Innovation summary

Mental health problems are a significant issue for millions of people across the globe. The WHO estimates that depression will be the second largest cause of disability by the year 2020.1 As traditional approaches cannot be scaled up to meet this overwhelming need, new technologies are required to expand access and improve health outcomes at lower costs. Big White Wall aims to break down barriers to access by offering a scalable and integrated online service for community building, and connectedness - critical factors in supporting well-being, positive behavioral health, and engagement.

Big White Wall is a digital platform and community, which supports its members to self-manage their care with the collaboration and guidance of clinicians, caregivers and peers. It offers a range of therapeutic interventions including:

  • 24/7 clinically-moderated service and community
  • Creative self-expression and talk forums
  • Guided groups informed by recognized therapies
  • Tools for self-managing psychological distress
  • Networking based on peer support
  • One-to-one therapy via webcam, audio and instant messaging with experienced counselors and therapists 

Impact summary

  • Available to 29% of the UK adult population, and expanding in the US and New Zealand. 40,000+ members reached since 2007
  • 70% of enrolled members report improved wellbeing2
  • Recovery rates for BWW therapy services in the UK are 12% above national average, and 8% above national target3
  • Big White Wall is estimated to create up to £38,000 (U$54,800) in direct healthcare savings per 100 members with six month memberships in the UK4 

"The first mental health network where people can express themselves anonymously online without fear of being judged."

 

- The Times

​​

​​

Innovation details

Big White Wall is an award-winning, HIPAA-compliant digital behavioral and mental health support service. It offers personalized support and recovery pathways through a clinically-supported, professionally-facilitated, safe and secure digital platform. It combines social networking principles with a choice of clinically informed interventions to improve mental wellbeing.

Big White Wall has three main features:

Support Network

Moderated and facilitated by trained health professionals known as Wall Guides, the SupportNetwork is an anonymous community available online 24/7. It includes:

  • Clinically moderated peer support
  • Support through groups and on a one-on-one basis; talk forums
  • Tools for self-managing psychological distress and improving wellbeing
  • A range of self-help resources, information, and opportunities for visual and verbal self-expression
  • Ability to transfer relevant individual and aggregate assessment data, demographics and utilization data to key stakeholders

Guided Support

Modular programs, for groups or individuals, designed to address various health issues such as depression, anxiety, smoking cessation, alcohol consumption and weight management.

LiveTherapy

Online synchronous one-to-one therapy is available using audio, webcam and instant messaging, via a secure platform. Patients can choose a therapist from Big White Wall’s experienced therapist pool, or service providers can plug in their own clinicians via a white-label LiveTherapy platform. In the US, Big White Wall augments our partners’ telemedicine and EAP programs.

All members have access to the SupportNetwork and Guided Support, which are available 24/7. LiveTherapy is an additional service.

 

Key drivers

  • Key stakeholders’ willingness to embrace digital technology to increase access, and improve engagement and outcomes
  • Commercial viability
  • Reduces unnecessary demand on healthcare and social  services
  • Ready intervention; no wait list
  • Accessibility anytime, anywhere: laptop, smart phone, computer
  • Focus on both mental health and emotional well-being
  • Integration of physical and mental health concerns (for example in GuidedSupport programmes), as recommended by the UK National Health Service’s Five Year Forward View report in 2015
  • Close alignment with government and local objectives for healthcare
  • Innovative methods of data collection, aligned to payer and provider requirements

Challenges

  • Introducing a new concept to the healthcare market
  • Resistance from healthcare professionals, general practitioners, and family doctors (who may be more or less skeptical about digital services) of the value of digital health support
  • Demonstrating efficacy – which we addressed, for example, through involvement in Randomised Control Trials, and building partnerships and obtaining funding to set up these clinical trials
  • Demonstrating safety and good governance in a framework designed for face to face services, for example through registration with the UK Care Quality Commission
  • Integrating as a complement rather than a challenge to existing face-to-face services

Continuation

Big White Wall plans to scale its services to new settings and larger populations. The innovation is ready for use among other Anglophone populations, for example in USA, Australia, and Canada. Additional international markets may be explored by replicating the Big White Wall model in other languages.

Partners

In many cases, people can self-refer online into Big White Wall’s Support Network

People can also be referred and sign posted to Big White Wall by a variety of partners, including:

  • Primary care providers, mental and behavioral health specialists
  • Improving Access to Psychological Therapies (IAPT)referral workers (UK)
  • UK armed forces welfare workers
  • University welfare services
  • Health Plans
  • Third sector/voluntary organisations
  • Employer wellbeing services

Funders

  • Healthcare, military, university contracts (UK)
  • Auckland District Health Board (New Zealand)
  • Health plans, health systems, providers (US)
  • Independent funding bodies

Evaluation methods

External evaluation

Big White Wall is currently the subject of two randomised control trials: one on the SupportNetwork as a self-referral intervention at the Institute of Mental Health, University of Nottingham, UK, and one on LiveTherapy in IAPT (Improving Access to Psychological Therapies) at the Centre for Outcomes Research and Effectiveness, University College London.

Internal evaluation

Big White Wall also conducts frequent member surveys to evaluate impact, plus analysis of test scores in Guided Support and LiveTherapy, and web analytics.  

Cost of implementation

The cost of implementing the service is dependent on the target population, the integration design, and reporting requirements. Implementation costs can vary, and the per member per month/year costs are driven based on population size.

Using UK NHS costs of treatment, our initial figures suggest that in the UK, Big White Wall can create up to £38,000 (US $54,800) in direct healthcare savings per 100 members with six month memberships. This does not include any savings for physical health care, to social care, or to the wider economy. International cost-effectiveness assessments are ongoing. 

Impact details

Wellbeing gains:

  • 70% report improved wellbeing2
  • 46% report sharing an issue for the first time2
  • 58% recovery rate as a result of engagement in Big White Wall LiveTherapy2* (12% above national average recovery)*

Widening access to care, for the people who need it most

  • Over 40,000 people reached
  • Over two thirds of logins are outside business hours2
  • People with higher mental health need make more use of Big White Wall at night, when other services are less available. Among members who have taken PHQ9 (depression) tests, 40% of postings at 1am are from people with a score of at least 20, indicating severe depression. Only 20% of postings at 1pm are from people with a score of at least 203

This impact has resulted in designation of “High Impact Innovation” recognition by the UK National Health Service, in addition to being named the best EU ehealth solution in 2014, amongst numerous other awards.  

*Recovery is defined as moving from a PHQ (depression measure) score of 10 or above and/or a GAD (general anxiety) score of 8 or above to below these measures. The UK national average recovery rate for face-to-face therapy services is 46%, and the target is 50%

 

References

  1. World Health Organization. (2001)  Mental Health: A call for action by World Health Ministers.
  2. Big White Wall UK internal data, 2015
  3. Big White Wall UK internal data, 2015;
  4. Based on BWW UK member survey 2015, using UK National Health Service (NHS) cost of treatment figures 

Research

Multimedia

Reports

Comments

Submitted by James Martin on Wednesday, 3rd August 2016
I can't find any info, but has it been implemented in Australia? Thanks...

Submitted by Hung-Tat Lo on Wednesday, 16th May 2018
Is it limited to certain regions ? Do the professionals get paid?
How useful did you find this content?: 
0
Your rating: None
4
Average: 4 (1 vote)
Log in or become a member to contribute to the discussion.

Submit your innovation

Create your own page to tell the MHIN community about your innovation.

Country

New Zealand, United Kingdom of Great Britain and Northern Ireland, United States of America

Gallery

Similar content

node teaser-image

Community-based Sociotherapy Adapted for Refugees (COSTAR)

Using an adapted Community-based Sociotherapy approach to reduce depressive symptomology in Congolese refugees.
Region: 
Africa
Population: 
Adults
Humanitarian and conflict health
Disorder: 
Depression/anxiety/stress-related disorders
2794 reads
node teaser-image

TrustCircle: Helping Improve Emotional Resiliency and Well-Being for All

TrustCircle utilizes peer-centered mHealth & AI technology to improve emotional resiliency & well-being for all with focus on prevention & early intervention.
Region: 
Africa
Middle East
North America
Central America and the Caribbean
South America
Asia
Europe
Oceania
Population: 
Children and adolescents
Adults
Older adults
Families and carers
Disability
Disorder: 
All disorders
5078 reads
node teaser-image

Mental Health and Psychosocial Support (Phase II) in Palestine

Five year plan including deinstitutionalization, decentralization of care, redistribution of resources and integration of services
Region: 
Middle East
Population: 
Humanitarian and conflict health
Disorder: 
All disorders
2263 reads
node teaser-image

UNITY

Arts-based leadership training programme that supports and empowers youth to address the critical challenges facing them through positive and constructive outlets
Region: 
North America
Population: 
Children and adolescents
Disorder: 
Child behavioural and developmental disorders
1798 reads