Brain in hand - personal technology for independant living

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To help deliver the right mental health support to young people, schools and colleges across Bolton have introduced Brain in Hand. Students report feeling more in control and confident. There has been 89% engagement levels and >50% of students better able to manage their condition, such as one pupil who has been discharged from CAHMS.

“Brain in Hand is speeding up responses and joining up support around individuals, as well as giving people access to the support they need when they need it.”
Martin Heuter, Commissioning Lead, Technology Enabled Care, Bolton Council and Bolton CCG.

Situation
Mental health is one of the key priorities in the Greater Manchester Strategy, ‘Our People, Our Place’. With 75 per cent of adult mental health problems starting by the age of 18, and only 25 per cent of young people with a mental health problem getting access to the right support, The Greater Manchester’s Mayoral Combined Authority (GMCA) aims to deliver early intervention support.

To identify how this aim would be delivered to residents across Bolton, one of Greater Manchester’s biggest boroughs, the Local Authority, NHS, Social Care and Voluntary teams came together to develop Bolton’s Locality Plan. It would reflect the borough’s motto ‘Supera Moras’, to overcome difficulties.

Solution
As part of the planning, the team looked at how ‘Technology Enabled Care’ could offer advantages and identified Brain in Hand. Based on well-established therapeutic principles such as CBT, solution-focused therapy and recovery-oriented rehabilitation, Brain in Hand gives people access to personalised support, in the moment, promoting self-care. A personalised plan including a diary, reminders, coping strategies and anxiety monitor are accessed through an app. If things get too much, the anxiety monitor also lets users immediately – but discreetly – ask for extra help from their support team.

The team agreed that Brain in Hand could offer better and more cost-effective support to children, young people and adults. It would give people access to personalised support, in the moment, promoting self-care. This would encourage increased independence and quality of life for service users who are better able to manage mood problems. It would also reduce reliance on other forms of support, reducing support service costs and taking the pressure off carers.

To be most effective, the team identified that Brain in Hand would be best embedded into existing education and health-based support services. 100 young people with a mental health difficulty or autism spectrum condition were selected from schools and colleges in the region to participate in the programme.

The Brain in Hand team worked with the support teams at Westhoughton High School, Park School, ESSA Academy and Bolton College. Drawing on their wealth of experience in the education sector, the team trained staff on how the system works and how best to integrate it into existing practices. It was of paramount importance that staff could see how Brain in Hand would strengthen their support systems.

Once staff training was complete, students were set up on the system. Each pupil worked through a Brain in Hand workbook. This helped the pupil and supporter to discuss goals and challenges, ensuring the Brain in Hand system was completely personal to them; this included working together to devise coping strategies and reminders that would help provide the most effective support.

For many students anxiety is a real difficulty and presents a barrier to learning; it can result in the inability to stay in class, to socialise, or to manage behaviour. For two-thirds (68%) of Brain in Hand users, anxiety was the primary challenge identified. Other reasons for wanting to use Brain in Hand included anger management, organisation and planning, and dealing with social situations. For some pupils, their focus was on keeping their morning routine on track, to ensure they arrived at school on time and ready for the day. For others, it was learning how to not get angry during break-times.

Each pupil’s Brain in Hand was linked to their school or college support team; staff members could see everyone’s anxiety status at a glance from a dashboard. When anyone needed extra help, the team would receive an alert. Each pupil was also given the option to link their parents or guardians to the system, so that they could also see their activity and receive an alert out of school hours. This enhanced communication between the student, the school, and those supporting them at home, creating a package of wraparound care.

Results
Users and support staff were asked about usage of the system. This assessment concluded that engagement levels in the support were extremely high, especially when compared with figures from alternative interventions:
• The vast majority, 89% of people made use of the system.
• 79% of supporters report that Brain in Hand had been useful for the user.
• Feeling more in control and more confident were consistent themes in feedback from the users.
• Half of users have made changes in their lives because of using Brain in Hand.
• 54% of supporters report that it has helped pupils better manage their condition. There are numerous examples of success including one pupil who felt improved enough to leave CAMHS.

Leaders and support staff echo this result. Janet Bishop, Head of Learner Support at Bolton College, said: “Brain in Hand has been really useful in engendering independence in the students. Staff have told me that they see the students growing in confidence, developing their own strategies for their own everyday problems they encounter. It’s meant we can step back and parents and carers have said that it is making their lives easier. Students are gaining the confidence to start thinking about new things that they can do that they never found possible before. We are chuffed to bits with Brain in Hand.”

James Dawson, who is the Brain in Hand lead at Bolton College, agrees, adding: “It’s giving us more time to deal with the increasing number of students who have anxiety, because people are using the app and managing their condition themselves.”

An independent survey received in-depth feedback from 28 pupils. Of these, almost four-fifths (79%) reported that it had been useful. Feeling more in control and more confident were consistent themes in feedback from the students.

Unprompted, pupils have reported that Brain in Hand helps in four different ways:
• Self-management – It helps students to calm themselves and, as a result, stay in lessons when previously they may have left class.

• Organisation – Students found Brain in Hand helped their organisational skills. For example, it helped one pupil to remember to take medication; it helped another to better plan for exams.

• Understanding – For some, it gave provided insight into the causes of their anxiety, to be better able to spot triggers and help them to be more self-aware. One student reported that because of this, he no longer felt he needed support from CAMHS.

• Discretion – students widely reported that they liked how with Brain in Hand, they could discretely ask for help in class: the student could be seen by a support staff member before a situation escalated.

Summarising, one pupil explained: “Throughout the day, you are with a lot of people and sometimes this makes me stressed. It gives me happy that I always have support with me. It gives me a sense of confidence. It’s like having someone with you that is always there; you always have a solution with you.”

Another added: “It reminds me to do things to do things that otherwise I may skip, such as medication or eating. It helps a lot with routines. It calms me down. I am able to reflect on myself more; I get into less arguments and I can make myself calm now. It’s a great way to help with your stress levels.”

Amongst the pupils who didn’t find Brain in Hand useful, many weren’t ready to make use of technology; often they were not yet a smart phone user.

The programme ran during academic year 2017 / 2018. Following a review, it has been determined that all participating schools will continue to use the Brain in Hand system. Looking to the future, the combined locality team is also planning to introduce the system into Adult Social Care Services, developing referral pathways so that more vulnerable people can benefit from the system. It’s estimated that thousands of people across Bolton may benefit.

Martin Heuter, Commissioning Lead, Department of People Services, Bolton Council and Bolton CCG said: “Brain in Hand is speeding up responses and joining up support around individuals, as well as giving people access to the support they need when they need it.”