A key challenge for mental healthcare providers is to provide clinically effective yet cost-efficient services. Computer-based cognitive behavioural interventions have been shown to be an efficient and innovative solution, especially for the high prevalence mental health presentations such as anxiety and depression.
Online interventions are highly accessible providing flexible, 24/7 access at a time and place that suits the individual. The relative anonymity of the online environment can also produce a sense of disinhibition, which removes the obstacle of accessing services due to the stigma around mental health issues.
Cost is also dramatically reduced as online interventions allow clinicians to engage with approximately 6 times more patients than in a face-to-face environment.
However, with a growing market of possible choices how can commissioners make informed decisions regarding the adoption of the most appropriate online solution that meets the parameters of clinical effectiveness and cost-efficiency?
Here are our key points to consider
Evidence based content: a first point to note is to ensure that the content delivered is evidence-based. The NICE guidelines (2009) recommend computerised cognitive-behavioural therapy (CCBT) as an evidence-based approach that is suitable for the treatment of mild to moderate anxiety and depression.
Supportive model: traditionally dropout rates for online programmes have been high, one of the main reasons identified is a lack of personal support. Online solutions differ greatly on the extent to which personal support is provided. Richards and Richardson’s (2012) found that any kind of personal contact by a supporter significantly improved retention rates. It is therefore important to ensure that an online CCBT programme offers supporter monitoring and feedback.
Engaging and tailored to the individual: client engagement is critical to maximise retention and completion. There are several important ingredients that can promote engagement with online programmes:
Non-linear delivery
Usage statistics from recent online solutions, with flexible content delivery and user navigation, indicate that a substantial proportion of users take an exploratory approach to content that may increase their engagement (Sharry et al., 2014).
Interactive multi-media content
Different individuals have different learning styles and personal preferences, also depending on their clinical presentation concentration may be an issue. It is therefore particularly important that online therapeutic programmes include a variety of media formats such as journals, videos, quizzes, interactive activities, reflective exercises etc.
Social and community features
Community features have been shown to be instrumental in promoting engagement, adherence, and completion. Features can include the user’s ability to share comments and rate programme content whilst still remaining anonymous.
Reporting capability: this is crucial in assessing the performance of services. One way that performance can be monitored is by using clinical outcome measures such as the Patient Health Questionnaire (PHQ-9) for depression and the Generalised Anxiety Disorder – 7 (GAD-7) for anxiety. An online platform should support the use and monitoring of such measures.
Optimising Service provision: finally, it is important to consider how an online solution can fit within the overall service provision. The solution should easily integrate into existing care pathways.
You may also be interested in our new white paper, Key dos and don’ts in commissioning an online Behavioural Health and Mental Wellness Solution, Dr Derek Richards, M.Sc., Ph.D., Director of Clinical Research & Innovation, SilverCloud Health; Noemi Viganò Counselling Psychologist, Reg Psychol PsSI Alliance Counselling: Professional Psychological and Counselling Services Stokes Court. Please email {encode=enquires@silvercloudhealth.com} to register your interest.
References
- Andrews, G., Cuijpers, P., Craske, M., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PLoS ONE, 5.
- Richards, D., & Richardson, T. (2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32(4), 329-342. doi: 10.1016/j.cpr.2012.02.00.
