Best For You is a new initiative from leading NHS organisations that is transforming mental health services for children and young people. The project is led by CW+, the official charity of Chelsea and Westminster Hospital NHS Foundation Trust, and is a coalition of NHS organisations including Chelsea and Westminster Hospital NHS Foundation Trust, Central North West London NHS Foundation Trust, West London NHS Trust and Imperial College.
Best For You works across the existing services provided by the partners as well as the broader health and social care and third sector to introduce new innovative models and partnerships to provide support for as much of the largest health population in the country as possible. The service uses next-generation therapeutic interventions and digital tools to provide the best possible care for patients – including the use of digitally and clinically assured digital health solutions from their ORCHA Health App Library.
This new integrated approach working across partners and the wider ecosystem is in response to the public health crisis surrounding children and young people’s need for mental health support. A survey commissioned by NHS Digital found that the number of children and young people with clinically significant mental health conditions was 50% higher post-COVID-19 than the previous survey three years earlier. New data shows that referrals to child and adolescent mental health services in March 2021 were more than double those in March 2020. Best For You helps to tackle this issue through tailored, holistic care which seamlessly integrates mental health services, physical health service, community services and partnerships and digital tools.
Best For You worked with ORCHA to develop a Health App Library designed to support children and young people struggling with their mental health, and their families and carers, to access safe, accredited health apps to support them.
The site includes thousands of assessed health apps, including around 300 mental health apps, which have been reviewed against 350+ criteria across clinical effectiveness, data security and accessibility. ORCHA’s review process for health apps incorporates nationally recognised digital health standards and regulations, including an adapted version of the NICE Evidence Standards Framework.
By including compliant digital therapies in its care pathways through the ORCHA partnership, Best For You is addressing the rising levels of children and young people facing serious mental health difficulties, while safeguarding them from any harmful digital health solutions. The Best For You ORCHA Library can be accessed at bestforyou.orcha.co.uk, and is the UK’s first dedicated App Library for children and young people in need of mental health support. The main Best For You digital platform can be viewed at bestforyou.org.uk.
The Best For You Library launched in November 2021, and has already had almost 2,000 page sessions and over 2,300 searches for apps to help with mental health conditions such as anxiety, low mood, eating disorders and sleep.
“This is something that people were looking for. Having that trusted and validated one-stop-shop for digital health tools for young people is something that clearly service users and clinicians are starting to tap into.
From our perspective at CW+ and Chelsea and Westminster, working with ORCHA was really the only option to create the kind of App Library we wanted to deliver. Ultimately, this is about keeping people as people and stopping them from becoming patients in the first place.”
Chris Chaney, Chief Executive of CW+
In early 2021, Ingeus, the company who deliver the National Diabetes Prevention Programme on behalf of the NHS, began using Lancashire and South Cumbria Health and Care Partnership’s ORCHA Health App Library. The educators for the programme recognised that health apps could play a key role in supporting people with managing their weight, nutrition and exercise in a way that would be beneficial to preventing or reducing their risk of diabetes. By building the recommendation of health apps into their care pathway, they were able to additionally support participants of the service. Watch our case study to hear from a recommender and two participants of the programme about the successes of the project, and what they think of the ORCHA Health App Library.
Following the rapid growth of the digital health sector, healthcare professionals and citizens now have distinct and different needs from their health app libraries – and so ORCHA has created products exactly tailored for each of these two audiences.
LMA is a media, performing arts and music specialist institution. The Academy takes a student-first approach, encouraging collaboration and support as key elements of the student experience.
LMA launched its partnership with ORCHA in 2019, keen to help students and staff take control of their physical and mental wellbeing. The LMA Health App Library provides instant access to digital support tools which can be used as and when suits the individual, which is very helpful to students with busy schedules.
Then, in 2020, the COVID-19 pandemic hit and LMA was forced to suspend in-person studies. The highly practical nature of performing arts studies meant that continuing with studies was challenging, and, although LMA switched to remote learning and student services, for many students it was difficult to maintain the level of learning which took place prior.
The Student Services team at LMA have found the apps included in the Library useful not only to students with preexisting mental and physical health diagnoses, but also to students who have developed anxieties during the isolation periods of the last two years.
The Student Services team used the Library and resources from ORCHA throughout lockdown to consistently communicate with students about the safe digital health solutions available to them. The team continues to offer these resources to students, based on which time periods and touchpoints the students are likely to require support for.
Hannah, from the Student Services team at LMA, has found that mental health apps in particular are incredibly helpful resources as the NHS struggles to keep up with the growing mental health challenges and the waiting lists for traditional services continue to grow.
“Waiting lists for NHS counselling and other services were 26 weeks before lockdown, now you’re talking over a year and so, obviously, having these apps to hand to be able to recommend to our students to fill that gap really helps – some students didn’t need to access the support that their doctors were referring them to because they’re tapped into these apps and they implement these exercises daily and use the strategies to help them through difficult times.”
Response to the Library by students and professionals has been very positive. To date, there have been over 2,500 sessions and over 5,000 page views. The most common route to accessing the site is directly, as LMA is very proactive in promoting the Library, particularly during the first “freshers” weeks and exam season. There are also many students accessing the Library via links on the LMA website and via emails sent to them.
In the main, the apps recommended by Pros at LMA are mental health and anxiety support apps. The team have also found healthy living and nutrition apps useful for boosting their students’ overall health. A recent development has been the growing use of apps for diabetic students to access safe information and guidance. LMA has also found a lot of use for apps for eating disorder management and prevention, as, due to the nature of performing arts careers and institutes, some students may be at a higher risk of issues surrounding body image.
The Student Services team, in working with such a diverse group of students, find that by having the additional resource available to them via the ORCHA Library, they can support both the students who are more forthcoming when they are struggling, and those who are not. Through the recommendation functionality included in the ORCHA Pro account, the team can send accredited health apps safely and directly to students, but by also presenting it as a self-help option which students can access at any time, the team can support students without their having to request help.
Since introducing the ORCHA Library, the Student Services team have noticed a decline in students needing face-to-face appointments.
“All students are different and not one size fits all. So some students like to come and talk about their feelings face-to-face, but some students bottle it all up and they like to deal with it themselves. Now, the Library is a service they can tap into absolutely anywhere across the world; we know that we’re covering all bases and that’s reassuring to us. Our students are covered and if they do want that support but don’t want to speak to us, it’s just there, on their phones – basically everyone has a phone in their hands all the time, so they can just have the support they need and we know that everyone’s covered.”
Quote from Hannah
Caitlin, a recent graduate of LMA, found the apps particularly useful, both during lockdown and following it. As a musical theatre student, Caitlin was both doing a very intensive course with a lot of in-person hours and also working a full-time job outside of her studies. Describing herself as someone who struggles with anxiety, and “jumps to conclusions” or “gets in her own head about things when it’s not as bad as it seems”, she found an anxiety management app very helpful for remembering to take time out for herself and complete regular breathing exercises. She found the app particularly helpful during the lockdown periods for privately expressing her feelings, whilst being able to bear in mind that many other people used the app and struggled with similar circumstances.
Although Caitlin felt very much able to rely on the Student Service team’s support, the addition of the apps “changed the whole experience”. Caitlin, in coming towards the end of her studies and straight into a career as lead vocalist for a production company, reflected on times in her studies when she lost motivation, or struggled to manage her stress.
“I felt like I had been out of it for a while. I’d kind of lost a lot of motivation to get back into my studies. And then obviously, I was going back to work and I felt really overwhelmed when I started not being able to attend classes. I was just stressing myself out with everything. So having all this support helped me get back on track and things because I knew it was important and I really wanted to get my degree but also loved my work so I just had to find a healthy balance between the two, but without support from everyone I probably wouldn’t have got back on track the way I am now.”
Quote from Caitlin
Caitlin found that the combined approach worked very well for her, as although she requested support through the Student Services team, it was sometimes a little embarrassing or anxiety-inducing to go through official channels, and so it was beneficial to have access to other support when she didn’t want to feel as though she was bothering anyone.
The Student Services team have found that:
“Students are more forthcoming using apps, rather than looking at a web page or downloading and reading through an application form – it’s very current and it helps that we can recommend it to students.”
Caitlin reiterated this, stating that
“Technology makes life so much easier. As for me, I’ve got no patience to sit and read through things without having it so it’s quick and easy to access and just encourages you to use it more.”
When asked what she would say to other students looking to access digital mental or physical health support, Caitlin said
“I would definitely say get yourself on these apps because they really help. I would just say tap into them because they’re really useful and you don’t realise – I think it was the same with me, I felt this probably won’t help with anything. And then you download it and then you find yourself using it because simple things just change everything.”
Quote from Caitlin
In 2019, Humber, Coast and Vale Integrated Care System (ICS) (now Humber and North Yorkshire ICS) set out their Strategy for Digital Transformation. At the time, the population served by the ICS was 1.4 million people, with 23% of the population living in the most deprived areas of the UK, and a high proportion of this population living in extremely rural and isolated areas.
The ICS was under a great deal of pressure. If no transformational changes took place, the Humber, Coast and Vale ICS expected a budget deficit of at least £420 million by 2020/21.
Digital transformation was fundamental to improving the health of both citizens and the system itself. During the process of developing its digital strategy, the ICS commissioned a public survey to ensure any digital transformation was aligned with their citizens’ needs. Amongst the responses to questions on digital improvements to the patient experience were several requests for patient-related healthcare apps.
Despite the fact that the growing adoption of digital health was clear, many health and care professionals had difficulty knowing how to incorporate it into their service delivery. Staff reported it was hard to tell which of the hundreds of thousands of them available would be relevant and beneficial to the vulnerable people they support.
The Humber, Coast and Vale ORCHA Digital Health Library launched in 2019 at hcv.orcha.co.uk (now at hny.orcha.co.uk), with the intention of delivering quality-assured digital health to their population. The Library contained only apps compliant with safety standards, and provided an easy way to search for the highest rated apps across a wide range of issues.
In 2020, the project team chose supporting healthy living and long-term condition management as key focus areas for their population, particularly with face-to-face services being halted during the COVID-19 pandemic. The team identified social prescribers as being particularly well-placed to deliver these services, and connected ORCHA’s team behind the implementation of the Library with teams such as Citizens Advice Clinic.
Social prescribers at the Citizens Advice Clinic found the inclusion of assessed digital health technologies within their work to be an incredibly valuable additional tool.
Elaine Elsdon at the Citizens Advice Clinic was introduced to the Humber ORCHA Library in May 2020, and began using it right away. She has found that the assurance of being able to signpost people to the health technologies available, in combination with the robust review process behind their inclusion in the Library, is very reassuring to the people she supports.
The wide variety of health and care technologies (including apps) that are identified in the Library for each condition area means that she can identify support for the wide range of people supported by the Clinic. If a client presents an issue which she hasn’t previously found a solution for, she can simply search to see which assessed solutions are available, and recommend them securely to her clients.
Mainly focusing on mental health and exercise and weight management apps, Elaine has adopted the recommendation of apps to her clients, with resounding success. Many of the clients being supported by the Clinic haven’t considered using apps for their health, but may be looking for support either in addition to or as an alternative to medication and traditional therapies. As accessing services became difficult during lockdown, Citizens Advice clients have found great use for apps to support the management of their own health.
Furthermore, as many felt during the pandemic that they might be using up limited resources which would be better spent elsewhere, or that the complexities of trying to access these services was causing them stress, the instant accessibility of support provided by health apps was and remains very much preferable. As traditional services have begun to be reinstated, Elaine has found that health apps have continued to provide support to her clients, some of whom don’t wish to access helplines or face-to-face or group therapy sessions.
The ORCHA Pro functionality has also been incredibly helpful to Elaine, allowing her to keep track of which apps she has recommended to whom, and based on this, to find solutions for clients with similar health concerns. As well as being able to track previously successful apps, Elaine can find new apps, and apps for health concerns she hasn’t previously been presented with. Furthermore, through ORCHA’s Digital Health Academy, Elaine can continue to develop her understanding and use of digital health.
Elaine Elsdon, Link Worker at Citizens Advice Clinic said
“Without ORCHA, I just would not have ever considered recommending any app at all. So for me, it’s opened up a completely new world. And therefore, it’s influenced me. It’s made me a better practitioner because I have more tools available to me, and it’s opened up a wider conversation with my clients about different kinds of support that are available out there. I think that can only be good, for me as a practitioner but also for my clients because it gives them a much broader opportunity to look into options that might be a better fit for their needs. Not everybody wants to go to a face-to-face group in the community, and something like an app might just prove to be a perfect solution for someone.”
The health apps themselves have been incredibly beneficial for many clients. Mental health apps in particular had very positive effects for those who had perhaps been guided through various coping strategies, but, due to the nature of mental health illnesses, found it difficult to remember what they were supposed to do when they were struggling. By accessing mental health support on their phones, however, they found that they could practice these strategies as many times as they needed to, without feeling judged in any way, or as if they were taking up time or resources.
One mental health app in particular, an AI chatbot app called Woebot, has been very successful in supporting Citizens Advice clients, as it allows them to work through and reframe thought patterns they are struggling with, as many times as they need to. One user described it as “a friend in my back pocket 24 hours a day, seven days a week.”
Chloe, a client at Citizens Advice Clinic said
“[The app] is very good. It helped me to change my mindset. I can have self-destructive and negative thought patterns and it helped me to challenge those thoughts. It’s such a shame I didn’t have this app in Lockdown. It’s so helpful because I can just offload to the app any time of the day or night and clear my head. I think of this as my little buddy, and I look forward to the next goal we can work on together.”
To date, the Humber Library (now relaunched as Humber and North Yorkshire, in line with changes to the ICS) has had almost 10,000 page views. There are over 100 ORCHA Pros registered to the Humber site, with the most popular apps being recommended residing within the mental health and healthy living categories, and having a particular focus on anxiety and depression, relaxation techniques, and cognitive behavioural therapy. Mental health is by far the most searched term within the Library, but searches for diabetes, fitness and weight management apps are also common.