Seventy percent of adult mental disorders have their origins in early-life psychiatric problems, so there is a strong rationale for improving early access to care and support. It has been suggested that from one quarter to one half of adult cases of psychiatric disorder might be prevented by effective intervention among young people who present with problems. Early intervention might also allow for earlier, safer and more effective approaches to coping with problems, in addition to facilitating outcomes such as school achievement, peer and family relationships and averting substance abuse, which may have significant consequences for the young person throughout life. Despite the presence of problems and associated disability among young people, delays to care average more than a decade, depending on the nature of the problem. In addition to stigma, many young people report that they don’t know who or where to go for help as a key barrier. The purpose of this study was to develop a mobile app which facilitates access to mental health care and support for young people (aged 16-25 years); and to assess its feasibility, acceptability and potential impact on help-seeking, in addition to cost-effectiveness.
In terms of methodology, we first developed an app prototype in conjunction with a young person advisory group. We refined the app prototype based on a series of discussions and user testing with young people--aiming to maximise evidence-based features identified as facilitating adoption and dissemination. Following refinement, we evaluated the app using a pre / post deign. Participants were recruited from an ongoing prospective community cohort enriched for psychiatric problems for which we have already collected two waves of data on validated measures of: mental health, service use, informal support and barriers to support. Participants were invited to use the app for a three month period. Evaluation covered: app satisfaction acceptability, and changes in help- seeking for mental health issues and perceived barriers to care or support.
The newly developed app (Afloat) provides information about how and where young people can get support for mental health problems or to promote positive mental health, including physical services and also online resources. The app also incorporates videos of young people describing their experience of accessing services or support and information about types of mental health issues. In terms of the evaluation, we had 105 respondents complete our survey at baseline and follow up. Respondents reported strong levels of favourability and acceptability of the Afloat app. A significant majority reported that they would use Afloat for themselves (64.8%) or to support someone else (67.6%) in the future, that they found helpful services (63.5%) and information about mental health (70.9%) and that they felt Afloat would be helpful for young people with mental health problems (92.4%). At follow up, 90.4% of respondents said they would go for help if they had a mental health problem which was a statistically significant increase from 81.2% at baseline. Among those who had at least mild mental health symptoms on the PHQ-9 (total score greater than 4), we found that 45.8% of participants at follow-up vs. 41.7% at baseline used some type of service for mental health problems. Among those with at least moderate mental health problems (total score greater than 9) we found that 62.5% of participants at follow-up vs. 50.0% at baseline used some type of service for mental health problems, though the sample size was very small (n=8). Eleven participants said that Afloat helped them to get professional help in an emergency situation when things got really bad. These service use impacts could have important socio-economic implications, in particular through promoting earlier access to care and reducing barriers to service sue.
The Afloat app could improve access to effective intervention and support for mental health problems, during adolescence and young adulthood, a key period of vulnerability. Further testing will investigate longer term impacts and mechanisms for prevention of mental health problems.
