Impact case study database

Professor Stallard’s research has improved the mental health treatment for high risk young people who self-harm. The BlueIce research programme has produced a much needed novel, digital, self-help intervention for young people with mental health problems who engage in repeated and serious self-harm. BlueIce is being widely used (intervention adoption) and has demonstrated measurable reductions in self-harm (improved mental health) and estimated cost savings to the NHS (financial savings). Impacts available from 2017 are summarised below.

(a) Intervention adoption: BlueIce has attracted much local and national publicity including news stories on the ITV, Guardian and BBC (A, B, C). It is the only self-harm prevention app for children and young people recommended in the NHS Health Education England 2018 self-harm and suicide competence framework of good clinical practice (D). It is one of only 20 mental health apps/digital services to meet the rigorous standards for national endorsement on the NHS app library (E). BlueIce won the Innovation in Digital Health Award at the 2019 National Positive Practice in Mental Health Awards (F) and was highlighted as outstanding practice by the Care Quality Commission in a recent inspection (G). BlueIce is now available to child and adolescent mental health services (CAMHS) across the UK and has been prescribed by CAMHS across Bath and North East Somerset, Buckinghamshire, Cambridgeshire, East London, Wigan, Bolton, Salford, Manchester, Trafford, Bury, Heywood, Oldham, Tameside, Stockport, Oxfordshire, Swindon, Peterborough and Wiltshire to 2,520 young people with serious, repeated self-harm. Our aim is to make BlueIce available to all CAMHS in the UK and to extend access to young adults who self-harm.

A collaboration with colleagues at the Murdoch Children's Research Institute, Melbourne, Australia (H) has resulted in BlueIce being made available via the Australian App Store (I) where it has now been downloaded on 2,760 occasions.

(b) Improved adolescent mental health: Our initial work showed that after using BlueIce for 12 weeks, 73% of young people reported that their self-harm had reduced by an average of 10 episodes per person (R1). There were significant post-use reductions on standardised measures of depression (Mood and Feelings Questionnaire: mean difference =4.91: t31=2.11; p=.04; 95% CI 0.17-9.64) and anxiety (Revised Child Anxiety and Depression Scale: mean difference=13.53: t30=3.76; p=.001; 95% CI 6.17-20.90) (R1). The independent feasibility study in Australia found that young people felt more able to manage suicidal thoughts and feelings after using BlueIce for 6 weeks (H). Young people involved in our current randomised controlled trial in the UK rate BlueIce highly (G5). Average ratings were 9.6/10 for ease of use, 7.1/10 for helpfulness, 8.0/10 would recommend BlueIce to a friend with an overall app rating of 4.1/5 stars.

For some young people BlueIce has resulted in life-changing improvements:

“If CAMHS had given me that app around 3 or 4 years ago I wouldn’t be cutting now” (J).

“I used to harm myself pretty much every day I think there were only a couple of days when I wouldn’t. Since having the app I’m like clean, I haven’t done anything” (J).

Parents also observed improvements:

“… it may not change the situation she’s struggling with, but it changes her and it’s a positive change, I don’t mean she’s bouncing round happy but more stable I guess is what I’m trying to say and it’s, it’s amazing” (J).

Finally, CAMHS professionals’ noted benefits:

“A ll ‘my girls’ (patients) are finding the app very helpful! From my point of view, the self-harming incidents are much less frequent for those using the app” (J).

(c) Financial savings. Study participants: Over the course of our study BlueIce prevented 295 episodes of self-harm in 28 young people (average of 10.5 episodes per person) (J). Because most adolescent self-harm does not result in Emergency Department treatment we modelled potential cost savings based on different assumptions (described in our Health Foundation Report p15-17 (J)). We estimated the cost of an Emergency Department attendance following self-harm at GBP362 and conservatively assumed that 1 in 100 of the episodes of self-harm that BlueIce prevented would have required hospital treatment. Modelling this to the 2,520 young people in the UK for who BlueIce has now been made available suggests a total saving to the NHS so far of at least GBP69,923. Potential future savings: The Local Government Association (2018) reported that 19,000 children attended hospital following self-harm in 2015. If BlueIce was available to all these children, taken up by half and prevented 50% of these episodes, the NHS would save GBP1,700,000 per year from reduced emergency department attendances.

Whilst the potential financial savings to the NHS are significant it is the personal benefits that are of the utmost importance. As summarised by one young person:

“It’s actually really good, it has helped a lot and I haven’t self-harmed in a while. Since using the app I’ve done it once and that is over 4 weeks which is really good” (J).