From helping humans live longer and hacking our performance, to repairing the body and understanding the brain, WIRED Health will hear from the innovators transforming this critical sector. Read all of our WIRED Health coverage here.
Mental health apps have had a tough time of late. Studies from the American Psychiatric Association's Smartphone App Evaluation Task Force and the University of Liverpool have found that, despite a surfeit of mental healthcare apps available online, many lack an "underlying evidence base, a lack of scientific credibility and limited clinical effectiveness".
Not so for Big White Wall. The company, founded by entrepreneur Jen Hyatt in 2007, is a mental healthcare tool that uses data and rigorous clinical governance to provide a service that is both free and effective. The service was recently highlighted as one of the few NHS mandated apps proven to be clinically effective. "I've always been fascinated by the patterns and insights that data can bring to us," Hyatt tells WIRED. "This might mean looking beyond the obvious, like who someone is and how they're using a service, to when people experiencing depression mostly call on a service, or how natural language use correlates with scores for standard assessments for anxiety." "This can aid with personalisation, ensuring that people can access content and services that are most relevant to their needs. It can also help with risk stratification, through identifying those with higher acuity of need," Hyatt explains. "And if we're able to have our own data visually represented to us – our own patterns and behaviours – we can choose to take that first step towards changing what is causing us pain, harm or poor health."
Big White Wall is an online community for people experiencing mental health problems. Users can talk to other members experiencing similar crises, express their feelings via images or join online programs that use recognised therapies to provide guided support. Members can also take part in self-assessment, set goals and track their own progress. The app is available, for free, through the NHS, employers and universities.
Hyatt, who will be speaking at WIRED Health 2016, says that her life experiences have shaped her as a social entrepreneur. From an early age, Hyatt says, she was drawn to finding solutions "to large scale social challenges".
An early education in economic and social history at the University of Liverpool allowed her to study alongside "local people who had been impacted by major shifts in the economics of their city". She later undertook a masters in social research methods at Surrey University. After graduating, she founded a number of social projects across the world, including suicide prevention work in Sri Lanka, creating masters programmes in social development in post-communist Europe and founding a grant-making foundation in the Balkans.
It was Hyatt's own experiences with mental illness that drove her to found Big White Wall. One in four people may experience mental illness, she says, but her approach is broader.
"It's a feature of all of our lives as much as, and clearly connected to, our physical health," she says. "At the more extreme end, my father was a lifelong depressive and an alcoholic. Various family members and friends have experience of schizophrenia, debilitating stress, social anxiety, bereavement and autism to name just a few mental health issues."
The trigger for Big White Wall came when a friend messaged Hyatt to tell her she had "made an arse of herself through drinking too much", and that she wished she could talk about her experiences in a safe, anonymous place. Her words resonated with Hyatt, who was "in a fairly fragile state at the time too", and she realised that technology could do something "extremely exciting".
In creating the tool, Hyatt says she combined the principles of anonymised social support with open expression and 24/7 clinical availability. This placed everyone using the service "in a place of control", something Hyatt believes is absent during the usual mental health journey. "The leitmotif of my work is helping create the conditions in which people can determine their own futures, freely and appropriately supported," she says. "One particular thread of that has been providing the right kind of support in the moment that someone reaches for it - emotional support that is available on demand. This is one of the factors that led to Big White Wall."
Unlike other mental health apps, which are often clinically ineffective, Big White Wall relies on data. Hyatt feels passionately about data-driven work - her "first and last proper job" was at the National Centre for Social Research, where she was a founding member of their Qualitative Research Unit. She founded Big White Wall alongside the Tavistock and Portman Trust, a leading mental health provider.
"In its early days, we recognised the importance of clinical rigour and an evidence-base in the digital space," she explains. "We learned how to operate standards that were equivalent to those in primary or secondary care."
Later, Big White Wall employed its own clinicians, and now has a full roster of clinically trained staff who help with risk identification, management and user engagement. Their role is to "ensure the community is safe", says Hyatt, as well as using rigorous clinical protocols for escalation.
Hyatt feels that companies developing health apps - especially those for mental health - have a "responsibility" to their users, and that many companies pay "insufficient attention" to clinical governance. "There are so many obstacles facing digital companies, including interoperability, establishing an evidence base, resistance from clinicians, insufficient attention paid to clinical governance and a poorly informed marketplace, from commissioning and investment perspectives," she says. "It's imperative that companies take these issues seriously." "So many mental health apps are not taking evidence and clinical governance seriously," she says. "For me, that is negligent, and a disservice to those of us who work diligently to ensure that digital tools can be truly transformative in healthcare."
Hyatt believes that the best way to combat a lack of clinical efficacy is "through rigour of intent and practice", saying that companies should "build digital tools and services that are co-created, both literally and through data".
Hyatt says she's become "less focused on mental health per se", and is now focusing her research on "the systemic thinking that connects mental and physical health, as well as the social, educational and ethical". "It is the relationship between these that makes us human," she says. "In particular, genomics and neuroscience are the new frontiers of discovery, and I'm an avid student of their exploration. Connected to this is my interest in using data in much deeper ways and harnessing artificial intelligence to shape a healthier future."
She's is now developing a new product, amo, which aims to "help a generation of teenagers develop the best mindset" for healthy lives. She's also hopeful that "through collaborative effort" the digital mental healthcare industry can become affordable, evidence-based and clinically robust. "Time to leave realism on one side, perhaps," she says. "This era needs a disruptive and compelling vision for our collective future."
Jen Hyatt will be speaking at WIRED Health 2016 on April 29 in London. From helping humans live longer and hacking our performance, to repairing the body and understanding the brain, WIRED Health will hear from the innovators transforming this critical sector.
Now in its third year, tickets are still available for this incredibly popular one-day event. Discounts are available for NHS and government employees and for people working for health sector startups.
This article was originally published by WIRED UK
