Silvercloud Health has been at the forefront of digital solutions in the mental health sector for almost a decade, but with new impetus to increase access as demand spirals, it is eyeing growth in new territories and new service lines. Lloyd Humphreys, Head of Europe, talks to Maria Davies about partnership working, expansion and the move to population-based health
Digital transformation has become the phrase of the moment in healthcare as services are forced to quickly adopt new ways of working during the COVID-19 pandemic, but according to Dr Lloyd Humphreys, Head of Europe, at Ireland-based digital mental health platform SilverCloud Health, it is far more than a functional solution in a crisis and has the power to democratise mental health by ensuring access for all in times of need.
Trained as a clinical psychologist, it was early on in his career in primary care that Humphreys became interested in improving access to mental health services.
‘I started my career in research, evaluating the effectiveness of cognitive behavioural therapy working with research teams at the University of Manchester looking at the effectiveness of CBT in psychosis, schizophrenia and in PTSD,’ he tells HMUK. ‘Then I did my clinical training, and wanted to focus on the more vulnerable groups, the ones that perhaps might have less ready access to psychological therapies.’
After specialising in work with refugees and asylum seekers, Humphreys left the NHS to co-found a company providing psychological support to vulnerable groups, such as looked after children, before co-creating the first online addiction service to launch in the UK, Breaking Free Online. He spent the next decade working in digital mental health provision before joining SilverCloud Health in early 2019.
‘At that time, SilverCloud Health was very well known within Improving Access to Psychological Therapies, or IAPT, within the NHS, but there was a lot more that it could offer and add value outside of that specific pathway. And so, I joined the organisation to help scale it across the UK, Ireland and the rest of Europe,’ he explains.
Spun out of Trinity College Dublin in 2012, SilverCloud Health was one of the first digital mental health providers to launch in the UK and now provides digital mental health solutions to between 75% to 80% of NHS IAPT services.
However, the company’s reach extends far beyond IAPT. It currently has over 30 SilverCloud programmes and modules across the mental health spectrum from wellbeing, including sleep problems and money worries, to mild and moderate conditions as well as more complex mental health problems and addiction.
‘We can be the digital constant through someone’s life because all of us will face challenges from time to time in life. Some of those need a little bit more help and support to get through, some need less, so SilverCloud really provides that digital support when you need it,’ says Humphreys.
The company now has operations in the UK, Ireland, Germany and the growing US market, working with partners to deliver a ‘blended package’ of mental health solutions. In the UK alone, as well as working with the NHS, it partners with over 35 universities and higher education establishments, schools, housing associations, employers, insurers and third-sector organisations.
‘We don’t have a direct to consumer offering yet,’ Humphreys says. ‘And that was a very conscious decision for two main reasons. Firstly, we felt that the best way to achieve scale and to help as many people as we could, was to leverage existing networks to get SilverCloud into as many hands as possible, which is in line with our mission and our values.’
The second reason, he explains, is that many of the programmes are designed to dovetail with other services where users can access the support of a mentor, coach or therapist.
‘When we work with partners like the NHS, insurers or employee assistance programme providers, we know that they can provide that one-to-one support, where necessary, for people with mental health issues,’ he adds.
However, another advantage of this partnership approach is greater acceptance by existing services, which see the programmes as complementing rather than competing with more traditional therapy modes.
‘It fits very neatly in terms of traditional therapeutic approaches, so those people with mild to moderate psychological challenges can often go through the programmes on their own while those with more complex problems can access support,’ says Humphreys. ‘It slots into their therapist’s way of working so there isn’t the tension that can sometimes be seen in multi-agency solutions and digital therapy is viewed as very much part of the normal treatment pathway. And the research evidence shows that it has quite a significant kind of equivalence with other forms of therapy so we know that it is part of a package of care that can be used.’
There has been an explosion of digital mental health platforms in recent years as evidence builds of its efficacy in the treatment of mild and moderate conditions but, according to Humphreys, the potential benefits of digital in the treatment of more complex conditions is only just beginning to be realised.
‘Over the last 18 months to two years, we’ve seen a greater acceptance of digital as need increases against the backdrop of capacity constraints,’ he says. ‘People are starting to think, well, if SilverCloud is evidence-based in IAPT, where else can it add value? It’s no longer a question of whether it’s effective or not – we can see this from our randomised control trials, we can see this from our independent NICE evaluation – the question is not ‘is it useful?’ but ‘where else can it be useful?’’
To date, the company’s moves into complex care are relatively small in scale compared with its core offering, but it is making inroads. In North East London, it is being used as part of the psychotherapy service, including for complex presentations such as personality disorders. It has also developed a bipolar tool kit, which is used alongside traditional therapy to prevent relapse by detecting early warning signs and triggering interventions.
However, Humphreys believes one of the most innovative developments is in helping to support patients while they are waiting for specialist services.
‘When there’s a waiting list, SilverCloud can be used to help people get ready for therapy,’ he says. ‘We’ve seen that with Post Traumatic Stress Disorder, for example, where it can be used prior to traditional therapy to get people ready by building resilience and coping mechanisms, as well as getting them used to some of the tools and techniques they may need to use later on.’
At the other end of the scale, Humphreys says there has been a surge in interest in its resilience and wellbeing programmes since the start of the Covid-19 pandemic. Insurance companies and employers, in particular, have been keen to offer these digital wellbeing solutions at a time when employees and members are under heightened stress.
‘In terms of the wellbeing side we’ve seen a real shift,’ says Humphreys. ‘Traditionally, SilverCloud was used as part of treatment, often after a claim is made and the mental health need has been established. What we’re seeing now is that insurance companies are seeing SilverCloud as much more of a preventative wellbeing, value added, benefit for their members.’
There has been a lot of buzz around the digital healthcare revolution since the start of the pandemic as, like the rest of life, more and more services move online. Humphreys agrees that COVID-19 has accelerated the role of digital in healthcare provision, partly because rather than being overlaid on existing services, it has, in some instances, had to replace them. But while he believes it will be impossible to go back to how things were done pre-pandemic, he also thinks the age of digital was beginning to dawn long before coronavirus.
‘Digital therapeutics has really come of age over the last five years or so as the research evidence, the effectiveness and the value that it can offer has emerged,’ he says. ‘And so there has been growing interest for some time, but obviously with the pandemic the role of digital has become central to healthcare delivery paradigms.’
And with increased demand has come heightened interest from investors. In March, SilverCloud Health raised £13m in a Series B funding round led by MemorialCare Innovation Fund and including US healthcare groups LRV Health, OSF Ventures and Unity Point Health Ventures as well as existing investors ACT Venture Capital and B Capital Group.
‘It’s a vibrant sector and investors see us as one of the leaders in the field because of our breadth of programmes and the depth of our research. We are one of the most evidence-based and informed organisations of its kind, so that sets us apart from some of the newer market entrants,’ he says.
SilverCloud Health is using the funds to expand in its existing geographies, particularly North America, but also in Europe, where it is looking to work more closely with insurers. However, Humphreys says that while the company would not be averse to the ‘right acquisitions’, its focus remains on expansion via its tried and tested partnership models.
‘For us, making sure people can access the services as easily as possible is really important so that we can reach as many people as possible,’ he says. For example, we work with Express Scripts in the US – a pharmacy benefit management organisation with around 130 million members. We couldn’t reach those kinds of numbers on our own right now, but working with Express Scripts, we can. For us it’s all about coverage and scale. As a growing organisation, it’s about how we can deliver that efficiency of service delivery. Partnership is the best model for us right now, but who knows what the future might bring.’
However, one thing Humphreys is certain about, is that the already overstretched demand for mental health services is only going to increase in the wake of the pandemic as a ‘tsunami of mental health needs’ lags behind the immediate health crisis. And that will require a large-scale rethink of how services are delivered.
‘Mental health services have always been siloed. I think the power of digital is that it can break down the walls that exist in mental health and connect services together. So, what I hope is that we take a trans-diagnostic approach where diagnosis doesn’t matter, and we just provide help right across the board and continuity of care on a population basis. Digital mental health could lead to a shift towards more population based, trans-diagnostic and unified approaches to mental health care delivery. In terms of SilverCloud Health, growth for us will come in being able to drive and support that new approach.’