In the depths of Tech City, East London, amidst the constant social media chatter and start-up dreams sits a small and unassuming socially oriented digital company. Buddy - the offspring of Sidekick Studios, a social innovation company, and it’s collaboration with NHS Trusts – is now very much part of the new generation, a potential disrupter built on simplicity and need.
What is it?
Buddy is a diary, a tracker and a reminder. At the centre of Buddy is an online platform that can be accessed from any connected device. For each client regular text messages are sent out asking “Hi… how was your day today?” with a rating from 1-5, well below average to well above, and followed by “What did you do today?”. The client texts back their response which is then integrated into the platform. This allows a picture of their progress to be built up over time, accessible by themselves and the clinician. Appointment reminders are sent out before each session, also by text. Further options include client session plans, goals and customised text messages from clinician to client.
The interface and usability is excellent. It is easy to understand and accessible for all levels of tech experience. For clinicians there may be some difficulties at first for those who have never used the internet and those with shaky confidence may want to get used to the platform before trying out any of the extras. For clients the only experience they need is with a mobile phone. I would love to give Buddy 5/5 for usability but unfortunately the platform itself is not web responsive. This means that for anyone who only has internet access through a smartphone the platform features are inaccessible. Apart from that it ticks all the boxes – engaging, user-friendly interface, clear and concise and very natural, simple processes.
Security and Safety 4/5
Having been co-created in its earliest conception by a tech company and an NHS organisation, with input from Deloitte, there is little doubt that the security is excellent. The look is non-clinical which makes it inconspicuous for users. Clients can delete the text messages and are encouraged to put passcodes on their mobile phones so the chance of human error is slim, however it is still possible. Because of the reliance on not only the clinician ensuring the client is aware of the risks but also that the client is capable of taking on that responsibility, I’m afraid Buddy had to miss out on a point.
It is important to realise that this is a tool to be used by clinicians to improve their service rather than seen as an intervention in and of itself. Whilst clinical outcomes like reduction in symptoms remain firmly the outcomes of the therapy itself Buddy can offer a way to engage and empower clients, allow self-reflection and provide some real-time data. The difficulties of funding research for a small digital company, its social outcome aims and the wealth of evidence outlined below prevent me from knocking a point off for lack of RCTs.
Buddy is the kind of app that anyone can use. The reasoning behind it is excellent and its usability means it is effortless. For anyone interested in improving their practice this is an innovative and effective tool that can adapt to the needs of clinicians and clients alike. If you’re interested in implementing Buddy within your organisation they also provide training direct to staff in an interactive and effective way.
Established in 2012 Buddy was developed in response to a recognised need to connect with people in psychological therapies, particularly those engaging with IAPT through primary care which was without a digital pathway at the time. An iterative process using the expert knowledge of service users, designers and NHS workers it began as a transistor radio but the usage challenges led to development of a technology that could take advantage of something far more ubiquitous – the text message. According to the Office of National Statistics there are more mobile phones than there are people in the UK. Mobile phones are no longer considered highly specialised, they can be bought and run cheaply and best of all they sit in our pockets and are checked up to 150 times a day. Text messages have long been recognised as a viable form of delivering behaviour change interventions (Stephens & Allen, 2013), reminders to encourage adherence (Branson, Clemmey & Mukherjee, 2013), for support (Agyapong et al, 2012) tracking symptoms (Price et al, 2014) and even a potential way for the NHS to reduce DNA (do not attend) rates and waiting times.
Buddy sits comfortably amongst this evidence in its design (Treanor et al, 2011) and development (Treanor et al, 2010) with future publications and research in the pipeline. It has a proven track record in the eight NHS trusts that currently use it and Buddy’s regular Newsletter often has case studies from clinicians recognising “as a CBT clinician [it has] added value” and seeing clients “make better use of our sessions”. From relationships to PTSD its value is in its role as a form of gathering information, a product that can adapt to the needs of the clinician as well as the client.
I spoke with Syed Abrar, Director of Buddy, and James Ryan, Research and Development Lead, about the rewards and challenges associated with providing an e-mental health application direct to NHS Trusts.
Q1. When you were developing it initially what were the most important aspects you decided to integrate into Buddy?
S.A. When Buddy was first developed it took the form of a transistor radio where you could input your moods and upload them to to your clinician in real-time. We realised there were challenges with the actual usage and we needed to develop something where there was no need to adapt to new technology. The obvious answer was mobile phones, building from SMS studies in the US for smoking cessation – it’s known, people have it in their pockets, they already send messages. It was important to involve people at all levels, from service users to clinicians, and co-creation, co-production, led to the development of an application that could help engage people in therapy, help empower them. Rather than just focusing on the mental health aspect we also realised that it needed a whole person approach – the physical can be just as important.
Q2. What do you think are the benefits of Buddy?
S.A. For the organisation there’s the ability to offer a digital pathway to services, which chime well with the population who live in a digital world but engagement with services are analogue. It delivers a valuable insight into a patient’s life in between sessions and creates or saves time in sessions for valuable discussions. Greater engaged patients are leading to higher percentage of patients completing their therapy. For the clinician and clients… People find it hard to remember what they’ve been doing. Because the platform is a web app and they can post to it using text messages that data can be uploaded straight away. Short-term it can provide information to discuss in the session, somewhere to begin, and over time it gives information that you can look back at, reflect on.
J.R. For the patient the value comes from empowerment and engaging in therapy, also being able to help support their clinician to support them. The clinician gets value from the data of what is happening around the sessions. What we also found was that it can be quite emotional to go into therapy and you only have a certain amount of time, but sometimes that emotion can override your memory so you end up with a bias that exists. So for the clinician its gives them a true context rather than a snapshot, that bias in depression can especially slow recovery rate. (after I asked whether anyone ever writes something they don’t want to talk about) We had a quote from a clinician whose client found Buddy paramount to their recovery because there was indirect disclosure and he really saw the value of that. For the NHS Trusts as a whole the return on investment and service value.
Q3. What have been the challenges you’ve faced and how have you overcome them?
S.A. Within NHS Trusts there is the issue of money and time, although now we have the evidence to show it saves time. Outside of the NHS the discussions are different because return on investment is most important. There’s also the problem of pilot fatigue which has led to a culture of apathy towards new innovations within the NHS. For the clinicians utilisation is the biggest challenge. We went from 17%, not unusual, to 40% once we started implementing a ‘hearts and minds’ strategy, we have champions in the organisations who are enthusiastic about Buddy and help get others on board. In the future we’re planning on our utilisation going to about 60-70%.
J.R. Within the Trusts we work with there is varying levels of engagement; be that in management, uptake or compliance. Our most successful implementations come from top down understanding and grassroots buy-in because then you have input of cost/return as well as care, which leads to organic usage. When Buddy was built it was optimised for IAPT where there is a high turnover and designed for wellbeing within a CBT model. But since then we have spread across other services and now we work with clinicians that are outside of that model so we’ve had to adapt. The training can also be a challenge. I have delivered intimate training to four people, which was very effective, whilst presenting to thirty-five was a challenge to offer in-depth value and understanding to all! Having more time to engage with the clinicians is very beneficial as well, letting them use a demo account and ask questions means they leave positive and engaged and they’ve thought about how to use it.
Q4. What has been most rewarding in your experiences with Buddy?
S.A. Being able to reduce stigma and increase engagement, reading the case studies from people. But most of all the social impact – three thousand people have benefited so far, each of them has an impact on four people at least so the indirect benefits for individuals as well as society as whole are huge. Social impact, after all, is the basis of Buddy and by 2018 we intend to have impacted #1MillionLives.
J.R. For me the most rewarding are the case studies and speaking to champion users. I recently did a talk and met many of them face to face. It was inspiring and motivating to meet the people who are advocates of innovation, especially in an environment where they are around people who are challenging it and they are able to counter with their own experiences.
Q5. What do you hope to achieve in the future?
S.A. Impacting more people in a positive and meaningful way and delivering a greater patient centred approach to existing pathways. It would be great that when accessing services, the default position is you receive access to Buddy. And continue doing what we do and doing it well!
J.R. I guess moulding the product we have now to work for the clinicians. It flourishes within the IAPT model which is a testament to the designers. But now there is a movement to start utilising it in different services in the NHS so we need to adapt it to integrated care models where there are secondary clinicians who need to interact with the platform as well, like early intervention where a whole team is assigned to a patient. We are also looking to collaborate in terms of research, to collect clinical data that can highlight the effective outcomes such as reduced DNAs and cancellations, so we are in discussion with a number of academic institutions.
If you are interested in Buddy please visit their website www.buddyapp.co.uk or you can contact Syed Abrar via email firstname.lastname@example.org or telephone 020 7490 4573
Agyapong, V. I., Ahern, S., McLoughlin, D. M., & Farren, C. K. (2012). Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. Journal of Affective Disorders, 141(2), 168-176.
Branson, C. E., Clemmey, P., & Mukherjee, P. (2013). Text message reminders to improve outpatient therapy attendance among adolescents: A pilot study. Psychological Services, 10(3), 298.
Price, M., Ruggiero, K. J., Ferguson, P. L., Patel, S. K., Treiber, F., Couillard, D., & Fahkry, S. M. (2014). A feasibility pilot study on the use of text messages to track PTSD symptoms after a traumatic injury. General Hospital Psychiatry, 36(3), 249-254.
Stephens, J., & Allen, J. (2013). Mobile phone interventions to increase physical activity and reduce weight: a systematic review. Journal of Cardiovascular Nursing, 28(4), 320-329.
Treanor, A., Harris, K., Abrar, A., & Carson, J. (2011). Buddy: a digital mental wellbeing service. British Journal of Wellbeing, 2(7), 11.
Treanor, A., Abrar, A., Harris, K., Morris, E., & Carson, J. (2010). Using digital technologies in community mental health. Social Work and Social Sciences Review, 14(3), 95-107.