Health July 7, 2019
A digital solution for anxiety and depression in children and young people

By Dr Nihara Krause - Accountable Care Journal

Recent research has confirmed a high prevalence of anxiety disorders and depression in children and young people (CYP). In fact, emotional disorders are the most prevalent psychiatric disorders experienced in childhood and adolescence and include; Generalised Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Phobias, Post Traumatic Stress Disorder (PTSD), Body Dysmorphic Disorder (BDD) and Major Depressive Disorder.

Emotional disorders affect self-esteem, interpersonal development and cause significant distress impacting on a child or adolescent’s general functioning and quality of life through to adulthood. Due to co-morbidity, they can be associated with a number of psychiatric conditions which lead to high use of NHS services. Anxiety disorders that start in childhood and adolescence often continue into adult life. The Adult Psychiatric Morbidity Survey (2016) indicates that depression and anxiety disorders affect 1 in 6 of the adult population.

Anyone who experiences an anxiety disorder will tell you how acutely disabling it feels. However, even with such high prevalence and impact, anxiety disorders are under-diagnosed and under-treated in the UK.

The NHS crisis in the provision of adequate mental health care is well publicised. Years of underfunding has resulted in mental health services being poorly resourced creating a bottleneck for treatment; the long wait for treatment is also likely to lead to more complex problems, which in turn, necessitates more specialist and longer-term intervention. The NHS is at breaking point, especially in Child and Adolescent Mental Health Services (CAMHS). stem4’s recent survey (2018) of 1000 GPs found that 90 per cent think that mental health services for young people are inadequate, with nearly all (99 per cent) fearing that children in their care could come to harm while waiting for specialist treatment.

Clear Fear App - Home

In such circumstances, the NHS has had to unofficially perform triage when it comes to crisis-level mental health conditions. As a result, CYP suffering from anxiety disorders lose out. Under current government funding proposals, new services to tackle rising mental ill health among children and young people are being developed, but the wait is long in the face of an urgent need for good-quality, comprehensive services. Even under these new funding proposals, it is unlikely that a robust programme for anxiety disorders will be rolled out in the near future. However, anxiety disorders are very responsive to early intervention in the form of evidence-based treatments such as CBT.

stem4: Using digital to tackle the problem

stem4 is a London based, teenage mental health charity I founded 8 years ago. It offers early detection through mental health education in secondary schools and digital intervention via smartphone Apps. Based on requests made by many students, and awareness of need observed in the course of my own clinical practice, I developed Calm Harm for stem4 in 2017, a mobile phone app to help young people manage their urge to self-harm. Calm Harm has met NHS Clinical Governance standards and is included on the NHS App Library. Incredibly, in the 18 months since its launch, Calm Harm has had over 900,000 downloads worldwide. It is mainly used by young people under the age of 19, and 93 per cent of them report that their urge to self-harm passed after each use of the app.

Clear Fear App - Dashboard

In 2018, based again on requests from young people, I developed Clear Fear for stem4, part funded by a Comic Relief and Paul Hamlyn Tech for Good grant. Clear Fear helps CYP manage symptoms of anxiety using the principles of CBT, providing tools to help negotiate challenges. It does this by offering relaxation training, self-monitoring and ways of challenging negative thoughts. It also harnesses the benefits of humour, provides inspirational quotes, examples of inspirational people, and endeavours to help find the ‘grit’ needed to keep going when the going gets tough. Released in December 2018, it is too early to comment meaningfully, but in five months there have been 30,000 downloads and is currently undergoing NHS App library approval.

While digital therapies should not be seen as a substitute for face-to-face engagement, assessment and treatment, a handful of studies confirm that online CBT is as effective as a face-to-face treatment for anxiety and depression. It, therefore, constitutes a first step in helping young people self-monitor and benefit from simple techniques for anxiety management. Calm Harm and Clear Fear may be of benefit to those CYP who do not reach the threshold for acceptance to services, for those who are on a waiting list or to use in conjunction with treatment. stem4 hopes to use app analytics as well as research data to further confirm effectiveness.

Dr Nihara Krause is a Consultant Clinical Psychologist and Founder and CEO at stem4. The Wimbledon Business Centre, 4 Queens Road, London SW19 8YB

Dr Nihara can be contacted at For more information about Clear Fear, click here.

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