Daniel Freeman, NIHR Research Professor and Professor of Clinical Psychology, University of Oxford and Oxford Health NHS Foundation Trust
How can we improve outcomes for people with severe mental health difficulties? The issue is an urgent one: all too often, individuals with psychosis find day-to-day life so anxiety-provoking that they simply withdraw. Everyday tasks — getting on a bus, doing the shopping, speaking to other people — become very challenging. Work and home life suffer. And mental and physical health deteriorate.
A stark statistic: people with psychosis (and the NHS cares for over 200,000 such individuals each year) have a life expectancy 14.5 years shorter on average than the rest of the population, with inactivity a major contributory factor.
Yet a ruinous spiral of isolation is most certainly not inevitable. Psychological therapy can be very beneficial here. But it needs to be the right kind of therapy. What works best is active coaching in the situations that trouble people, helping patients move beyond their fears. However, this is difficult without a skilled therapist who has the time to get out and about with patients. And patients often find the idea frightening. The result is that a potentially powerful treatment is seldom actually delivered.
A technological solution
This is why we’re so delighted to be the first winners of the NIHR i4i Mental Health Challenge Award. We believe it will enable us to help transform the lives of many NHS patients with severe mental health problems, dramatically increasing access to the most effective types of psychological intervention. How will we do this? By using state-of-the-art immersive virtual reality technology.
In our VR we take people into sophisticated simulations of the real-life scenarios they find troubling. We do it in a graded way, so patients aren’t presented with situations they really can’t cope with at first. And we make it fun. Patients find it easier to do this work in the virtual world – and they enjoy using our VR applications. As one of our pilot study patients commented: “It’s an incredible experience.” But the beauty is that the benefits transfer to the real world.
One of the most innovative features of our VR is our virtual therapist. A friendly computer-generated avatar, voiced by a real person, carefully guides the patient through the therapeutic work, helping them practise techniques to overcome their difficulties. In effect, the treatment is automated, making it a low-cost yet effective complement to existing care.
Video credit: Oxford VR
Accessibility is key
At present VR isn’t routinely used in NHS mental health services. But the i4i Challenge Award will change that, allowing us to demonstrate the positive difference VR therapy can make — both for people with psychosis and, in the future, for patients with other psychological disorders.
Our project comprises three main stages. First is the design and development of the VR treatment, building on the work we’ve done over many years. Our aim is a treatment that’s easy to use, engaging, and right for patient needs. Here the involvement of the McPin Foundation, who will ensure that the patient voice is heard at all stages of the project, will be invaluable. Stage two is a large multi-centre clinical trial in NHS trusts across the country to demonstrate the benefits of the VR treatment. The third part of the project will see us develop a roadmap to roll out the treatment across the NHS.
The Award has allowed us to assemble an amazing — and unusually diverse — team, bringing together patients, psychologists, psychiatrists, nurses, designers, computer scientists, healthcare experts, statisticians, health economists. As well as the McPin Foundation, we have the Royal College of Art, who will contribute innovative, socially inclusive design; NIHR MindTech, who are specialists in the development and adoption of new digital technologies in mental health; the University of Oxford spinout company Oxford VR/Nowican, who will build the treatment and help plan for the long-term adoption of the technology; and several NHS mental health trusts, who will trial the treatment and its implementation.
A large team, to be sure, and one drawn from a variety of disciplines and organisations. But our goal is clear: to combine the very best psychological science with cutting-edge technology. By doing so, we believe we can help many more individuals with mental health problems to lead the lives they wish to lead. With the i4i Challenge Award, that aspiration has taken a huge step toward realisation.
Daniel Freeman, NIHR Research Professor and Professor of Clinical Psychology, University of Oxford and Oxford Health NHS Foundation Trust, and winner of the 2017 i4i Mental Health Challenge Award.
*Do you have an innovation that could address unmet clinical need in mental health through medical technology? More information on how to apply to the 2018 Challenge Award is available on the NIHR website.
The project applicant team are Prof Daniel Freeman, Dr Felicity Waite, Prof David Clark, Dr Aitor Rovira, Prof Ly-Mee Yu, Dr Jose Leal, Prof John Geddes (University of Oxford and Oxford Health NHS Foundation Trust), Dr Thomas Kabir and Dr Dan Robotham (McPin Foundation), Prof Chris Hollis, Dr Jennifer Martin, Dr Mike Craven, and Dr Sue Brown (NIHR MindTech and Nottinghamshire Healthcare NHS Foundation Trust), Prof Mel Slater (University of Barcelona), Jonathan West and Ed Matthews (Royal College of Art), Dr Robert Dudley (Newcastle University and Northumberland, Tyne and Wear NHS Foundation Trust), Prof Tony Morrison (University of Manchester and Greater Manchester Mental Health NHS Foundation Trust), Dr Kate Chapman (Avon and Wiltshire Mental Health Partnership NHS Trust), and Jason Freeman (Oxford VR/Nowican).