Meet the company that brought online therapy to the British National Health Service

The only behavioral and mental health therapies that work are ones that are used by patients.

Patients treated for depression and anxiety with cognitive behavioral therapy (CBT) get much better results when they are fully engaged in the treatment, studies show.

But patient dropout from CBT is a serious problem. A meta-analysis of studies involving nearly 21,000 patients that was published in 2015 in the Journal of Clinical Psychology found 16% of patients prescribed CBT dropped out before beginning treatment, and another 26% dropped out during the course of their therapy.

Psychiatrists and counselors have been experimenting with online forms of CBT to come up with a solution. But a 12-year research project by Trinity College Dublin and Mater Misericordiae University Hospital in Dublin showed online CBT solutions came up short.

“You would see results when they were delivered in laboratory situations – the results seemed positive and encouraging,” said Ken Cahill, co-founder and CEO of SilverCloud, which has developed an online CBT program. “But the reality was when they were actually delivered in real-world deployments they fell very, very short.”

Cahill said the research findings were instrumental in designing SilverCloud Health's online CBT platform, which was launched in 2012. Their program attached a user-friendly, CBT interface to evidence-based content developed by therapists and publishers at Wiley, the University of Central Florida, Boston University, and Stanford University.

SilverCloud developed an online tool composed of personalized, interactive programs that allow the user to work at their own pace. It's backed by experts who are immediately available online to discuss issues like depression, anxiety, eating disorders and obsessive compulsive disorder.

Modules consist of 30 to 40 minute sessions that can be completed over an 8- to 10-week period. An online supporter is available for patients to contact when needed.

The United Kingdom's National Health Service became an early adapter of SilverCloud's online approach, which now provides half the NHS' mental health services. The median age of platform users is 49, but the age range of the audience is anywhere between 17 and 74, according to Cahill.

Though the bulk of the patients the program treats are those with mild to moderate mental health issues, a growing number of health organizations are looking to deploy SilverCloud to treat patients with more acute mental health conditions. It's used as an adjunct to in-person visits.

“Some aspects of quality, particularly fidelity, can be more readily maintained with online and computerized CBT programs than with in-person visits,” said Dr. Isabelle Rosso, director of the Anxiety and Traumatic Stress Disorders Laboratory at McLean Hospital in Massachusetts. “In the case of depression, only about a quarter of patients in face-to-face treatment receive at least minimally adequate care, and about half of people experiencing depression do not receive any form of treatment. - empirically-supported online CBT programs offer the potential for reliable access to care that meets evidence-based treatment guidelines.”

SilverCloud's program is versatile. It fits easily into the workflow needs of healthcare organizations, whether large or small.

“Each one is unique, but typically the bell curve is quite the same,” Cahill said. “About 95% of deployment is the same.”

A customer implementation plan developed with a client before deployment allows a healthcare organization to customize its program content. Clinical staff are encouraged to review and approve what's presented on the platform before deployment.

In addition, clients can monitor the success of program by tracking if and where patients drop out. That feedback allows the company to change its approach for that particular client.

“This is about hearts and minds on both sides,” Cahill said. “We're trying to deliver something for the patient, but the clinician has to believe in this too."

At NHS, where primary care physicians can now routinely prescribe online CBT, over 50% of patients using the platform require no further treatment after 6 to 8 weeks. “That's just such a huge benefit in terms of reducing costs of care delivery,” Cahill said.

Since its launch, SilverCloud has been deployed in more than 110 organizations, including universities, employers, insurers, pharmaceutical firms, and both public and private healthcare providers. It is rolling out its technology at 12 U.S. healthcare systems this spring and plans to be in 15 academic medical centers within the next few years.

Illinois-based OSF HealthCare is in the final planning stages for deploying SilverCloud at six primary care sites, which make up about 20% of the provider's total primary care volume. The push coincides with the health system's move to embed a behavioral healthcare specialist in all its primary care clinics.

“I think of that technology as something of a bridge,” said Matthew Warrens, vice president of Innovation Partnerships at OSF. “It doesn't stand alone, it gets partnered with those human assets we're putting in place.”