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How Are Things? Mood & Symptom Checker

Information for health care professionals

Supporting people who are experiencing difficulties with their mental health early, effectively, and safely is vital. Whether it’s about taking steps to help themselves or accessing further professional support to feel well again, starting earlier helps prevent escalation of symptoms, reduces the overall ‘dose’ needed, and spreads precious therapist resources further.

The How Are Things? Mood & Symptom Checker is designed to catch people earlier and help them take action sooner, before they feel more unwell. It’s part of meeting Ieso Digital Health’s overall mission to tackle the global mental health challenge by starting sooner, treating smarter, and scaling everywhere.

The ‘How Are Things?’ Mood & Symptom Checker is a class 1 medical device

The How Are Things? Mood & Symptom Checker is an evidence-based online mood and symptom checker, comprising a questionnaire, a report, and suggested resources. It has been developed by Ieso Digital Health (IDH), one of the largest providers of online CBT to the NHS. IDH also has an advanced and prolific mental health research team. As a certified class 1 medical device, the mood and symptom checker can match and explain symptoms, flag severity, and recommend treatment, but it is not a diagnostic tool. People with concerns about how they are feeling receive a snapshot of their mental wellbeing, together with advice around how to help themselves and find further help, if it’s needed. It's an additional option for those who would like to receive support sooner or with greater privacy.

How is the How Are Things? Mood & Symptom Checker different from other mental health questionnaires and quizzes?

There are many online questionnaires which seek to provide insight into an individual’s mental health. Some are free, some are paid, and some are evidence-based but many are not. How Are Things? has been designed to combine a safe, evidence-based questionnaire with a rich, practical, empathetic report. Its hopeful, expert, and personal feel, using a conversation agent rather than a standard online questionnaire format, encourages individuals who might not feel they can speak to their GP to explore their difficulties. How Are Things? helps people tackle how they are feeling, supporting and motivating them to help themselves - and seek additional help - if needed. How Are Things? reaches people who might not easily find evidence-based, robust resources and bridges the gap to more formal help, where appropriate.

What questions does the How Are Things? Mood & Symptom checker ask?

Individuals complete our online depression and anxiety questionnaire, which comprises PHQ9, GAD7, and our own evidence-based free-form self-assessment questionnaire. Early feedback from therapy practitioners is that giving patients the opportunity to describe symptoms and experiences in their own words in these free-form text boxes adds enables them to get to the core of patients' issues quicker.

What do individuals receive when they purchase How Are Things?

Within two working days of completing their questionnaire, individuals receive a detailed report on their state of mind, including their PHQ9 and GAD7 score with appropriate contextual information and a personal action plan. This plan includes tailored self-care advice from our expert clinicians, and, if appropriate, signposts NHS/ IAPT support and selected other services. 

The report and action plan that follows the self-assessment depression and anxiety questionnaire provides targeted, evidence-based psycho-education relevant to the symptoms they reported in four sections.

  • Their scores (shared in context, with empathetic and tentative commentary).
  • A summary of their symptoms with some explanations for what they might be experiencing.
  • Activities that might help ease their symptoms.
  • Options for seeking further help (if appropriate, based on their scores and symptoms).

For some, this will be enough to help them back to better mental health. For others, it will help signpost them to the next stage of their journey, quickly.  

Who is How Are Things? suitable for (and not suitable for)? 

How Are Things? is for people aged 18 and over who feel low and / or anxious, who want help, but are not sure if a GP visit is the right next step. This includes people who have not yet started their IAPT care journey, as well as those at Step 1 and Step 2. It is particularly relevant for those at the Watchful Waiting stage of Step 1.  

It is not suitable for people aged under 18, people experiencing severe symptoms, or those who are already receiving secondary care or are in crisis.  These suitability criteria are made clear in the information provided to those considering using the service and all users must confirm they do not meet any of these criteria before they are sent the questionnaire.

What do healthcare professionals and patient advocates saying about the How Are Things? Mood & Symptom Checker?

We developed How Are Things? in consultation with therapists, IAPT services and GPs at every stage. We also shared the service with a range of mental health care professionals before release to gauge their honest opinions about its role and usefulness.

Here are some of the comments they made.

“How Are Things? is an accessible, low key service that does not pathologise feelings. It’s a very straight forward way to say to patients ‘here’s something trustworthy you can do right now with no fuss’.” Mental Health Patient Advocate

“How Are Things? gives people with low level mood and anxiety symptoms an element of control, in the same way as using the couch to 5k app does with people starting out on a physical health programme. They don’t just tick vague symptoms; they get to describe their personal experience in their own words. They don’t have to wait three weeks for an appointment and answers, they get answers and useful tips within two days.” Mental Health Patient Advocate

“How Are Things? could come in really handy for people who are not sure if they need help or people who have not been able to access their GP or psychological services for different reasons. People who don’t have a GP, including visitors from abroad, could benefit from it.” NHS Psychiatrist

“If someone brought this report to me at the start of their sessions it would be really helpful. Especially the bits where they have filled in details in their own words. I love the qualitative element of the information it captures about patients. Hearing about how they feel in their own words, rather than in words that have been translated by practitioners, is so helpful.” NHS Psychotherapist

“How Are Things? gives patients quick validation of how they are feeling.” NHS Therapist

“How Are Things? has a real potential to help those suffering with anxiety and low-level depression feel like they are taking back control. There is a real need for this at the moment.” Mental Health Nurse & Patient Advocate

“How Are Things? gives patients a sense of freedom and the ability to feel anonymous enough to talk about how they are really feeling without the fear of stigma. It reduces stigma and people may engage better with services and support as a result of using it.” Mental Health Nurse & Patient Advocate 

“How Are Things? has the potential to become a strategic planning solution to the massive problems of reducing waiting lists. Used with patients at the beginning of the wait will divert, prevent escalation and improve long term outcomes.” NHS Clinical Manager

“How Are Things? is accessible and gives people a sense of taking control back during a time when they are really frustrated by NHS waiting times.” NHS Clinical Manager

“How Are Things? gives patients a feeling of being back in control. The psychoeducation it provides is really helpful and will help them stay in control. It will help cut waiting lists, ensure those who make it into the system are treatment ready and improve outcomes.” NHS Clinical Manager

“We have problems in my service relating to screening referrals and contacting people in a timely manner. How Are Things? could be really useful.” IAPT Service Development Lead

“I think this looks like a really useful service for people who may be interested in seeking support but unsure where to go, how to do it, or whether they ‘need to’.” IAPT Service Development Lead

“For somebody who does not need an intervention, How Are Things? provides clarity, information, helpful tools and strategies. These may be enough for them to feel better and regain control. They may even be enough to prevent escalation and future interventions.” IAPT Service Development Lead

How are we keeping users of ‘How Are Things?’ safe? 

Our top priority in creating How Are Things? is to provide appropriate advice and to protect vulnerable individuals. There are a number of safeguards we have put in place, including the following.

How Are Things?:

  • Is designed in line with NICE guidelines, plus all report content is evidence-based and checked by clinicians
  • Signposts anyone reporting high level symptoms to 111 and Samaritan helplines, or to 999 in an emergency, before they purchase the service
  • Provides a sensitive crisis message with the option to stop the test and receive a refund if an individual answers any questions about suicidal thoughts positively. If they continue, our algorithms flag up the case as high risk
  • Is not described as a mental health assessment or diagnosis, but instead a mood and symptom checker
  • Provides a sample report prior to purchase to enable individuals to judge if this will be a helpful service for them
  • Signposts the NHS option of assessment via IAPT and GP services prior to purchase
  • Offers a full quibble-free, post-purchase refund if individuals feel the report was unhelpful or not valuable.

How can ‘How Are Things?’ be accessed? 

How Are Things? can currently be accessed and purchased via the Boots website, in the “Healthhub” section, as well as directly from the How Are Things? website. The cost is £10 - similar to the price of a prescription.  Improving access, particularly in hard-to-reach patients, is very much on the NHS agenda and we are already discussing how the clinical capability and technology behind How Are Things? can support NHS IAPT services. If this is of interest, please get in touch. 

How does How Are Things? fit with the Ieso Digital Health referral pathway?

If an individual purchases How Are Things? and then goes on to seek treatment with Ieso Digital Health, they will receive a full refund. However, How Are Things? is not designed as a direct referral source for Ieso and is available whether Ieso has a contract in that area or not. Ieso’s therapy services are only ever signposted appropriately based on symptoms and alongside other options, which might also include self-referral via IAPT and a visit to their GP.

How is ‘How Are Things?’ designed to support the NHS?

How Are Things? is an early intervention online service that is designed to support and dovetail with IAPT services by improving patient motivation, managing patient expectations, lowering therapy doses, and improving access and engagement of harder to reach patients.

Designed for people who are struggling with their mental health and at the start of their journey to getting help, How Are Things? is particularly suitable for people who may not want to visit their GP or who would like to get assessed faster and are happy to pay the price of a prescription to do so. How Are Things? tentatively reassures patients who are experiencing mild symptoms which might respond well to Step 1, giving them clear advice for how to help themselves. It prompts those at Step 2 or Step 3 to seek further help.

As an early intervention service, How Are Things? provides an early warning system, aiming to reduce therapy treatment doses. Similarly, self-knowledge and mental health literacy patients gain from their reports may speed up conversations with GPs and IAPT services and provide sufficient motivation to successfully complete therapy. The report can also help GPs quickly gauge severity, shape the in-appointment conversation, and inform their recommendations. In addition, there is some evidence suggesting that patients who pay to access treatment are more engaged and have better outcomes (Herrell, 1993).

Features we are adding to How Are Things? in 2021

Continually improving the How Are Things? experience to ensure it remains as effective, useful, and safe as possible is at the top of our agenda.

These improves are already scheduled to include:

  • The ability to repeat the PHQ9 and GAD7 questionnaires multiple times and to receive an updated report with a visual summary of changes in scores over time
  • Further post-report care emails at intervals, to remind, encourage and reinforce some of the supportive, hopeful messages in the report
  • The ability to ensure that same questionnaires do not need to be repeated unnecessarily if the user goes on to refer for NHS or Ieso treatment.

How to get involved

Creating self-service digital tools to help more people identify and address mental health difficulties sooner, throws up a number of valuable discussions, including: the pathologisation of the normal ups and downs of life; meeting demand and expectations; and the interplay between care available privately and via the NHS.

It’s clear that we need to use digital technology to help address mental health. We must do this carefully, safely, with consideration for the whole system – and with great courage and tenacity.

You can join us to discuss these issues in more detail in our Autumn 2021 series of webinars on the role of digital tools in mental healthcare in the UK. To receive an invitation to these webinars, please contact us.

References

Herrell, James M. The therapeutic value of fees: What do practitioners believe? Journal of Mental Health Administration ; Thousand Oaks Vol. 20, Iss. 3, (1993): 270

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