Mental Health & Technology

Researchers in Nottingham are at the forefront of using the latest advances to help tackle the pressing burden of mental illness; the largest single disease burden in the UK. One recent breakthrough has been in the field of the diagnosis of ADHD (Attention Deficit Hyperactivity Disorder).

Nottingham is harnessing advances in computer science and bio engineering to provide solutions to mental health problems, which cost the UK economy around £100 billion a year.

The NIHR Nottingham Biomedical Research Centre (BRC) is focusing on translating research into new treatments for patients with mental health conditions.

The Mental Health and Technology research theme is making an important contribution to the nation’s healthcare, and that of people living outside the UK. Not only are mental health problems the largest single disease burden facing the UK, two in three people with mental health conditions receive no help at all.

BRC research theme leader Professor Chris Hollis explained there is a demand for personalised and objective diagnosis in this field, and the time is right to take advantage of the rapid growth in smart technologies to improve patient care.

As well as heading the NIHR Nottingham BRC Mental Health & Technology theme, Prof. Hollis is director of the NIHR Mindtech Healthcare Technology Cooperative. The BRC theme’s work, closely involves Nottinghamshire Healthcare NHS Trust, and focuses on five areas.

Digital interventions will drive better healthcare

The theme is concentrating on:

  • Digital interventions and therapies
  • Objective assessment, monitoring and wearable devices
  • Neuromodulation and neuroimaging
  • Tools to aid with decision-making, risk assessment and data analytics
  • Digital user experience (often known as ‘UX’)

Concerns about ADHD diagnosis

For ADHD (Attention Deficit Hyperactivity Disorder), a condition affecting children and young people, there is a great need for objective assessment, given a 10 fold growth in diagnosis since the 1980s.

Prevalence of ADHD among children is between 3-5%, equivalent to one child in every classroom, and there has been a 50% increase in the prescribing of stimulants such as Ritalin (methylphenidate) since 2006.

NHS services are being overwhelmed, said Professor Hollis, with long delays in assessment for ADHD and an annual assessment bill of £23 million in England and Wales.

Since assessment currently relies on subjective behavioural ratings and there are concerns about both over – and under – diagnosis of ADHD, there have been calls for more objective tests which would increase both the speed and accuracy of the diagnosis.

The ‘AQUA-Trial’ was a randomised controlled trial which investigated whether an objective computerised test, the ‘QbTest’, could help improve the assessment of ADHD. The QbTest involves participants completing a 20-minute computer task whereby they are asked to press a hand-held button when certain (target) stimuli appear on the screen, and not respond when other (non-target) stimuli appear.

This measures their attention and impulsivity. At the same time an infra-red camera records the patient’s activity levels during the test. A report is instantly generated at the end of the test which compares the patient’s performance with a normed sample.

The test can be used to inform clinical decision-making with regards to ADHD symptoms, but should not be used as a stand-alone test.

The AQUA-Trial took place across 10 CAMHS (Child and Adolescent Mental Health Services) and community paediatric clinics and recruited 267 people aged six-17 years-old.

The findings showed that clinicians were more than 40% more likely to reach a diagnostic decision (confirming or excluding ADHD) within six months when they had access to the QbTest report than when no report was available.

Clinicians with access to the QbTest also required 15% fewer appointment minutes needed to make a diagnostic decision and felt more confident in their decision. Using the QbTest to aid clinical judgement did not affect diagnostic accuracy. The QbTest also resulted in cost savings to the NHS.

The test has now been taken up by clinical practitioners in Leicestershire and Lincolnshire.

The time is right to take advantage of the rapid growth in smart technologies to improve patient care in mental health.