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Mental Health Member’s Network; Beating the Blues with NHS Highland

Hannah Mountford Support Officer – Technology Enabled Care SSHC 

02 October 2019 

Our Mental Health Member’s Network has recently been launched to support learning and sharing amongst community of practice members, with the first network call taking place on 17th August.  Kylie Dentith, Senior Support Officer for Technology Enabled Care SSHC, began the call by giving an overview of the aims of the Member’s Network, and some of the current applications of Flo for mental health.  If you would like to read an overview of these, please take a look at our blog.

Following this, Kylie introduced the call’s featured clinician, Iona McMurdo, who is a CBT Project Support Officer with the TEC team at NHS Highland.  Iona joined us to share her experiences of supporting the implementation of Flo with Beating the Blues (BtB). 

BtB is an online cognitive behavioural therapy course, used for the treatment of low to moderate anxiety and depression.  The course aims to help people to challenge and change their thinking patterns, understand their feelings and learn how to overcome negative thoughts by the use of interactive tools.  Case studies have shown that CBT is just as effective in treating anxiety and depression as antidepressants, with the added benefit of helping to prevent symptoms returning.

Previously, BtB had to be accessed using a PC, but updates have now allowed service users to access modules via mobile devices such as phones and tablets, making the course more accessible.  BtB comprises of 8 sessions, each with 3-4 modules, and on average it takes 10-14 weeks to complete.  Flo provides additional support to those completing the BtB course between sessions to encourage people to continue with and complete the course.

NHS Highland first implemented BtB with Florence in 2017, and data gathered indicates that service users are 30% more likely to complete the course if they opt into Flo also.  Initial engagement is also improved, as they are able to receive the link to BtB from Flo, and then start the first module directly thanks to the update allowing mobile devices to access the course.  Flo’s messages can also be reassuring for those living alone with anxiety or depression, as they make people feel as if someone cares about them.  NHS Highland aims to focus on inactive and pending users to encourage them to activate the course, and this is something Flo is able to support in her gentle & friendly manner.

As with any implementation, Iona and the team did experience some challenges initially, including poor mobile signal in rural areas, service users on multiple protocols having a few too many messages from Flo, and some unfounded concerns around a charge for opting into Flo.  

Iona’s key advice here is to educate and inform patients from the start, so that they have a better understanding of how the system works, including that it is free to use and their confidence around it is improved.  Part of this includes a phone call from Iona after referral, allowing service users to be as informed as possible around the benefits of engaging with both BtB & Flo. 

Iona was also able to share some fantastic patient feedback:

“This is an amazing course that has really helped me. I feel it should be part of the education curriculum! It is so helpful and so beneficial and I can see how my thinking errors started quite young. I have told everyone and anyone who was prepared to listen of the benefits of Beating the Blues/CBT”
“Beating the Blues was a brilliant course, and my GP has been a fantastic support… Really I couldn’t be more grateful to you all. Feel Saved!”

Iona finished by discussing some of the next steps for Flo & BtB in NHS Highland:

  • Ensure better communication with service users as they begin their journey with BtB, and provide more information around Flo to help them make an informed decision.
  • Improve how the team measures outcomes to assess the impact of the programme.
  • Focus on activation, drop-out and completion rates to explore contributing factors; for example, patients who opt into Flo compared to those who don’t.
  • To meet with and communicate with the wider BtB team to discuss challenges and share learning, with the aim of continually improving service delivery moving forward.

Following Iona’s presentation, community members who had joined the call had the chance to discuss and ask Iona some questions.   The group discussed improved use of technology in older populations.  It is often thought that technology such as Flo may not be suitable for older users, but increasingly this is found to be inaccurate as tech literacy improves.  
Other discussion topics included: the addition of evaluation questions in Flo protocols, how to evaluate cost-effectiveness of programmes such as BtB, choosing the best language for your patient cohort and how clinician confidence when discussing Flo can improve patient engagement.

If you would like to find out more about NHS Highland’s BtB programme, you can contact Iona at

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