JMIR Publications

ABSTRACT

Background:

Suicide is a growing, global public health problem which has resulted in an increase in the demand for psychological services to address mental health issues. It is expected that 1 in 6 people on a waiting list for mental health services will attempt suicide. Therefore, there is a need for new methods to track suicide risk in real time and gain a greater understanding of the ways in which people communicate or express their suicidality. Mobile applications are therefore seen as a cost-effective solution to bridge the gap within mental health services and improve patient outcomes. However, the evidence base for the clinical effectiveness of mobile apps in adult mental health is only slowly emerging. There is a clear need for more research to be conducted on the use, reliability and efficacy of apps in the field of mental health.

Objective:

To report the practicalities and implications of setting up and trialling digital technologies within an inpatient mental health setting in the UK.

Methods:

Service users were recruited from 6 inpatient wards within the North West of England. Service users who were eligible to take part and gave consent were given an iPhone and Fitbit for 7 days and were asked to interact with a novel phone application - Strength Within Me (SWiM app). Interaction with the app involved journaling (recording daily activities, how this made them feel and rating their mood) and the option to create safety plans for emotions with which service users have difficulty with. This involved identifying strategies that help with these emotions. Participants also had the option to allow the study to access their personal Facebook account to monitor their social media usage and activity. In addition to this, clinical data (i.e. assessments conducted by trained researchers looking at suicidality, depression and sleep) were also collected.

Results:

80 eligible participants were recruited to the study (43% response rate). Out of the total sample, 67 participants engaged in journaling with the average number of entries per user being 9.74. Overall only 24 participants created safety plans, with the most common ‘difficult emotion’ to be selected was feeling sad (n=21). Within the safety plans several helpful strategies were recorded including, talking to someone, participating in exercise, listening to music and engaging in a hobby. The study reports on the engagement with the SWiM app, technical difficulties with which the research team were faced, the importance of building key relationships, gatekeeping issues and the implications of using Facebook as a source to detect suicidality.

Conclusions:

This paper has raised important issues and lessons learnt from implementing a study involving a novel digital intervention for service users in an in-patient setting. Clinical Trial: N/A