The panel noted that it is hard to predict which service users may get the most benefit from Space from Depression, so it is essential to:
ensure that people can choose what kind of treatment they would like to have
put Space for Depression in the stepped-care model, so people whose symptoms do not improve are given the option to try other types of treatment or a higher intensity therapy if needed
monitor people's progress and act quickly if they stop engaging with Space from Depression, and try to encourage them to re-engage.
The panel highlighted this gap in understanding and noted that further research in this area would be useful.
The panel stated that the company (SilverCloud) may wish to consider offering therapists more flexibility in how, and how often, they can contact the service user. This could include adding regular telephone contact or the capacity for ad-hoc messaging, based on the needs of each person.
Evaluation data showed that the effectiveness of Space from Depression varied widely between Improving Access to Psychological Therapies (IAPT) services. The panel noted that the IAPT services that achieved good recovery rates with Space from Depression spent time planning service provision and helping therapists to offer and use Space from Depression efficiently. The Haringey IAPT service, which used Space from Depression before the evaluation took place, showed the highest recovery rates of the 3 IAPT services involved in the evaluation. SilverCloud has stated that outcomes within each service improve over time, because the product can be firmly established in the service, staff can get used to it, and problems can be identified and resolved.
Service providers that are new to Space from Depression, or those with lower recovery rates than anticipated, may wish to consult other IAPT service providers. This will help to identify any potential changes to their service planning that may improve effectiveness and efficiency.
The panel discussed the responsibility of IAPT services to ensure equal access to care across the community. The panel noted feedback from IAPT services about particular groups of people whose access to treatment may be improved through digitally enabled therapy. These included people who do shift work, those with caring responsibilities, and people living in rural areas who would need to travel a long distance to reach an IAPT service. The panel suggested that SilverCloud could consider if it can use the potential of digital therapy to reduce inequalities in healthcare.
Digital therapies in general may currently be unsuitable for people with learning difficulties or people with visual impairments that would prevent them from reading text.