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NICE Recommends Digital CBT for Children and Young People

In its first rapid health technology guidance the National Institute for Health and Care Excellence (NICE) has recommended digital mental health technology for children and young people.

Last year, in its report, The mental health of children and young people in 2022, NHS Digital said that in 2022 1 in 4 teens aged 17-19 has a probable mental health disorder – up from 1 in 6 in 2021.

Earlier this week, the Department for Education published its State of the nation 2022: children and young people’s wellbeing report, and highlighted that "anxiousness" among pupils appeared to have worsened during the 2021/22 academic year, and that rates of probable mental disorders and eating problems among young people in England remained at "elevated levels" compared with before the pandemic.

"It's deeply worrying to see that as many as a quarter of young people aged 17-19 are now experiencing a mental health problem, up from 1 in 6 in 2021 and 1 in 10 in 2017," said Interim CEO for the mental health charityMind, Sophie Corlett.

Olly Parker, head of external affairs at YoungMinds, said that the figures demonstrated the "unprecedented crisis" happening in young people's mental health, and pronounced the increase in the number of young people now having a probable mental health problem as "staggering".

"The mental health needs of young people are increasing rapidly - 1 in 6 young people aged 7-16 are currently facing a mental health problem," said Gemma Byrne, head of health policy and campaigns at Mind.

CBT-Based Games, Videos, and Quizzes

In its announcement, NICE explained that four digital technologies that can help children and young people with mild to moderate symptoms of anxiety or low mood have been recommended for use in the NHS.

The four self-guided products offer a mix of games, videos, and quizzes, based on cognitive behavioural therapy (CBT) principles. They are:

  • Lumi Nova (BfB labs)
  • Online Social anxiety Cognitive therapy for Adolescents (OSCA)
  • Online Support and Intervention for child anxiety (OSI)
  • Space from anxiety for teens, space from low mood for teens, space from low mood and anxiety for teens (Silvercloud)

They aim to help children and young people learn techniques to better understand and manage their symptoms of anxiety or low mood, underlined NICE.

"The guided self-help digital CBT technologies can be used as an initial treatment option for those aged 5 to 18 while evidence is being generated," NICE said, and "will be able to be used once they have been given Digital Technology Assessment Criteria (DTAC) approval by NHS England".

This topic is the first to be published as final early value assessment (EVA) guidance, new NICE guidance that provides conditional recommendations on promising health technologies that have the potential to address national unmet need, and that can be used within the NHS while further evidence is generated to enable earlier access for patients. NICE guidance will then be reviewed to include this additional evidence and make a recommendation on the routine use across the NHS.

Early value assessment guidance is expected to take around 6 months to produce - quicker than the current time scale for NICE medical technologies guidance, applauded NICE.

Mark Chapman, interim director of medical technology and digital evaluation at NICE, said: "Patient experts told our committee that mental health services are in high demand, access varies widely across the country, and there is an unmet need when it comes to receiving treatment while on waiting lists to see specialists. These four technologies offer low risk options to children and young people who need to begin treatment as soon as possible."

An initial assessment with a healthcare professional is needed before using these technologies to make sure they are suitable, and children and young people are then checked on a regular basis. Those using the technologies will have regular support from a healthcare professional, and safeguarding and risk management processes must be in place, explained NICE. "This means that if the treatment is not working and symptoms are getting worse, it will be identified quickly, lowering the risks to the child or young person", reassured the regulator.

Children and Young People Appeal

NHS Digital's report, Psychological therapies: Annual report on the use of IAPT services, England 2021-22, showed that the number of people accessing talking therapies through the NHS for conditions such as anxiety and depression had increased by over one fifth (21.5%) from 1.02 million in 2020-21 to 1.24 million referrals in 2021-22.

Ms Byrne pointed out that “the earlier a young person gets support for their mental health, the more effective that support is likely to be”. However: "Young people are still left facing an agonising wait in a system that cannot keep up with demand," she said.

The four technologies could offer a useful additional treatment option for around one million children and young people who may not be able to access current treatment or are on a waiting list and so are not currently in treatment.

Digital CBT is delivered via mobile phones, tablets, or computers, and can be accessed remotely. It offers flexible access, greater privacy, increased convenience, and increased capacity, and may be particularly appealing to children and young people who are typically regular users of digital technologies, such as smartphones and tablets, highlighted NICE.

Early evidence suggests that digital CBT technologies may improve symptoms of anxiety for children and young people with mild to moderate symptoms of anxiety or low mood, explained NICE. It went on to suggest that earlier treatment could reduce the demand on other treatment options such as face-to-face CBT and potentially prevent progression to more severe symptoms, which could be more costly to treat.

Into the Hands of Those Who Need It

"Digital mental health tools offer millions of people vital support and guidance to explore and help manage their mental health issues every day," said Johan Ordish, head of software and artificial intelligence at the MHRA. He pointed out, however, that there are a number of "regulatory complexities" in establishing when these products should be regulated and what evidence they must have to demonstrate safety and effectiveness.

Last year, Medicines and Healthcare products Regulatory Agency (MHRA) and NICE  welcomed £1.8 m in funding to explore the regulation of digital mental health tools. Although these online tools can be helpful for people experiencing mental health problems, the MHRA said they "present regulatory challenges", such as clarity around whether they are medical devices and, if so, which "risk classification" they fall under.

Mark Salmon, programme director for information services at NICE, said that this project can help the MHRA and NICE "simplify and streamline" the process of getting wide-scale adoption of "safe, clinical, and cost-effective" digital mental health products "into the hands of the people who need them".