The Overview
We partnered with the amazing Animorph Co-operative on an (Innovate UK funded) prototype that demonstrates how Extended Reality (XR) products might be used for relapse prevention for people with a diagnosis of bipolar, psychosis or depression.
The Brief
According to Bipolar UK, there are 1.3million people in the UK affected by bipolar disorder, as well as a further 600,000 people affected by psychosis and 3million by depression. The annual cost to the National Health Service (NHS) of managing bipolar disorder alone is estimated to be a staggering £2billion.
Additionally, after completing mental health therapies, service users often lack a compelling tool to keep their learning accessible. This can impact their ability to sense the early warning signs of a potential relapse.
Staying Well
Our Staying Well XR project, working with Animorph and Clinical Psychologist Dr. Fergus Kane, set out to understand whether mental health outlooks could be improved if Extended Reality (XR) tech was applied to an established staying well technique: the card sort exercise.
The card sort exercise helps people to reflect upon the events leading up to a recent episode and so recognise future signs of an emerging, potential relapse.
However, Dr Kane believed that traditional physical methods are not sufficiently engaging enough to support service users in carrying out the card sort on their own, and that there could be room to make their outputs more memorable. This would help people to better recognise their unique signs of a potential relapse.
XR to help prevent relapse
As part of our collaboration, Animorph Co-operative created an enhanced XR version of the card sort exercise. The aim was to:
- Create a more immersive, engaging and therefore memorable experience for service users
- Allow users to map the symptoms from a recent episode on a timeline in three-dimensional space
- To allow them to visually customise each feeling / symptom in this episode. For example, the size, colour, or give them “vibration” etc.
- Provide users with a way to save, update and share their early warning symptoms outside of the tool
Working with Animorph, Outlandish took on:
- user research with clinicians and people with lived experience of bipolar and psychosis
- usability testing of the XR prototype
- a feasibility report
- evaluating the software’s user experience
- analysing the product market
- and outlining a route to market for product adoption
Our Solution
A shot from our testing of an early alpha version of the Extended Reality tool, showing the user choosing between a range of common card sort symptoms in virtual space.
A shot from our testing of an early alpha version of the Extended Reality tool, showing the user choosing between a range of common card sort symptoms in virtual space.
A shot from our testing of an early alpha version of the Extended Reality tool, showing the user customising the visual and physical qualities of a symptom in virtual space and positioning them in time.
1. User Research
Our first activity was user interviews with service providers and service users. We hoped to identify whether an XR solution was logistically suitable, and to confirm whether or not it could properly address existing problems.
We established that:
- The card sort exercise can be triggering or upsetting, so it was necessary for any tool to be mixed reality (i.e. not purely Virtual Reality), so that service users could ground themselves, quickly ‘snap back’ to normality and feel more in control of their environment.
- There was some scepticism around tech and AR/VR…
- …. but it was something that was being explored in the health sector and both service users and providers were keen to explore how it could help
- A shareable output from the session was important to both user types
- A lot of emphasis was placed on the physicality of card sorting, so it was something that all users were keen for our solution to replicate as well as possible
User journey mapping
Using the research from our interviews, we created a User Journey map. This is a visualisation of the process that a clinician and a client have to go through to complete a traditional card sort. It identifies the typical experiences, emotions, pain points (and opportunities for improvement), as well as all the systems and processes that need to be in place to ensure the card sort happens.
Maps like these are useful tools for turning an experience into something understandable, and ours helped the team to spot opportunities for XR product features that could help improve upon the effectiveness of analogue card sorts.
A screenshot of the full user journey map, showing the systems that need to be in place for an effective card sort, and charting the emotional states of participants.
2. Usability Tests
Following these interviews, we summarised the feedback and prioritised changes for Animorph to make tin their development.
Following their amendments, we conducted some alpha usability tests with some lovely folks in Space 4. This really helped to provide some quick feedback for Animorph to make one final iteration, before testing with Dr Fergus Kane and several service users.
Here we broke the test down into three areas; Symptom selection, Shaping and visualising symptoms and Mapping symptoms on a timeline.
While there were some mixed reactions and users found the session triggering – mostly due to the tool being an MVP and a little buggy – all users said they would do it again, but would not want to shape all their symptoms.
3. Feasibility report & market research
Outlandish also undertook in-depth analysis of the digital market for bipolar and psychosis care products, and examined the potential of the Staying Well VR product to establish itself and meet the needs of clinicians and patients.
This analysis included a review of 121 existing products, producing a final report that covered:
- A competitor Review
- A dive into the spend in the B2B and B2C markets
- An overview of competing solutions
- A product feature comparison
- Commercialisation recommendations
- Ways to establish and build the early market
An example visualisation from our report, showing just 6% of mental health tech funding going into bipolar products. This is exclusively going into the business-to-consumer space.
Our key findings included:
- Investment Trends: Based on the 121 products we reviewed, the wider mental health tech market is robust, with over $1 billion invested in B2B products and $1.2 billion in B2C products. However, of the products we reviewed only 6% of this funding goes towards products explicitly for bipolar, psychosis, or relapse prevention – and this is all in the B2C market, indicating a significant gap in the B2B market.
- Virtual Reality (VR) and Augmented Reality (AR): Meanwhile, there is considerable investment in VR/AR technologies in the mental health space, but none of the VR products we found cater to bipolar, psychosis, or relapse prevention.
- Demand for Bipolar Products: The B2C market however demonstrates a notable demand for bipolar-related products, with the 16 B2C apps in this area installed over 2.8 million times on Android devices alone.
- Common Functionalities: Popular B2C products we reviewed included tracking/diary features and signature profiles, with the most downloaded ones being developed alongside therapists and featuring coping strategies for their users.
- Staying Well Product Analysis: Following this, to help secure product-market fit, Staying Well should incorporate signature profiles and coping strategies, and its marketing should emphasise its co-design with therapists.
- Competitive Landscape: Staying Well stands out from competing B2B and B2C solutions due to its VR delivery, therapist collaboration, and personal signature profiles.
- Commercialisation Strategy: We propose a phased approach to market entry, starting with establishing Staying Well as a non-medical Tier B device (to speed time to market), engaging with early market segments (Innovators and Early Adopters), and proceeding through various phases of network engagement, codesign, innovation support, and industry events.
- Challenges and Opportunities: The fragmented mental health market, especially in the B2B sector, offers both challenges and opportunities. We suggest targeted strategies for Staying Well, including focusing on regional NHS Trusts and Integrated Care Systems, and leveraging charity-funded pilots and partnerships to build evidence and the early market.
In conclusion we found a significant market opportunity for Staying Well, especially in the B2B segment for bipolar and psychosis.
Our feature comparison matrix of digital bipolar products.
Next steps
Staying Well is a fascinating prototype and we’re proud of our work with Animorph – and it was great to work first-hand with users with such a clear need, on a challenge that is so impactful yet also under-addressed by current provisions.
Our market and product feasibility report has been submitted to the Innovate UK team, and we look forward to the response. In the meantime, we’re going to continue to consider ways that digital card sorting can be used to better help people with a bipolar diagnosis.
Cover image by Maxim Tolchinskiy on Unsplash
In content image by Adrian Deweerdt on Unsplash
