Using Digital Technologies for Health Promotion in Young People with Mental Illness

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People with psychotic disorders (such as schizophrenia) experience large inequalities in physical health; which is increasingly recognised as a human rights issue. In particular, there is a highly elevated incidence of cardiometabolic comorbidities, as psychotic disorders are associated with 2-3 fold risk of obesity, diabetes and cardiovascular disease compared to the general population. These physical comorbidities account for much of the ~20 year gap in life expectancy observed in this population, which is widening overtime. This poor physical health is attributable to a combination of antipsychotic medications (which have severe metabolic side-effects) and a range of adverse health behaviours, or 'lifestyle risk factors', including lack of exercise, poor diet, and high rates of smoking. Importantly, my previous research has shown these lifestyle risk factors are observed from very onset of illness (termed 'first episode psychosis', FEP). When combined with antipsychotic treatment, these risk factors cause the physical health of young people to deteriorate rapidly - which, in turn, further impedes their well-being and recovery while increasing the personal, social and economic burden of illness. Nonetheless, recent pilot studies (led by myself and others) have demonstrated that providing lifestyle interventions to young people with FEP can reduce cardiometabolic risk, and improve both physical and mental health outcomes. Unfortunately, the resource-intensive nature of individualised lifestyle interventions can impede the clinical translation and scalability of these approaches. Thus, new approaches are required to produce sustainable and scalable interventions for protecting metabolic health in young people treated for FEP. The NHS Five Year Forward view calls for fuller use of digital technologies to tackle unresolved issues in healthcare. Furthermore, reducing physical health inequalities and improving early intervention are both key priorities within the 'Five Year Ambitions for Mental Health' put. Alongside this, our upcoming Lancet Psychiatry Commission (which I led as Chair and first author) identified that mobile health (mHealth) may present novel opportunities for protecting metabolic health in young people with mental illness, given the high accessibility and acceptability of mHealth interventions in this group. To date however, there is a dearth of research in this area. Therefore, I will use this fellowship to examine how digital technologies can be used to protect the physical health of people with FEP, by targeting health behaviours in the early stages of illness. This will involve a strategic program of three work packages (including observational and experimental research), to produce 'first-in-field' findings, while also informing large-scale implementation studies and new technology development. First, I will conduct qualitative and quantitative studies with key stakeholders (including patients, carers and clinicians) to gain insights into optimal features/functionalities of health apps in youth mental health. Following this, I will conduct a range of experimental studies, empirically testing the usability and effectiveness of existing NHS-endorsed mHealth lifestyle interventions in young people with mental illness. Within this, I will also explore the potential benefits of adopting healthier lifestyles (as facilitated by mHealth technologies) for improving physical health outcomes and psychological well-being among young people with FEP. While completing these novel studies, I will also work with world-leaders in digital mental health interventions to develop bespoke lifestyle interventions for FEP, and evaluate their implementation with existing care systems. Collectively, this work will provide fundamental insights into the acceptability, efficacy and implementation of digital lifestyle interventions for protecting physical health and improving outcomes in young people with mental illness.