Digital health technologies to help manage symptoms of psychosis and prevent relapse in adults and young people: early value assessment

Health technology evaluation
Reference number: HTE17
Published: 25 March 2024

1 Recommendations

Adults

1.1

Three digital health technologies can be used as an option in the NHS while more evidence is generated, to help manage symptoms of psychosis or prevent relapse for adults. The technologies are:

AVATAR Therapy, for managing auditory verbal hallucinations (hearing voices)
SlowMo, for managing distressing thoughts or paranoia
CareLoop, for monitoring symptoms of psychosis to prevent relapse.

These technologies should be delivered or supported by a mental health professional trained in the technology. They can only be used once they have appropriate regulatory approval including NHS England's Digital Technology Assessment Criteria (DTAC) approval.

1.2

The companies must confirm that agreements are in place to generate the evidence (as outlined in NICE's evidence generation plan) and contact NICE annually to confirm that evidence is being generated and analysed as planned. NICE may withdraw the guidance if these conditions are not met.

1.3

At the end of the evidence generation period (3 years, or sooner if enough evidence is available), the companies should submit the evidence to NICE in a form that can be used for decision making. NICE will review the evidence and assess if the technologies can be routinely adopted in the NHS.

Young people

1.4

Research is needed on 3 digital health technologies to help manage symptoms of psychosis or prevent relapse for young people. The technologies are:

AVATAR Therapy, for managing auditory verbal hallucinations (hearing voices)
SlowMo, for managing distressing thoughts or paranoia
CareLoop, for monitoring symptoms of psychosis to prevent relapse.

1.5

Access to the technologies for the population and indications in section 1.4 should be through company, research, or non-core NHS funding, and clinical and financial risks should be appropriately managed.

Evidence generation and more research

1.6

Evidence generation and more research are needed on:

change in the target symptoms managed by the technology, including long-term benefits and who may benefit most from using the technologies
rates of relapse or worsening of symptoms
the effect of the technology on functional outcomes, including social functioning and personal recovery (for example, the person's perception of how they are feeling)
adverse events
resource use, including healthcare professional grade and time needed to deliver treatment or support
implementation and training costs associated with the use of the technology
resource costs associated with relapse, such as hospital stay costs
adherence, including frequency of use and completion rates.

The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies and potential real-world data sources. It includes how the evidence gaps could be resolved through real-world evidence studies.

Potential benefits of use in the NHS with evidence generation for adults

Access: Access to psychological interventions for psychosis, such as cognitive behavioural therapy for psychosis (CBTp) varies and is very limited for some people. Digital health technologies for managing symptoms of psychosis offer another option for adults with psychosis who may otherwise not have psychological interventions. Technologies for monitoring symptoms may detect early signs of relapse, which could allow quicker access to treatment when needed. This could particularly benefit people having treatment in early intervention in psychosis (EIP) services.
Clinical benefit: Clinical evidence suggests that digital health technologies may improve symptoms of psychosis or prevent relapse in adults.
Resources: AVATAR Therapy and SlowMo may use less staff resources and time than CBTp. CareLoop may detect relapse and enable earlier treatment, which could reduce hospital stays and demand on crisis intervention services.

Managing the risk of use in the NHS with evidence generation for adults

Clinical assessment: Digital health technologies should only be offered after assessing symptoms of psychosis and if the technology is suitable for the person. Some people may choose not to use digital health technologies and may prefer another treatment option, particularly people whose psychotic symptoms relate to digital technology. Everyone has the right to make informed decisions about their care.
Clinical support: Digital health technologies must be delivered or supported by a mental health professional trained in the technology. Services should have protocols for delivering digital health technologies, including for initial clinical assessment and matching the right treatment to people's needs and preferences. This includes ongoing monitoring and managing the safety and progress of people using them. This means that worsening symptoms can be identified quickly and appropriate action taken. For CareLoop, additional clinical support should be set up to monitor and respond to alerts.
Adverse events: The clinical experts advised that adverse events may occur with any treatment when managing severe mental illnesses such as psychosis, regardless of the delivery method. Some serious adverse events have been reported in the published studies for all the technologies. All adverse event data should be collected for these technologies as part of further evidence generation.
Costs: Early results from the economic modelling show that the technologies could be cost effective. But there is considerable uncertainty because of the limited evidence. This guidance will be reviewed within 3 years and the recommendations may change. Take this into account when negotiating the length of contracts and licence costs.
Equality: Digital health technologies may not be accessible to everyone. Additional support and resources may be needed for people who are unfamiliar with digital technologies or who do not have access to the internet. People's ethnic, religious, and cultural background as well as their personal experiences of healthcare may affect their views of mental health services and digital health technologies. Other treatment options may be more appropriate for some people.

NICE also recommends that gameChangeVR (a virtual reality [VR] technology) can be used in the NHS while more evidence is generated, to treat severe agoraphobic avoidance in people with psychosis aged 16 and over. It should be used with the support of a mental health professional. See NICE's early value assessment on virtual reality technologies for treating agoraphobia or agoraphobic avoidance for the full recommendations and guidance.