A mental health app, designed to help manage negative emotions and periods of extreme anxiety for young people, could have a significant impact on reducing self-harm according to research.

The BlueIce app, developed in conjunction with patient groups by leading clinical psychologist Professor Paul Stallard, is now included in the national NHS app library. BlueIce, is a prescribed app and designed to be used alongside traditional face-to-face therapies.

A series of research papers published in the Journal of Medical Internet Research (JMIR) suggest that BlueIce could help tackle self-harm, the hidden health challenge affecting many young people. Off the back of this, in September 2019 Professor Paul Stallard started a randomised controlled trial to monitor BlueIce's impact on self-harm to see if it reduced the number of young people needing to attend Accident and Emergency (A&E) Services.

BlueIce app

BlueIce is named to be discreet. Although it does not directly mention self-harm, BlueIce refers both to low mood (blue) and ‘in case of emergency’ (ice). It consists of three parts:

• mood monitoring
• mood lifting
• routing to emergency numbers

Through it, young users monitor their mood each day, recording how they are feeling. If their mood is low, they are automatically routed to the mood-lifting section which includes evidence-based ideas from Cognitive Behaviour Therapy (CBT) and Dialectical Behaviour Therapy (DBT).

CBT helps users re-evaluate and develop alternative, more helpful ways of dealing with distressing thoughts whilst DBT helps them to tolerate their distress without self-harming. This section is personalised by the user to capture helpful ideas and materials such as activities which make them feel good, including an uplifting music library or a photo-gallery of good times.

The app includes audio relaxation and mindfulness guides and opportunities to record and challenge any destructive or distressing thoughts. Ultimately, and if necessary, the app can route users through to emergency contacts including Childline and the 111 service.

Using technology to improve mental health

Paul Stallard, Professor of Child and Family Mental Health in our Department for Health and Head of Psychological Therapies for Oxford Health NHS Foundation Trust developed the App. Professor Paul Stallard explains how the idea came about:

'The idea for BlueIce emerged from my work with CAMHS in Oxford. Many of the young people I was working with were self-harming but nearly all had their mobile phone close by. Our young people’s participation group at Oxford Health NHS Foundation Trust thought that a smartphone app could be a way of helping at times of distress and with their input we produced BlueIce.

'BlueIce is a prescribed app to be used alongside traditional face-to-face appointments with a child and adolescent worker. It helps the young person to monitor and manage their unpleasant emotions and to find alternative ways of coping. Feedback from young users has been overwhelmingly positive, and there’s a huge potential for it to make a difference to young lives across the UK and internationally.'

Reducing self-harm

Self-harm is common among adolescents and is associated with a higher risk of suicide. Up to 18% of adolescents will engage in an act of self-harm. Nearly all self-harm occurs in private.

Recent years have seen a significant increase in the availability of smartphone apps for mental health problems. Despite their proliferation, very few apps have been developed for and with young people, and almost none have been subject to any form of evaluation.

The NHS library contains apps that have gone through both clinical and technical reviews. BlueIce is one of only 20 mental health apps to meet the rigorous standards for national endorsement on this library.

Analysing the impact of BlueIce at 12 weeks on a group aged between 12 to 17 years, Professor Stallard and the research team found that three quarters of the young people assessed either stopped or reduced their self-harming as a result of the app.

Making an impact

BlueIce is the only self-harm prevention app for children and young people recommended in the NHS Health Education England self-harm and suicide competence framework for good clinical practice.

BlueIce is now available to Child and Adolescent Mental Health Services (CAMHS) across the UK. It has been prescribed by CAMHS in Bath & North East Somerset, Buckinghamshire, Cambridgeshire, East London, Manchester, Oxfordshire, Peterborough and Wiltshire to 2,520 young people with serious, repeated self-harm.

Following a collaboration with the Murdoch Children's Research Institute in Melbourne Australia, BueIce is available for download through the Australian App Store where it has now been downloaded 2,760 times. An evaluation of the BlueIce app has also been published.

BlueIce won the Innovation in Digital Health Award at the 2019 National Positive Practice in Mental Health Awards and it was also highlighted as outstanding practice by the Care Quality Commission in a recent inspection.

It is hoped the development and rollout of BlueIce can become an important element in upcoming government strategies covering mental health and suicide prevention, as well as the wider NHS digital health drive.

Work for this project is funded by the National Institute for Health Research (NIHR), independent charity Health Foundation and NHS Digital.