Special Projects designs NHS app to treat patients with psychosis

Special Projects has redeveloped a “digital therapeutic” mobile and web app called SlowMo intended to help treat people with distressing psychosis alongside in-person therapy.

The first version of the app was developed five years ago by a team at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) at Kings College London (KCL), alongside the Helen Hamlyn Centre at the Royal College of Art. Dr Amy Hardy – who was the client for this project – led the team, which has now received £1.3m from charitable health research foundation Wellcome to fund the next stage of clinical trials in three NHS Trusts.

SlowMo was created as a solution to the limitations of current therapies, which may feature only intermittent face-to-face interactions and can take a long time to access. The app is designed to help patients to integrate the tools and new habits learnt in therapy into everyday life and act as a framework for therapists.

Special Projects became involved in the summer of 2022, after the app had obtained positive results from earlier clinical trials. The studio’s co-founder and director of technology Adrian Westaway says that Dr Hardy’s team “understood the value of human-centred design and had got it to a really great place” before Special Projects became involved.

He adds that the KCL team were “robust in their research”, providing the studio with beneficial insights to create the next version. Their research revealed that people suffering with psychosis might have “lower tech-literacy than average”, may be in financial difficulty, and may have an older smart phone. The research also found that one quarter of people with severe pyschosis did not own a smartphone at all. Special Projects had to ensure SlowMo was “as inclusive as possible”, with a programme and copy designed to be “accessible to all ages” through all phones, says Westaway.

While working closely with therapists at KCL, Special Projects also interviewed people with lived experience of psychosis, some of whom had tried the first version of the app. Westaway says that while the original version “understood user needs” and implemented the “core idea of using bubbles”, its simple structure meant it could do only “one or two basic things”. As well as updating the UI and UX design, Special Projects considered the various contexts in which SlowMo might be used.

“The goal of the app is to stop using it”

Unlike apps such as Headspace, it cannot be downloaded by anyone, but comes as part of a therapy programme and requires pre-approved access from a healthcare provider.

Initially the app is for use during therapy sessions to track progress and provide visual guides to session content, but the patient can also use it when they’re alone, at home or in public, when an episode might start.

In the app worries are represented by spinning grey bubbles, with safer thoughts in more colourful bubbles. With the new system designed by Special Projects, users can interact with the bubbles, changing the size to “represent the severity of the worry”, Westaway says, changing the opacity in relation to how true the user feels the worry to be, and altering the speed of rotation to match the user’s thinking. Safer thoughts then appear, aiming to shift the patient to a healthier thought pattern.

Video content on the app is meant to be watched with the therapist to help patients learn “a new way of thinking”, say Westaway. Patients or therapists can then bookmark specific videos, enabling the user to access selected content rather than having to download a lot of data, a choice linked to the client’s research into the financial circumstances and access needs of people living with psychosis.

Content can also be printed if patients cannot access a phone, but still want help on hand.

Westaway describes SlowMo as a “humbling project” with a few learning curves. “There were lots of times where, as designers, we’d try something but then find out that there were some really interesting psychological implications”, he explains.

The progress cards originally featured a line running upwards through them representing a patient’s progress, until Westaway learnt this could be “damaging for a person with psychosis”. The solution was a line that showed forward movement, with subtle ups and downs, representing the true nature of the therapy process. Similarly, Westaway was conscious not to include a reward or points system that might “adversely affect treatment”.

“The goal of the app is to stop using it” and cope without it, using what you’ve learned during therapy, says Westaway. Designing something from the perspective that “success means the user will not need it anymore” was a new concept for Special Projects, he adds.

“Approachable but not too playful” branding

Although not required for marketing purposes, SlowMo’s “approachable but not too playful” branding aims to help patients to “look forward to using it”, says Westaway. He adds that the app’s bespoke logotype takes influence from the rounded shape of a bubble but it has no logo mark or icon as the studio “didn’t want it to look too corporate”.

All fonts used are off the shelf as they had already been tried and tested in terms of legibility. SlowMo’s colour palette was also kept “quite sober”, says Westaway, with the occasional application of “iridescent colours” based on the hues reflected inside a bubble.

Patients can also personalise their experience by creating their own avatar in the app, with line-drawn illustrations by Cyrienne Buffet, who was commissioned by the studio.

In essence, the aim was to keep the branding simple but “friendly” because people would have a personal relationship with it, according to Westaway.

After the next stage of testing across three NHS trusts, the plan is to scale up across the NHS in the next five years.