Puffin O’Hanlon and Michelle Eskinazi are involved in the ARIES study, which has developed smartphone app ‘My Journey 3’ to support recovery in psychosis. Here, they reveal more about this self-management tool and its potential impact for #tomorrowspatient

Health impact

smart_phone_simpleEarly Intervention Services (EIS) provide intensive support to people who have experienced a first episode of psychosis for a period of around two to three years, but current evidence suggests that despite an association with improved outcomes, relapse rates remain high with many not achieving a functional recovery. The five year ‘critical period’ for relapse is therefore not covered by the current provision of services and with evidence that the impact of EIS does not persist after discharge, a new approach is needed to plug this gap.

Self-management approaches offer an opportunity to extend the impact and benefit of EIS beyond its current availability by empowering service users to take control of their own recovery and learn skills to help them detect, manage and anticipate symptoms, triggers and early warning signs of relapse. The development of personalised coping strategies in response is intended to help them take the necessary steps to protect
themselves from future relapses and admissions.

While the benefits of self-management interventions are proven to reduce the risk of relapse and to contribute to improved functional recovery, challenges remain with long term engagement with such tools. In addition, the cost of delivery of many of these interventions and the stigma attached to their use has resulted in them reaching only a fraction of those who might benefit. An innovative approach is needed to meet these challenges.

Introducing innovation

In this digital age, the rapid change in available technology has transformed the way that we approach and engage with the world and ourselves. This is in large part due to the increasingly wider availability of smartphones and their use in everyday life. Evidence suggests that people with psychosis are using this technology in a similar way to the rest of the population and we saw an opportunity to design a digital intervention to support EIS service users which is cost-effective, time-unlimited, personalised and non-stigmatising.

The ARIES (App to support Recovery In Early intervention Services) study developed a self-management smartphone app – ‘My Journey 3’ – to support recovery in psychosis as a complement to existing treatment from EIS. The app is for people who have experienced psychosis and is designed to help people build confidence, learn skills to help take back control, and reduce the chance of experiencing psychosis again.

In designing this tool, we have drawn from existing recovery and relapse booklets to develop an app where users can make plans for their recovery and for what to do if they feel unwell in the future, to keep track of how they’re doing and any medication they are taking, and to find information about mental health and mental health services.

Users can choose to share their recovery and relapse prevention plans and records of their progress via email with their mental health workers, friends, family, or other contacts if they wish.

The first iteration of the app was developed by Surrey and Borders Partnership NHS Foundation Trust (SABP) and was then adapted to incorporate existing relapse prevention and recovery tools.

Next steps

The app is still in the early trial stages. We have so far completed one round of usability testing and a feasibility study is currently underway in anticipation of a pilot RCT to commence in January 2017.

‘My Journey 3’ is a native smartphone app developed in the first instance for an Android platform. If results of the pending ARIES pilot RCT study suggest that the app is acceptable, feasible, and potentially beneficial, we will seek further funding to develop the app for other platforms, including iOS.

Potential impact on the healthcare system

Our hope is that ARIES ‘My Journey 3’ app will help fill the gap between available EIS provisions during the five-year critical period, by promoting and improving engagement with self-management of recovery thereby reducing relapse rates and hospital admissions.

More information about the ARIES study and ‘My Journey 3’ app is available here.

The ARIES study is a partnership collaboration involving NIHR CLAHRC North Thames, University College London, Camden and Islington NHS Foundation Trust.