Interview Series: Barnaby Perks, Oxford VR  

In our latest interview series we asked Barnaby Perks from Oxford VR a few questions.

Can you tell me about yourself and your organisation?

The business started as a spinout from the Department of Psychiatry at the University of Oxford in 2016. Daniel Freeman, who is Professor of Clinical Psychology and NIHR Research Professor at the University of Oxford had been researching VR and mental health treatments for the best part of two decades. Oxford VR is commercialising that pioneering work that Daniel had been doing at Oxford and before that, at King’s College in London.

I got involved at that point as Co-founder & CEO. My background was in mental healthcare, I was CEO of ‘Ieso Digital Health’ where we delivered remote internet-based therapy to patients and built a business where we were treating 15,000 NHS patients per year, with patients receiving treatment from their homes and therapists delivering treatment from their homes as well. I am an engineer originally and have worked in technology and healthcare for most of my working life and the last 10 years I have been working in mental health.

How has your organisation responded to the Covid-19 pandemic?

Since the onset of COVID-19, we have tried to understand how the new world after lockdown will be different from the one that we left behind, and what the implications will be for clinical service delivery and therefore our products.

Care has moved quickly from the clinic into the home and we think it will stay that way after the crisis subsides.  We started running several product sprints to accelerate development of VR therapy solutions suitable for home use.  Our clinical, technical, and product teams are working with our international clinical partners to develop and evaluate home-based interventions for worry, stress, and low mood.  This is an exciting opportunity to develop effective and accessible treatments for the challenges many of us will face as we come out of lockdown.

There are technical challenges around VR for home use because the headsets we were using were tethered to high powered gaming PCs, so the graphics processing capacity that we had was extensive and so we shifted to standalone devices that were not tethered to a PC, which means your graphics processing power is limited; this, of course, leads to some tech trade-offs when your building the products, so you probably have slightly less animation and slightly fewer characters but once you know its strengths, you can build treatments using exactly the same technology that was used for tethered treatments with standalone headsets, and that’s where our focus is at the moment.

The main message for me is that the world that we are going to be entering into when we come out of COVID is going to be very different from the world that we left behind.

Could you tell me about one of your customer projects that you’ve been engaged with over the past 12 months?

We’ve been working extensively with a company in Hong Kong over the last 9 or 10 months, building up towards a randomised control trial with the Chinese University of Hong Kong with the Hong Kong population, and this has involved not only modifying our products to be more suitable for a Hong Kong environment but also it involved translating the product into Cantonese as well to be used by the local population.

So that has been quite an interesting project for us and that RCT is still due to start, it has been delayed of course initially by the political demonstrations in Hong Kong and then of course by COVID, but that is still due to start this summer and alongside that, we will be piloting a number of our new products as we develop them with some of the employee benefits served by that.

That has been a really interesting learning curve for us. Alongside that, we have been working extensively with the NHS where we’ve had a number of our products in clinics through the NHS IAPTs (Improving Access to Psychological Therapies) programme, we are working with a number of services in England to gain experience of patient use, patient feedback from that use, but also having clinicians using VR and incorporating it into their treatment programmes.

What’s next for you?

We are working on several small components that can be used in a range of different conditions. Our first programme was a programme based on the fear of heights.

We have since shifted to a process focus where we built a programme initially for patients with psychosis; we weren’t treating psychosis; we were treating the common symptom of psychosis which is anxious social avoidance – avoiding social situations.

We then built on from that and have made that anxious social avoidance programme more appropriate for more generic populations. Anxious social withdrawal is one of the most debilitating aspects of mental illness and is a major unmet need in mental healthcare. It is common in multiple mental health conditions such as agoraphobia, panic disorder, social anxiety, depression, personality disorders, substance abuse disorders, and schizophrenia.

Following on that process, we have identified a number of different processes and treatment targets that apply across multiple diagnoses, so we are now building more components to deal with things like worry and attention that can be deployed across a range of patients with different disorders co-morbid of each other.

Part of the shift about this is not just creating smaller components that can be used across multiple disorders across a variety of different ways, but also, we can make things that are suitable for home delivery as well; touching on my point earlier, where treatment is moving from the office into the home.

Do you think there’s a link between digital technology and the rise in social anxiety/depression disorders?

I am sure that for many people if the technology is used in the wrong way then it can clearly have an impact on a person’s mental health. We hear about isolation in technology, access to unfiltered news, can lead to a huge amount of anxiety. Some of our colleagues in the mental health delivery space have reported huge increases in anxiety about viruses and infections during the COVID-19 crisis.

So yes, I think technology can be unhelpful and it is incumbent on all of us to help people to use technology in a better way. In terms of using technology to deliver treatments, I think there’s an opportunity here not just to enable people to use or benefit from the immersive nature of technology such as VR, but also to use those tools to understand better how to make beneficial use of technology in their lives, rather than let it become a worry.

What are you most proud of over the last 12 months?

I think we are probably proudest of the outstanding team that we have put together to solve this very challenging problem. I believe that if you’re going to make a significant difference in a market such as mental health, everyone in the team has to really believe in our ability to meet this challenge, their role in helping us to meet the challenge but also understanding the challenge as well.

So, when I look at the team which is incredibly diverse, from clinicians to commercial people on one end, to engineers, animators and artists on the other end, we’ve actually got an incredibly diverse and talented group of people who all try as hard as they possible can to understand each other’s challenges and each other’s part within the programmes that we’re putting together. That collective understanding of the importance of mental health and working as a team is the key to making really rapid progress.

What’s the best piece of career advice that you’ve ever received?

It was very clear actually, it was about making decisions; I had a boss some years ago who said the most important thing is to make decisions, you’ll find that in many cases you don’t have all the information you think you require so just make decisions based on the best of your ability. A lot of the time you’d be right and a lot of the time you’d be wrong but the most important thing is to break down the paralysis, make the decision and move ahead.

What’s your go to entertainment at the moment?

I have an 11-year-old son, and a 12-year-old daughter and so during lockdown, one of the benefits has been that we get together and watch a movie together. Both of them are really taken by the Marvel series of movies, so we’ve just completed the entire Marvel series; in fact, we’ve just completed it last night so that’s been our go to entertainment for the last couple of weeks. The other one is being able to play cricket with my son in the garden.