Heather Cook, the Interim UK Director of Big Health, and Dr Masood Nazir, a GP in Birmingham and the Director of Primary Care for the NHS Transformation Directorate, led a discussion focusing on digital treatment for mental health needs, at HTN’s latest Digital Primary Care conference.
Joining the duo on the panel, saw Dr Liz Mear and Dr Ian Wood, who spoke about the role digital therapeutics can play in transforming lives and alleviating some of the pressures the mental health system faces.
“Our products are accessible whenever and wherever they are needed”
Heather Cook began by recalling her own journey into healthcare, via a health-tech start-up named Brain in Hand. The company uses human support and digital tools to help people with neurodevelopmental disorders be more independent. “It is a very different subject area to Big Health,” she acknowledged. “But the challenges of integrating anything new into traditional care pathways are very similar.”
One of those challenges, inevitably, was securing budget. “I learned the hard way,” said Heather, “that having gold standard evidence, combined with a really well constructed economic case and a compelling scalable model, was the key to unlocking the potential of digital.”
Now Heather leads Big Health, a digital therapeutics company focusing on insomnia and mental health. “What we mean by digital therapeutics,” she explains, “is that we take evidence-based non-drug therapies including Cognitive Behavioural Therapy (CBT) and we fully automate them. We effectively turn behavioral interventions (like CBT) into products that can be digitised, and we do it without the need for clinicians or coaches.”
“We probably all know,” Heather continued, “that when we empower our patients to take more control themselves and self-manage, outcomes tend to improve. And that’s exactly what we do.” Big Health’s two products are Sleepio, for insomnia, and Daylight, for anxiety. “Because they’re digital, they can be rolled out at pace, our products are accessible whenever and wherever they are needed – and that helps to reduce health inequalities that’s so important in this post-pandemic world.”
“The front door for primary care has a really long queue outside it”
For Heather, digital therapeutics can have a big impact on primary care. General practice is under strain: in 2021 1.6 million people were on the waiting list to access mental health support, she said. Heather called the NHS’s recognition of CBT “fantastic”, but mourned resource constraints. “The front door for primary care has a really long queue outside it”, she said. “Unfortunately, what’s been experienced far too often is that the only access to treatment for most people is medication because of the lack of therapists or treatments.”
Digital therapeutics offer a solution: “guideline-recommended care” at scale. If mindfulness or meditation apps are like “digital vitamins”, which help manage stress and resilience but are not proven to treat clinical conditions like insomnia and anxiety, at the bottom tier of digital solutions, therapeutics offer a “digital medicine”, a treatment that is clinically proven to drive consistent clinical outcomes. To illustrate their effect, Heather shared a case study.
A pilot scheme in October 2020 saw Sleepio and Daylight offered across five Scottish health boards. The results, said Heather, were significant: “70% of patients using our products experienced a significant improvement in anxiety symptoms”, while patients also gained “an extra seven hours of good quality sleep per week”. Then, in October 2021 Scotland made the products available to every adult in the country – around five million people. “Within a week of adoption,” said Cook, “over a thousand patients had started treatment.”
Cook said it was important the system was accessible to all patients in need. “We think that’s really important in the adoption and usage design, so that patients can triage themselves to our therapeutics at a time and a place that’s convenient to them, rather than joining that ever-increasingly long queue outside the door of primary care.”
“My sleep was much improved”
Dr Liz Mear, a coach, advisor and Non-Executive Board Member of Health Education England, joined via a video. She has benefited from Sleepio herself. “While I was Chief Executive in the Academic Health Science Network,” she said, “we used to support a range of digital products that would enhance people’s lives. And Sleepio was one of them.”
Prompted by broken sleep that “made me a bit grouchy”, she tried the tools, and found they performed impressively compared to other digital products she’d seen. “It helped me so much,” she explained. “And it helped me very quickly. At the end of a six-week programme, my sleep was much improved.” Dr Mear highlighted specific learnings, such as the effect of alcohol at night, and the power that these messages gave her to develop her own healthy sleep patterns.
“That extra bit of wellbeing each day”
The ability for Big Health’s therapeutics to be used by staff as well as patients was also explored by Dr Masood Nazir, Director of the NHS Transformation Directorate. Dr Nazir has been a GP in the same Birmingham practice for 21 years, and spoke movingly about the “extreme amount of stress and anxiety” felt by colleagues across the NHS and the feeling among some that they should just “cope with it”.
Dr Nazir’s desire to help colleagues informed his move, 15 years ago, into digital transformation, and has shaped his practice management. After surveys revealed challenges in mental wellbeing at his practice of “almost 110” staff, measures such as team-building exercises and a reflection room were introduced, and further resources were signposted.
Dr Nazir wanted to do more, and introduced Sleepio and Daylight for staff. “If the staff had used the service and benefited from it,” he added, “they’d be in a better place to promote it to patients.” Big Health’s therapeutics were introduced to practice staff via clinical and managers’ meetings. “The best thing about this,” continued Dr Nazir, “is we don’t need to know who’s accessing this. It’s anonymous. We’re promoting it, and people can use it.”
Dr Nazir, like Dr Mear, has seen the benefits first-hand. “You can be gung-ho and get on with it, and think you’re invincible,” he said, “or you learn a bit more about yourself, and you learn better techniques that will give you that extra bit of wellbeing each day.” He also praised the instant impact of digital therapeutics compared to more traditional approaches. “I think the most frustrating thing as a clinician,” he said, “is when you identify somebody has an issue – and it can be mild. But then they have to wait weeks for something to be done about it.”
With products such as Sleepio or Daylight, you can do something immediately. “You’ve done something really positive for your patient,” he said. “You can bring them back in a week, encourage them, make sure they’re using it… and ask, ‘How are you feeling?’ And they’re at the start of the journey.”
“Sleep is just such a necessary process”
Dr Ian Wood, a GP in Windsor and the Clinical Lead with Big Health, is able to offer Sleepio and Daylight to patients. Speaking from his surgery, he said not being able to use them would be “unbearable”, and addressed the scale of the mental health issues in the UK.
He noted that mental health is a factor in 50–60% of his primary care appointments, and flagged World Health Organization research that suggests that by 2030 depression will be the leading cause of disease burden globally. “I think primary care has been really good at identifying and opening up discussions around poor mental health conditions like anxiety and depressive disorders,” he said. “But I think what came as a really big surprise to me when I started, and something that will probably surprise many people, is the prevalence of insomnia amongst the population.”
Ian noted that lack of sleep is often factored into assessments as a secondary causative factor. “But,” he explained, “when you flip this around to look at insomnia as a primary or at least contributory causative factor, you can quickly appreciate how important it is. Sleep is just such a necessary process, it’s vital for problem-solving and to rest from the day, but also for our emotional regulation.”
“I can’t imagine not being able to offer easily accessible treatment”
Dr Wood described Sleepio and Daylight’s impact as dramatic. “They’re appropriate, they’re desirable to patients, and most importantly they’re effective for the majority of our patients. For those for whom they’re not, they should dramatically drive down the waiting list on CBT or other therapy.”
He suggested the products fell between CBT, which could be “very effective” but had long waiting lists, and consumer apps. “There are thousands of digital mental health solutions out there and they offer quick access,” he said. “But look if they have the evidence that they are effective clinical treatments for mental health, and how can we ever think about offering them to our patients or commissioning a treatment that is not grounded in evidence?”
He was hopeful that Sleepio and Daylight could be used more widely across the UK, noting that they solve a “frontline pain point” and offer cost savings. “I can’t imagine not being able to offer easily accessible treatment for these common mental health conditions,” he concluded.
Watch the full presentation via the video the link below:
