Creating apps to combat mental health

11^th June 2014

Dr Andres Fonseca, Co-founder & CEO of Virtually Free, sets out a plan which uses apps to solve mental health issues

Mental health problems affect 1 in 4 of us during our lifetimes. The World Health Organisation estimates that around the world approximately five hundred million people are diagnosed with depression, anxiety and related disorders every year. Only 1 in 3 people seek help and their options are limited.

In countries with a national health service there is psychological treatment available, but it usually involves facing gatekeepers and waiting lists. Access is further limited as the mental health condition can affect motivation and their ability to advocate for their treatment.

In places where such a health system does not exist the barriers are greater, the main one being cost. A typical treatment programme usually requires 10-15 one hour sessions using models like cognitive behavioural therapy. Insurers tend to only cover a limited number of sessions and paying out-of-pocket may be beyond people’s means.

Online therapy, telephonic therapy and other options using telecommunications have existed for a time. This may be more convenient for the person but it does not solve the problem of limited therapists, and it does not reduce cost significantly.

Last month the American Journal of Psychiatry published an article reflecting on the huge need that exists to provide therapy at scale in both richer and poorer countries. The authors propose strategies to solve the problem, such as increasing the number of therapists by delegating to less qualified staff. The article also explores book-based and computerised forms of self-help which have shown to be very effective. The most common problem with these is lack of engagement, with only 10 per cent completing. However, the advantages are clear: this method is the most scalable and cost-effective way of providing therapy.

Dr Russell Green and I, both consultant psychiatrist, founded Virtually Free in 2012. We both had experience of the challenges in organising psychological therapy for our patients and we decided there should be a better way. There is an activity which people do for long periods of time without anyone telling them to; playing games. This is not niche any more, you only have to look at the success of Candy Crush to know this is a mainstream phenomenon. We looked at the literature on serious games as applied to education and we thought the same principles could translate to therapy. We decided that the best way forward was to harness the power of games to get people to finish computerised cognitive behavioural therapy programmes.

To achieve this we recruited Richard Flower who has 20 years of experience developing commercial games. He was part of the Core Design team that developed the original Tomb Raider series and he has also worked for EA and other major developers. To date we have created two apps: Stress Free that teaches relaxation techniques using 3D animated and voice acted sessions, and Phobia Free that uses exposure therapy in the form of games to treat arachnophobia.

We started with specific phobias as many concepts we will use to treat it apply to other more serious conditions and they have low clinical risk. We use augmented reality—a technique that allows mixing real and virtual images so that the person experiences the virtual images as being part of the environment they are in—in exposure therapy. We created a true-to-life augmented reality tarantula that the person can hold in their hand as viewed through the device. Both of our apps have been approved by NHS England.

We have nearly completed what we consider to be our first ‘clinical’ app to treat agoraphobia. We have developed it in partnership with people suffering from the condition and using what we have learned from Phobia Free. We have ethical approval to start a randomised controlled trial looking at how effective it is.

In the future we plan to develop apps for all common mental health problems treatable with therapy. Our goal is to empower all those that suffer from mental health problems to free themselves from the burden of these conditions. All at their convenience, in their own time, without appointments or asking for time off. Also, our apps are discrete; nobody needs to know whether you are reading a book, watching a film of having your treatment.

We are excited about the possibilities that future technologies bring. In particular affordable virtual and augmented reality platforms will allow us to simulate a whole range of scenarios for exposure but also to convey in a visual way more abstract therapy concepts. There are new algorithms that are able to recognise facial expressions and the emotional content of language, which will enable us to create experiences that directly respond to the emotions the user is feeling in the moment.

We exist to solve a global problem. Our aim is to make therapy more accessible, affordable and appealing to all that need it around the world.