MiniMe - Innovation Labs

MiniMe Formerly known as ‘Tamagotchi Me’

Introduction MiniMe is a personal interactive recovery guide inside a smartphone app. Young people with mental health issues can use it to avert or deal with rapid deterioration in their mental health. As an app it is reactive and proactive and aims to promote independence and strengthen resilience. It is a simple idea that offers users a timely means of support that can be personalised and tailored to the needs of the individual. The app uses a 3 tier traffic light system to guide them through a series of supportive activities in response to how they are feeling. As a result of using MiniMe users will experience improved mental health, fewer periods of ‘crisis’ and require less professional intervention. Service providers will see improved recovery outcomes and reduced costs per patient.

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SECTION A: CONTEXT 1. Needs and problems Getting speedy support is difficult when managing a crisis Accessing professional support when approaching crisis or experiencing heightened levels of distress can be difficult for young people with mental health issues, even if they are already engaged with a service. Services are usually provided on an appointment basis with limited access to key workers in between sessions. This means they are unable to provide the speedy, timely and personalised support that young people approaching or recovering from crisis need. Young people want and expect self help strategies and tools In the last decade the number of digital tools available to manage life and work has massively increased. Their development has predominantly been led by 1830 year olds looking to leverage technology to enhance their quality of life. Out of this has emerged the ‘Quantified Self’ movement - led by users and organisations who create their own methodologies and apps that help people to monitor and self manage their health conditions. Within mental health this has led to the creation of apps like Moodscope and Buddy (see below). As a result young people are increasingly coming to expect that they will be able to use digital technology to support their mental health. The advantages of self help digital tools include: ● convenience, you can use them in your own time and when it suits you; ● value for money, negligible cost if you have a mobile phone that runs apps; ● targeted, they can be customised to help with most mental health issues. The emergence of self help digital tools supports the recovery model of mental health treatment. The model encourage users to look beyond perceived limitations of having a mental health issue to move forward, set new goals and do things that give their lives meaning.

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2. What already exists in relation to the problem? There are a range of digital self-help tools available to people with mental health problems. Some are like MiniMe in that they try to help users avoid rapid deterioration of their mental health. However none of them help users to actually manage a crisis and none are targeted specifically at young people. NHS Self help resources - a range of video, audio and printable self help guides from Northumberland, Tyne and Wear NSH Foundation trust. Beating the Blues - an evidence based CCBT program for the treatment of depression. FearFighter - an online NICE accredited CBT program for the treatment of panic and phobia. MoodGYM - an interactive CBT based web program designed to prevent depression. It consists of five modules, an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment. MyHealthBox - an electronic personal health records system in use by South London and Maudsley NHS Foundation Trust. Users can keep track of how they are feeling, access resources and get tips on staying well and managing their health and wellbeing. Overcoming self-help books - offer courses of highly effective Cognitive Behavioural Therapy (CBT) in book form. My asthma log - a non-mental health app that uses a traffic light system to create a personal action plan to help users manage their condition.

3. History of MiniMe’s development MiniMe was first submitted as a wildcard idea that was put forward by a Labs Network member half way through the incubation phase. It was posted in the Self Help Group discussion forum under the title ‘Crisis’ and went on to rapidly gain popularity. Crisis was described as

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“An app that stores all your emergency numbers and email addresses including charity contacts like Samaritans for instance, a reminder section where you could put things like, what got you through last time, distraction techniques, positive quotes and music.” Early discussion points made reference to the app being simple, easy to use and focused. It was further described by a young Lab participant as “an app that you can turn to in a crisis”, that would also store of positive reminders tailored to the user, that could include inspiring quotes, photos and music. Its potential to bring information already residing on a smart phone into one easy to find place became a key distinguishing feature of the idea. Other topics discussed included: ● Can it be used by non-smartphone users? Should it be SMS based? ● Would it be useful for other people and services to have access to the app’s data? ● How can data be stored securely and safely? ● Are there issues around maintaining regular use - dealing with issues of data decay - not just a crisis app? At Lab 2 a small group of professionals and young people developed the app under the name Tamagotchi Me by using personae and scenarios to explore its use in a range of typical situations. Taking the traffic light system used by professional services to assess users’ level of crisis they developed red, amber and green storyboards charting the app’s use in different scenarios. This led on to the development of a priority sorted feature list. The final ideas were then captured as a cereal box and delivered in more detail as a verbal pitch. For trademark reasons the app was given the working title of MiniMe after Lab 2.

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SECTION B: CONCEPT 4. Key target groups MiniMe is for young people who currently have mental health issues and are at risk of crisis. As an app, it is targeted at people who have regular access to a smart phone. The key target audiences are: 1. 16-25 year olds with smartphones who have mental health issues connected to mood. 2. 16-25 year olds with smartphones who have general mental health issues. Though not a target audience it has potential to also be useful for 16-25 year olds with smartphones who are at risk of having general mental health issues.

Meet Lorraine... Lorraine is a 23 years old single mum with a daughter Maddy, who is 3 and half years old. Lorraine’s father died when she was nine and she spent a lot of time looking after her mother who was often ill. As a result she grew up quickly. At 15 the pressure of school and caring for her mother became too much and she had a breakdown. Since then she’s had recurring mental health problems. Lorraine has a full time job as an education support worker in a local multidisciplinary children’s team. Maddy spends most days with a child minder. Lorraine is tired when she gets home but makes a great effort to interact with Maddy which leaves her little time for socialising. As a result she hasn’t had a relationship since her partner left when she was pregnant with Maddy. She has a smart phone which she regularly uses to connect to friends and post updates to Facebook. Her self esteem has hit an all time low and she tends to drink alcohol in the evenings when Maddy has gone to sleep. This helps her to unwind and gloss over her feelings of loss and loneliness and the constant anxieties she has about earning enough to keep her and Maddy together under their own roof. The morning after the night before often has Lorraine thinking negatively and she is often angry that she has got herself stuck in such a negative cycle.

Meet Allalena... 5 Innovation Labs Grants Programme July 2012

Allalena is 18 and was previously know as Alan, she has aspirations to complete gender reassignment even though she is discriminated against in her local area. She suffers from depression and in the past has self harmed. Recently she has managed to get more control over this and only sees her Community Psychiatric Nurse every three months. She isn’t currently connected to any other professional support services. Allalena left school with poor GCSE grades and hasn’t got a job. The rejection letters really get her down. She’d like to start college to study for a career in music but finds the prospect frightening. She has a smart phone which she uses to keep in contact with those close family and friends who have accepted her changes. She enjoys the anonymous interaction of online gaming and is a big World of Warcraft player.

5. Narrative of use These journeys are based on storyboards generated by young people and health professionals at Lab 2. They represent a range of typical journeys that young people could take using the MiniMe app. User journey for ‘Red’ light Red is high risk and may mean that the user requires support from social services or a trusted family or friend. The scenario below outlines how the person can use the app for support when on a red light. Allalena Walking back from another unproductive and depressing visit to the job centre Allalena is verbally abused by a group of youths gathered around the doorway of a local newsagents. Although this makes her incredibly angry she has learnt from past experience that crossing the road and walking by jeering groups without making any eye contact is her best approach to managing them. She manages to run and just catch her bus home. Sitting on the top deck of the busy bus she is feeling a mix of emotions: angry, out of breath and scared. She launches her MiniMe app which welcomes her back. She is greeted with a screen showing three lights, red, amber and green and is prompted to choose a color that represents how she is feeling. She selects the red light knowing that this will enable her to alert members of her family. The screen changes to an interactive image of her personalised family tree, she knows her Dad will be at work and that by now her Mum will be at home. She clicks on the icon representing her Mum and gets an option to call or text. As she is surrounded by people on the bus who might overhear her conversation she 6 Innovation Labs Grants Programme July 2012

opts to text her Mum. The app sends one of Allalena’s pre-defined text messages indicating that she is in a crisis but can’t talk at this point and will be home soon. The message is sent to her her Mum’s mobile phone and she immediately gets a message back to say that it has been received. Her mum texts a supportive message back which appears as a speech bubble on her icon. Allalena feels reassured that she will be able to see her Mum when she gets home and that she will know that she isn’t feeling great and won’t have to go into detailed explanations. She closes the family tree and the app suggests that it might be useful to do some problem solving to work out what has happened to trigger this event. She agrees and presses OK. The screen offers her a choice of pre-defined responses that she is familiar with and has used before. She clicks on the appropriate one which is automatically saved to the app and will be used at another time to help her reflect on her progress and what works well. She is then offered a selection of activities that might help to manage the situation. The noise of passengers chatting on the bus isn’t helping her feel any better so she selects the music option and pulls her headphones from her pocket and plugs them into her phone. She selects a track that she knows will help her to feel more calm. The inbuilt music player on the phone launches and the noise of the engine and chatter from the bus fade away as she sits back in her seat and stares out of the window. Ten minutes later the app prompts her with a question, ‘Are you still feeling stressed’ alongside the red light icon. She has a choice of yes or no. If she presses ‘yes’ she knows the app will give her the option to call to 999 or her Community Mental Health team’s out of hours number. She clicks ‘no’. The app acknowledges her response and provides a pre-defined positive statement. She smiles to herself because this particular statement was one that her friends use when they are together to indicate they’re having a good time. Stepping off the bus she feels pleased that she has made it home without getting too upset and has actually managed to calm herself down. Her mum is waiting at the front door and wraps Allalena up in her arms as she enters the house. Storyboard image - http://flic.kr/p/bXNeqW User journey for ‘Amber’ and ‘Green’ lights Lorraine had a bad day yesterday and by the time she had put Maddy to bed it was 9.30. She felt tired because Maddy had woken during the previous night with a bad dream and she’d spent over 2 hours talking to her and helping her get 7 Innovation Labs Grants Programme July 2012

back to sleep. As if that wasn’t enough she was really struggling to keep on top of her increasing workload, creating a constant background stress. At one point during the day she felt completely overwhelmed and on the verge of tears. She grabbed her phone and rushed out of the office managing to hold her tears back until she made it to the safety of the ladies toilet. She looked down at her phone and opened MiniMe. The app welcomed her back with a photograph of Maddy and text that read, “Hello Lorraine”. The three traffic light options appeared on screen and Lorraine took a moment to think about how she was really feeling. It wasn’t a red day. She selected the amber light and the screen presented a range of options: ● ● ● ● ●

Call Jenny Go for a walk Listen to music Follow relaxation techniques See videos

Lorraine considered her options; Jenny is her best friend but she would be at work too at this time so they wouldn’t be able to properly talk. She couldn’t go for a walk and didn’t have her headphones to be able to listen to music. She pressed the relaxation button taking her to the next screen which offered her three relaxation activities. She selected one and spent the next five minutes engrossed in the activity, eyes closed and breathing calmly. The app vibrated in her hands and asked how she was feeling. The five minutes had passed quickly. “Are you feeling better?”, the app quizzed. She clicked ‘yes’ and a text box appeared, “great, what helped?”, she filled in the brief learning assessment to help her reflect on the activity in the future. Later, just after she and Maddy had eaten their tea, Lorraine thought about her day, the app, locking herself in a toilet cubicle and how she actually felt better for once. Tonight, she decide, she would not have a drink but would see if the app could give her some positive suggestions. Maddy was tired and dozed off quickly. Lorraine headed down stairs to the sofa at 7.30 and put the TV on enjoying the comfort of background noise. She opened MiniMe and was welcomed back with a message reminding her of her progress earlier that day. Selecting the green light it noted the positive change, “great, you’re feeling good!”. The following screen asked a few questions to help her understand what she had done to feel good. She selected the ‘I practiced relaxation techniques’ option and then saw the note she had made earlier that day. Those 5 minutes had really made a difference. She felt pleased that she had 8 Innovation Labs Grants Programme July 2012

decided not to have a drink and created a new option for the list, “I haven’t drunk any alcohol”. She submitted it to the app and it immediately appeared on the list. She clicked the option and then filled in the text for the learning assessment. The app said ‘nice one’ and told her to check back in 3 hours. She got absorbed in watching TV as she made her way peacefully through her ironing, something she usually hated. She sat down for a cup of tea at 11 and her phone vibrated. The screen asked her “Still feeling good?”. She chose yes. The app congratulated her and she submitted her learning assessment before turning the lights out and heading for bed. Storyboard image amber - http://flic.kr/p/bXNemY Storyboard image green - http://flic.kr/p/bXNehh

6. User stories ● ●

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As a young person, I want to customise my installation of the app, so that it’s help is more personalised when I need it. As a young person, I want to personalise my installation of the app with content that already exists elsewhere, so that I don't have to upload anything I've already got online. As a young person, I want the app to present clear signposting to the actions available to me, so that I can use it effectively when I'm in a heightened emotional state As a young person, I want my actions to lead to accurate suggestions of what to do next, so that I can get support for my current needs immediately. As a young person, I want to be able to review my journey through the app to help me customise it’s suggestions of what to do in a crisis, so that I can be sure they will be helpful. As a young person, I want the app to record my reflections and reactions to its suggestions, so that I can constantly improve them for the future. As a young person, I want the app to record my reflections and reactions to its suggestions, so that I can start to understand the triggers for my changes and become more proactive in taking the right actions without prompts from the app. As a young person, I want the app to analyse my reflections and reactions to its suggestions, so that it can improve them itself.

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7. Key features Overview MiniMe is a smartphone app. It uses personalised content to provide support tailored to the user’s individual needs, suggesting activities and storing useful information. Activities may vary depending on the users perceived level of distress: from reading inspirational quotes, undertaking distraction activities to alerting key family members and support services of the users need for further help. It stores useful phone numbers for accessing further support, lists current medications, links to web resources, personalised content for activities, text/email messaging, prompts to keep using it and check-ins for identifying triggers. It is pin protected.

MiniMe must have: ● ● ● ● ●

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a system for users to enter their emotional state in one of three modes: red, amber and green; a system which offers clear advice in response to those modes; a “Red light” response linking to crisis services directly and alerting health teams of a user’s immediate needs; the ability to alert a trusted family member or friend to help the user via email or text; a system that assesses how a user is feeling subsequent to a entering an emotional state through a series of questions, “Let’s problem solve”, “Are you still in a crisis?”; local services’ contact information and information support. the ability for users to submit responses to problem solving/activities they have undertaken that have changed their state into a text box; PIN access to keep the app personal to one user; the ability to be visually customised.

MiniMe should have: ●

the ability to learn more about the user the more they use the system and to prompt them to reflect on similar occasions and how they were feeling; ● a place for users to add their own thoughts, feeling, media (music/video/poetry) that can be accessed depending on how they are feeling; 10 Innovation Labs Grants Programme July 2012

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a means of suggesting options/activities: go for a walk, go to gym, listen to music; ● an interactive family tree to record contact details of family members; ● the ability to set up text/email messages that a user can send quickly to a pre-defined family member or support services; ● a place to record the user’s list of medications. MiniMe could have: check-ins to reflect on where, when and context of feeling. For example, a user’s workplace may make them feel anxious at the beginning of a particular day when they have to attend group meetings. This historical information can be used to understand personal triggers and ways to cope with them; ● badges/prizes/rewards to encourage more use; ● money reserve for phone calls - a certain amount of credit always available on phone, and an alert if your credit runs too low; ● a cartoon version of yourself, that you can feed, shower, socialise etc. Your reports on your activity could have an affect on this avatar: if you eat to much junk food, your avatar puts on weight; if you don’t take your medication, they become unwell. ●

MiniMe won’t have: ●

A moderated forum.

8. Anticipated outcomes from using MiniMe As a result of using MiniMe young people with mental health issues will: ● experience improved mental health ● experience fewer episodes of rapid mental health deterioration or ‘crisis’ ● experience increased autonomy in managing their mental health ● have increased levels of resilience; ● be less likely to lose connection with their preferred support networks; ● require less professional intervention. Service providers will: ● better understand their patients’ mental health issues and self management needs; ● experience improved outcomes of their existing programmes such as Recovery Star & WRAP; ● reduce their costs per patient. 11 Innovation Labs Grants Programme July 2012

SECTION C 9. Risks MiniMe’s marketplace is already competitive. There is a risk that failure to find the right development and delivery approach will lead to it becoming unsustainable. Mandating that it requires phone credit to use could create a barrier to use. Data decay - ie failure to engage the user enough in updating what prompts work at each traffic light level. What worked 2 months previously may not still work now. Keeping data secure and reliable - particularly data contained within MiniMe’s ‘crisis’ alert system Whether enough of the target user group have smartphones to make MiniMe viable Though a simple idea there is a risk of the app becoming an overly complex product that is difficult to use The app failing to work when at crisis point (e.g. due to bugs or phone memory issues)

10. Opportunities To work closely with existing mental health services to test, develop and market MiniMe There is a rapidly developing market for apps that help users manage their illness. MiniMe’s development could benefit considerably from learning from this market.

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11. Significant development questions See An Introduction to Developing and Sustaining Digital Mental Healthcare Products and the following questions: At what point of the mental health journey or within which care pathway would it be most useful for a patient to begin using MiniMe? What usability considerations will best mitigate the risk of data decay? Is MiniMe a short, medium or long term intervention or all of them? Could MiniMe’s collated data be useful in improving services? Could the user control how and with who they share MiniMe’s data (eg friends, family, services)?

12. Next steps could be.. MiniMe is ready to begin prototyping. This should include: ● Product design work with young people who are inexperienced in managing their mental health. This would help test and tune up MiniMe’s traffic light system. ● Mapping MiniMe’s user experience i.e. are you a, b, or c? if a, try x. Did x work? yes or no etc. ● Developing relationships with service providers to explore how MiniMe could support their users and improve their services ● Further exploration of how My asthma log facilitates user interaction and manages their data, including its overview and video.

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