillance in such contexts has recently been highlighted by the Department for Health and Social Care, mental health and wellbeing plan as key in helping to tackle the rising rates of mental health issues among the adult population. In addition the use of digital mental health technologies supports the development of a more human centered design to public service delivery, aligns with the National digital and data roadmap for 2022-2025 as well as the Mental Health recovery plan by providing a digital tool that enables early intervention which can help reduce pressures on NHS services.
Key policy stakeholders have provided in kind support and guidance on the policy usage of our work to the NHS and frontline public services including the Office for Health Improvement and Disparities (OHID), the Public Health Directorate Cambridgeshire County Council, the Eastern Academic Health Science Network (EAHSN)
What is Artemis and How are you?
In our ‘digital mental health thermometers’ ARTEMIS and How are you?* responses to only 3-7 questions are required taking 1 minute to complete. This reduces the administrative sludge that managers and staff are confronted by in NHS and non-health care settings when trying to identify, sift and signpost people who are struggling with their mental health. This is crucial in the hurly burly of an everyday frontline public service such as a job centre, school, A&E department, or fast-moving corporate workplace. In such settings there is little time or staff resource to have meaningful conversations about how someone is doing with their mental health let alone administer lengthy and intrusive clinical questionnaires.
Since 2017, our translational research combining clinical psychiatry, epidemiology, psychometrics and public policy, has been developing online platforms to characterise wellbeing and quickly identify individuals experiencing mental distress. We consolidate questions from existing, validated questionnaires already completed by thousands of people into extensive question banks. Next, when a new person is to be assessed, we use innovative, computerised adaptive testing (CAT) technology to administer small, bespoke sets of informative questions, avoiding redundancy but maintaining precision. Thus, our novel CAT platforms drastically improve measurement efficacy and reduce to under a minute the time necessary for valid and precise assessment of an individual’s mental wellbeing or distress.
Why assess mental health and wellbeing in frontline public services and workplaces?
- The social and financial costs of mental ill health are felt by individuals, communities, public services and our economies.
- Mental ill health is the single largest cause of disability in the UK, contributing up to 22.8% of the total burden, compared to 15.9% for cancer and 16.2% for cardiovascular disease1. The wider economic costs of mental illness in England have been estimated at £105.2 billion each year.
- Over 50% of workplace absence is due to stress-related conditions.
- Average cost of mental health absence per employee ranges from £1,475 to £2,277. This is similar across the public and private sectors.
- 12.8 million working days were lost due to work-related stress, depression or anxiety.
- Average return of £5 for every £1 spent on mental health intervention.
- In a recent Office of National Statistics report 21 per cent of people surveyed between January and March 2021 reported having moderate to severe symptoms of depression.
- The total annual cost of mental ill-health in the workplace to government has been estimated at between £24 billion and £27 billion. The overall annual loss to the economy has been estimated at between £70 billion and £100 billion.
How are you? Helps identify, prevent and support the recovery of millions of people who face mental health challenges as a result of the social and economic fallout of the Covid19 pandemic. As our field testing with policy partners has shown 'the main effects of the pandemic in terms of unemployment and mental health have not yet been felt'. Therefore, our platforms arrive at a time to provide much needed capacity to already over stretched frontline welfare services as well as help employers and employees deal with mental health in the workplace.
Enhancing organizational and staff capacity
Our digital platform increase the capacity of workplaces and frontline public services in the process of collecting data and assessing mental health and wellbeing; saving financial resources and staff time needed to implement and manage sensitive surveys at pace and scale. Above all, data flows and feedback are systematic and instant, helping individuals monitor their own mental health and support managers or administrators in signposting those struggling with their mental health. Rather than relying on ‘gut instinct’, those working on the frontline can make more accurate and rapid data informed decisions.
The platform can be deployed as standalone application via a web browser or can be embedded within any IT ecosystem. It allows the user to discreetly complete the questions in a service setting or in their own time on a phone or computer. This could be on their way to and from work, at home or during work hours.
Another unique aspect of our platforms is the inclusion of dashboard software for simple distribution, monitoring of data collection and bespoke reports which can aggregate data and map changes over time. This software allows organizations to manage mental health assessment at scale and pace.
How is our approach better than existing questionnaires, scales and measures?
The benefits of our platforms versus traditional mental health screening and assessment methods
Many mental health questionnaires take far too much time to complete than is available in frontline public services or a high stress workplace environment. Shorter assessments usually measure something specific (like depression, anxiety or subjective wellbeing) or are designed as screening instruments for the likely presence of a particular disorder. Our digital mental health thermometers combine the essence of existing questionnaires into a single construct ranging from mental wellbeing to distress measured precisely throughout its scale. Our technology uses responses to a small selection of questions, typically fewer than seven, assessed in the knowledge of responses from thousands of previous respondents.
The current climate of overwhelmed frontline public services, time demands on staff, increasing vulnerability of adults and children and the costs of administering lengthy questionnaires, present significant operational and resource challenges for collecting useful mental health and wellbeing data. We believe CAT is the future of measurement of mental health; we have summarised the advantages of this technology in The Lancet Psychiatry. In coming months, we will continue working with our partners in policy, civil society and business to help prevent an increase mental health issues in the UK.
For further information about this research project, please contact Dr Adam Coutts (apc31@cam.ac.uk).
*note: the Artemis and How are you? platforms are currently being assessed for their status as medical devices.