Close to 1 in 7 people suffer from a mental health condition , a leading cause of disability globally .
However, 75% of people with mental illnesses do not receive any treatment , highlighting the issue of access to mental healthcare, which has only been exacerbated by Covid.
The shortage of trained professionals in mental healthcare is a key contributor to the issue of access . Patients are faced with long waiting queues to receive care , with no promise of quality care, given clinicians’ heavy caseload . It is not uncommon that patients only receive 5 mins of clinicians’ time after months of waiting for the appointment . Indeed, a large study by Elsevier Health (2022), involving over 2800 clinicians and nurses from 111 markets, found that almost 1 in 2 of clinicians globally (69% in Europe) admit that time they are able to devote to each individual patient is insufficient “to give them good care” .
Clearly, there are plenty of opportunities to improve patients’ access, speed to, and quality of care globally. Promisingly, the same study found that over half of the clinicians (56%) state that patients have become more empowered to manage their own conditions, and that clinicians (62%) expect a change in role towards being more in partnership with patients over the next decade. Given that mental health costs a whopping $16 trillion to the global economy by 2030  and growing, there is an urgent need for solutions that are designed to tackle these issues in a scalable and cost-effective way.
The use of digital technology offers the potential to address this matter. In particular, the use of digital platforms for remote patient monitoring and health assessment could improve access and speed to care, and real-time patient analytics could enable personalised treatment and improved quality of care . Ultimately, to fully benefit from such technology, patient data needs to be managed securely, the design of the solution should focus on the needs of its users, and it should be continually assessed on its ability to deliver value to patients and clinicians.
Monsenso is a digital health company that enables better outcomes for patients and clinicians through data-driven decisions. We are focused on mental health and user-centred in designing our solutions for patients and clinicians. Our cloud-based platform is a CE-marked medical device (Class 1, pending Class 2a and MDR certification) that is HIPAA compliant, with certifications in ISO 13485, ISO 27001, Cyber Essentials, and TGA. Our solution has been clinically and scientifically validated by over 70+ peer-reviewed studies and can be configured for applications across mental health conditions. We work with healthcare systems, life sciences, and research organisations globally. To learn more, visit www.monsenso.com
 World Health Organization (2020). World Mental Health Day: an opportunity to kick-start a massive scale-up in investment in mental health.
 Wainberg, M. L., Scorza, P., Shultz, J. M., Helpman, L., Mootz, J. J., Johnson, K. A., Neria, Y., Bradford, J. E., Oquendo, M. A., & Arbuckle, M. R. (2017). Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Current psychiatry reports 19(5): 28. https://doi.org/10.1007/s11920-017-0780-z.
 Marchildon, J. (2020). 4 Barriers to Accessing Mental Health Services Around the World.
 Elsevier Health (2022). Clinician of the Future Report 2022.
 Royal College of Psychiatrist (2020). Two-fifths of patients waiting for mental health treatment forced to resort to emergency or crisis services.
. Becker, G., Kempf, D.E., Xander, C.J. et al. (2010). Four minutes for a patient, twenty seconds for a relative – an observational study at a university hospital. BMC Health Serv Res 10(94).
 Lancet Commission. (2018). Report: Mental illness will cost the world $16 trillion (USD) by 2030. Mental Health Weekly 28(39): 1–8. https://doi.org/10.1002/mhw.31630.
Self-care for mental health means that individuals should develop a healthier lifestyle by paying careful attention to their diet, exercise, and sleeping habits. A person’s lifestyle can have a significant impact on how their mind and body respond to a mental health treatment plan.
Stress can be defined as the brain’s response to any demand. Many situations can trigger this reaction, including change. It is important to learn to recognise the symptoms of stress which may include: difficulty sleeping, increased alcohol and other substance use, being easily angered, feeling depressed, and having low energy. 
The following activities may help individuals cope with stress:
- Set priorities. Decide what must get done and what can wait, learn to say no when it’s necessary
- Avoid dwelling on problems
- Schedule regular times for relaxing activities
- Explore stress coping programmes, such as meditation, yoga, or tai chi 
Exercise is one of the most efficient ways to improve a person’s mental health. Studies show that exercise can treat mild to moderate depression as effectively as antidepressant medication. Besides, it is a natural and effective anti-anxiety treatment. It relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins. 
A person can experience the physical and mental health benefits of exercise with just 30-minutes of moderate exercise a few times a week, and in some cases, two 15-minute or even three 10-minute exercise sessions can also work. 
Eating high-quality foods that contain lots of vitamins, minerals, and antioxidants nourishes the brain and protects it from oxidative stress — the “waste” (free radicals) produced when the body uses oxygen, which can damage cells. 
On the contrary, diets high in refined sugars are harmful to the brain. In addition to worsening your body’s regulation of insulin, these diests also promote inflammation and oxidative stress. Multiple studies have found a correlation between a diet high in refined sugars and impaired brain function — and even a worsening of mood disorders symptoms. 
Tips for healthy eating:
- Prepare your own meals
- Eat with moderation
- Reduce sugar intake
- Eat a mix of lean protein, whole grains and colourful fruits and vegetables on a daily basis
There is a close relationship between sleep and mental health. Over an extended period, a severe sleep problem could make an existing mental health issue worse.
- Establish a routine by going to bed and waking up at roughly the same time every day
- Feel comfortable. Ensure the temperature, light, and noises levels are right
- Stop any stimulating activities, such as working or doing exercise, and avoid looking at screens (phone, a computer, tablet, or TV) for one hour before going to bed
- Don’t try to force sleep. If it’s difficult to sleep, get up, go to another room and try to relax
- Avoid large meals, drinking too much water and stimulants such as alcohol, caffeine and nicotine during the evening 
The Monsenso smartphone app for mental health
The Monsenso smartphone app for mental health is an excellent tool to support self-care. It can help individuals with a mental illness to self-monitor by filling in daily self-assessment on their smartphones that indicate their level of stress, physical activity, anxiety, the number of hours they slept, and if they took their medication. It also tracks sensor activity such as physical activity, mobility and phone usage.
The smartphone app can be configured to notify users and their primary health care provider if they present any triggers and warning signs, which means that the system identifies some of the person’s behaviours that are likely to cause a relapse. If this is the case, the smartphone app also provides users with customised action plans that can be used when their symptoms appear so they can take action. By using the Monsenso smartphone app every day, individuals can monitor their progress over time and learn to avoid the behaviours that trigger their symptoms.
In addition to this, all the information captured by the individual’s smartphone is synchronised with the user’s primary healthcare provider in real-time; therefore, when a person is called for a consultation, the dialogue is facilitated by the information in the system. To learn more about the benefits of the Monsenso app for Individuals click here. If you want to learn more about the benefits for clinicians, click here.
 Fact Sheet on Stress. National Institute of Mental Health
 The mental health benefits of exercise. HelpGuide.org
 Nutritional psychiatry: your brain on food. Harvard Health Publications. Eva Selhub. 16 November 2015.
 How to cope with sleep problems. Mind.org
According to Gartner, in 2015, smartphone sales reached 1.4 billion units , and in the first quarter of 2016, they represented 78% of total mobile phone sales. 
A new report by the IMS Institute for Healthcare Informatics revealed that there are now more than 165,000 mobile health apps on the market. Nearly two-thirds are focused on general wellness issues like fitness, lifestyle, stress, and diet. The remaining third consists of apps focused on specific health conditions (9%), medication info & reminders (6%), and women’s health & pregnancy (7%). Mental health apps led among disease-specific apps, followed by diabetes. 
Nevertheless, with telemedicine, mobile health (mHealth) solutions, and wearable devices, the future of better patient engagement is certainly favourable.
During the last few years, the development of wearable devices that can track heart rate, blood pressure, calories and step-counters have experienced an enormous growth. This type of technology is revolutionising the level of patient engagement by proving individuals with an accessible platform to monitor their progress; information that until now was not available.
Nowadays, patients are increasingly looking for health information online, including their medical records. They request access to information and tools to take control of their health. To make this possible, clinics and patients can use a software platform that allows them to share information with each other while keeping the information safe.
Mental health care is not an exception. Now, more than ever, individuals want to be involved in their treatment. Up until a few years ago, patients with a mental illness, had a very passive role in their treatment. They were required to attend weekly consultations, take their medication every day and report their symptoms to the clinician at their next consultation.
The Monsenso mHealth platform empowers patients suffering from mental and behavioural illnesses, to take control over their illness and play an active role in their treatment.
The Monsenso platform helps individuals and clinicians to monitor the illness symptoms and mood patterns continuously. It also helps them handle their medication, as well as to recognise behavioural trends and early warning signs (EWS). 
Based on self-reported and automatically collected sensor data, it provides timely feedback to the patient, therefore, increasing illness awareness. By using it on a daily basis, it provides insights into the illness progression. These types of personal health technologies have the potential to apply machine learning techniques that can monitor and learn to recognise a patient’s circumstances and state and supply personalised context-appropriate clinical responses. 
Furthermore, clinicians need truthful information to offer better-quality treatment to their patients and assist in their recovery. Traditionally, psychiatrists provide patients with paper-based self-assessments. However, on a clinical study made with bipolar patients ranging from 18 to 65 years old, the raw adherence percentage of paper-based self-assessment is 58%. 
Most of the time, patients forgot to complete these assessments, and most people filled them out while sitting in the waiting room. This process generates a problem since most individuals couldn’t remember with certainty how they have felt since their last appointment.
Besides, clinicians may become distracted with paper-based self-assessments during the consultation. At the same time, they are required to interpret the self-assessments and enquire about the patient’s wellbeing. Likewise, once the consultation is over, the self-assessments are probably stored in a patient’s file and seldom retrieved.
On the other hand, recent research shows that the adherence rate of self-assessments when using the Monsenso smartphone app is 88% , making it a more reliable source of information.
The Monsenso system is much more than an mHealth platform; it is a personal technology solution that simplifies the continuous monitoring of critical patients, provides a historical overview of a patient’s condition and underlying behaviour. Furthermore, it also offers patients a list of self-help tools facilitating patient engagement and empowering them to become self-aware.
For example, improving illness awareness is vital to the treatment of individuals suffering from bipolar disorder. It is critical that patients monitor their mood and have a good action plan that helps them cope with their risk situations; this helps patients to manage their illness .
During the last few years, we have witnessed the development of wearable devices, mHealth solutions, and personalized medicine. Once mental health care providers widely adopt this technology, it will enable them to improve patient engagement. MHealth solutions like the one offered by Monsenso, allow clinicians to provide better-quality treatment based on accurate, real-time data.
The smartphone self-assessments helps patients become more aware of their condition as it helps them identify and learn more about their personal triggers and early warning signs. Furthermore, the information collected by the smartphones facilitates and speeds up the dialog between patients since symptoms and early warning signs can be discussed immediately.
 Gartner Says Worldwide Smartphone Sales Grew 9.7 Percent in Fourth Quarter of 2015. Gartner. (2016, February 18)
 Gartner Says Worldwide Smartphone Sales Grew 3.9 Percent in First Quarter of 2016. Gartner. (2016, May 19)
 New report finds more than 165,000 mobile health apps now available, takes a close look at characteristics & use. Satish Misra, MD. iMedicalapps. (2015, September 17) http://www.imedicalapps.com/2015/09/ims-health-apps-report/
 The MONARCA a Self-assessment System: A Persuasive Personal Monitoring System for Bipolar Patients. J. E. Bardram, M. Frost, K. Sz´ant´o, G. Marcu, in: Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium, IHI ’12, ACM, New York, NY, USA, 2012, pp. 21–30. doi:10.1145/2110363.2110370.
 Supporting Disease Insight through Data Analysis: Refinements of the MONARCA Self-assessment System. M. Frost, A. Doryab, M. Faurholt-Jepsen, L. V. Kessing, J. E. Bardram. Proceedings of the 2013 ACM international joint conference on Pervasive and ubiquitous computing, UbiComp ’13, ACM, New York, NY, USA, 2013, pp. 133–142. doi:10.1145/2493432.2493507. URL http://doi.acm.org/10.1145/2493432.2493507
 Designing Mobile Health Technology for Bipolar Disorder: A Field Trial of the MONARCA System. Bardram, Jakob E., Frost, Mads, Szántó, Károly, Faurholt-Jepsen, Maria, Vinberg, Maj and Kessing, Lars Vedel. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, pages 2627-2636, New York, NY, USA, 2013.
 Increasing Awareness, Insight and Adherence in Treatment of Bipolar Disorder through Personal Health Technology: Pilot Study. Mads Frost, Maria Faurholt-Jepsen, Afsaneh Doryab, Lars Vedel Kessing and Jakob E Bardram. Paper submitted for review to JMIR Mental Health (JMH), 2015.
A new survey by Accenture revealed that 54% of consumers would like to use their smartphones more to interact with healthcare providers. Unfortunately, most healthcare providers have failed to adapt to their patients’ needs. Consumers complain that most apps offer a poor user experience, and they fail to meet their needs.
As digital patient engagement becomes the norm and consumers become unhappy with their care providers’ lack of mobile services, they may look for alternatives. Care providers need to meet consumer expectations by adopting mobile technology and improving the overall user experience.
The Accenture survey identified that although 66% of the largest 100 US hospitals have mobile apps for consumers, less than 40% of that subset have developed their own.
Unfortunately, merely having a mobile app is not enough. Often, healthcare providers fail to engage consumers with these apps due to poor functionality and poor user experience. The survey revealed that hospitals are engaging successfully with just 2% of patients!
Patient-centred apps published by disruptive innovators are gaining traction in the market by fulfilling the users’ demand. These disruptor apps are focusing on functionality and user experience in line with the patients’ needs.
Technology slackers pay the price
The Accenture shows that around 7% percent of patients have switched healthcare providers due to poor customer experience. This is the same level of customer dissatisfaction as seen with hotels and telephone service providers, and according to Accenture, these losses represent over $100 million in annual revenue per hospital.
As consumers bring their service expectations from other industries into healthcare, care providers are likely to see higher switching rates, on par with the mobile phone industry, cable TV providers, or even retail.
Nevertheless, the rewards are clear for those who get it right. According to a survey by RBC Capital Markets, between 55% and 69% of users who use online health tools reported increased satisfaction.
Today’s consumers expect to interact with their care providers digitally, and most of them are being let down. As a result, in the increasingly competitive healthcare market, providers that ignore mHealth technology today could lose valuable customers to the competitors who adopt this technology.
Partnering up with technology innovators
Inpatient experience and mobile engagement are both part of the holistic patient experience that can lead to customer retention or switching.
MHealth technology can help care providers succeed in an era of individualized healthcare, where patients are empowered to help manage their own care. To improve customer satisfaction, care providers should create a better user experience tailored to the functionality demanded by patients. Care providers should partner with technology companies presenting innovative solutions to create a mobile platform that is tailored to their specific patient needs. For example, partner with ZocDoc for appointment scheduling, InstaMed Go for bill payments or Monsenso to support the treatment of mental illnesses.
Losing patience: Why hospitals must revive their digital health strategies.
Over the last few decades, there has been a shift in the way we think about mental illness, particularly schizophrenia. Until quite recently, schizophrenia was considered as an illness with a poor prognosis, offering little hope of living a fulfilling life. However, over the last two decades, research has shown that early and appropriate intervention can change the course of mental illnesses such as schizophrenia.
Schizophrenia was previously considered a shattering illness because it usually appears during the late teens or early twenties. At this point in life, young people are finishing their education or entering the workforce, exploring romantic relationships, and becoming independent. Disrupting this normal developmental trajectory, rather than the symptoms of the illness alone, is what has such a severe impact on young people suffering from schizophrenia.
However, studies have revealed that schizophrenia doesn’t appear suddenly; it usually has an onset after a long period of severe symptoms. Certainly, much of the disability associated with psychotic illnesses develops before the first episode of illness.
In the early 1990s, researchers conducted the first studies of early intervention in psychosis, and the results revealed that early and appropriate treatment led to better long-term outcomes for young people. This work resulted in the discovery that early and adequate treatment allows young people to make a complete recovery, with less ongoing disability, and for the first time clinicians considered that schizophrenia was not as hopeless as they once thought.
This discovery generated interest worldwide, and the ‘early intervention’ movement was born. Early intervention for severe mental illnesses aims to prevent the onset of illness, minimise the symptoms associated with the illness, and to maximise the chances of recovery.
Practically speaking, preventing the onset of a mental illness consists of determining who is at risk and then deciding how to intervene in order to prevent the illness. Unfortunately, we currently do not understand the biology of mental illnesses well enough, and much more research needs to be done to enable clinicians to develop diagnostic tests that are sufficiently accurate and concrete. What we do know at present is that most mental illnesses appear when individuals are between 14 and 29 years old, and seeking help for distressing symptoms is crucial to recovery.
Recognising that this group of young people is at high risk of developing a severe mental illness has allowed clinicians and researchers to develop some treatment approaches aimed at relieving their symptoms and preventing the onset of a more serious illness. This type of treatment is tailored to an early stage of the illness, and it likely includes counselling, education and supportive monitoring. If symptoms deteriorate, cognitive behavioural therapy may be offered, combined with antidepressants and anti-anxiety medication. Low-dose antipsychotics have also been tested in this patient group but are not recommended as a first line of treatment due to the adverse side-effects.
The early intervention and careful monitoring are crucial for these young people, because although many of them will not develop schizophrenia, their symptoms have the potential to evolve into a more severe mental illness if they are not treated effectively at an early stage.
For those young people who do experience a first episode of psychosis, the illness needs to be promptly recognised and treatment should be given as early as possible. Initial treatment involves low-dose antipsychotic medication to manage their symptoms. Yet, recovery involves more than just eliminating symptoms; it also means maintaining or regaining their normal developmental pathway—getting back to work or school, enjoying social activities, and moving on into becoming independent.
Subsequently, these young people and their families need to be able to rely on a comprehensive, integrated care system involving a continued case management team providing medication and psychological treatment to help them manage their symptoms and illness. This type of care should be provided for the first 2–5 years after the onset of the illness when there is a greater risk of becoming permanently disabled.
The care system should offer a youth-friendly, and inclusive environment where young people can be supported in their recovery by a multidisciplinary team with specialist medical, psychosocial, vocational and educational expertise in mental health.
This treatment approach, besides being much more cost-effective, has been very effective for young people in the early stages of illness and is highly valued by the young people and their family caregivers.
The importance of mental health issues, together with the demand for mental health services that recognise young people’s unique mental health care needs, have led to new service development in countries like Australia, Denmark, England, Ireland, Canada, and the United States.
For example, in 2006, the Australian Government established a national primary care youth mental health system which is now operating in 70 sites across the nation, with 30 centres to be added in 2016.
This approach offers holistic care from the beginning, and young Australians are gaining access to early intervention and evidence-informed, stigma-free care for mental health. Young people and their families deserve to be actively engaged and receive evidence-informed care in accordance to their needs. This type of care facility has shifted our thinking in mental health care offering better outcomes for young people, their families, and our society as a whole.
Another example is Denmark. The different healthcare regions in Denmark are taking advantage of new technologies such as mobile health (mHealth) solutions to support the treatment and remotely monitor young patients suffering from mental illnesses such as bipolar disorder, major depressive disorder, anxiety, and post-traumatic stress disorder amongst others.
For instance, the Southern Denmark Region is using the Monsenso mHealth solution to support the treatment of individuals suffering from borderline personality disorder undergoing Dialectic Behavioural Therapy (DBT), and other affective disorders – such as schizophrenia.
The Monsenso solution has incorporated the Diary Cards traditionally used in DBT into an electronic format that can be accessed by patients through their smartphones. The solution enables patients to fill in Clinical Questionnaires relevant to their disorder through their smartphone, capturing data electronically.
Living with Schizophrenia. World Federation for Mental Health. 2014. http://wfmh.com/wp-content/uploads/2014/09/WMHD_English.pdf
On the previous blog post, “Transforming health and social care with digital technology” connected health or technology-enabled care (TEC) was defined as the collective term used for telecare, telehealth, telemedicine, mHealth, digital health, and eHealth services. This type of technology can empower patients and carers by giving them more control over their health and social care needs. It can also help individuals to obtain more information regarding their health.
In broad terms, TEC can:
- Improve self-management through remote monitoring, education, and treatment adherence
- Tackle areas of unmet needs that traditional treatment struggles to address, such as mental health
- Supports the development of online patient portals and patient communities
- Transforms the relationship between patients, carers and healthcare providers to focus on co-creation
Nowadays, patients and their carers use technology to research information online, identify treatment options, rate providers, and share their experiences. Healthcare needs to acknowledge that emerging technologies offer a tremendous opportunity to transform the way people engage with their health.
Besides connecting patients and providers, digital technology leads to better outcomes and a more personalised service by educating patients in regards to their health-related issues, enabling remote monitoring, and supporting treatment adherence.
Informs and educates patients and carers
It is estimated that 75% of the UK population goes online for health information. Websites, apps, videos, texts and free online courses are being used to educate and provide information to patients and their family caregivers .
Figure 1 displays the most common category of mobile apps: fitness, medical reference and wellness apps, which provide information with other very limited functionalities.
Figure 1. Digital health app category, percentage share in 2014.
The use of digital technology to educate patients and carers is a crucial driver of patient engagement. Surveys suggest that patients are more likely to make better choices and be engaged in their health if they can access information quickly.
Digital technology connects patients and providers, leading to better health outcomes and a more convenient and personalised service, through informing/educating, two-way remote monitoring, and supporting treatment adherence .
TEC can help carers understand and support those they care for by:
- Providing psychological reassurance
- Enabling carers to co-ordinate their work-life-care balance through supporting flexible hours and remote working patterns (approximately 2.3 million people have had to give up work to become carers and three million have reduced their hours)
- Delivering peer-to-peer support
Facilitates remote patient monitoring (RPM)
Remote monitoring uses technology to monitor changes in patients’ health status outside conventional clinical settings.
Historically, it allows a patient to use a device to perform a routine test and send the test data to a healthcare provider. Initially, it depended on a healthcare provider recommending its use to patients. However, digital technology has increased the potential for remote monitoring and, with the advent of apps and wearables, patients are increasingly bringing the innovation to doctors .
New advances in the development of biosensing wearables are spreading their capability beyond simply tracking activity. New devices can monitor a broad range of physiology (from posture to brain activity) and convert this information into outputs, through advanced connectivity and computing power.
Biosensing wearables can support people with chronic conditions, automating monitoring and detecting real time changes in an individual’s health status. Data from biosensing wearables can be uploaded to an Electronic Patient Record (EPR) and this information can be used to display an overview of a patient’s medical history in real-time, supporting early diagnoses and early intervention.
If a negative change occurs, patients, family caregivers and healthcare providers can be alerted quickly, preventing emergency admissions.
Increases treatment adherence
In bad cases, failure to follow treatment can cause a patient’s condition to deteriorate, leading to an increased likelihood of hospital admission, permanent disability, or death. Electronic reminders and alerts, via text SMS or apps, can remind patients to follow their treatment regimens, thus improving health outcomes.
The World Health Organisation has calculated that adherence to long-term therapies in developed countries is around 50%, and is even lower in developing countries .
In the UK, between one-third and half of all medicines prescribed for long-term conditions are not taken as recommended. It is estimated that the cost of unused or unwanted medicine is around 100 million GBP per annum .
Improved adherence allows healthcare providers and pharmaceutical companies to obtain a better understanding of the impact of drugs, including any complications or drug interactions, providing useful data for research. An increasing number of pharmaceutical companies are investing in digital TEC projects to increase patient adherence to the drugs they produce. Likewise, patients and carers are increasingly using digital health software to register and monitor medication intake .
 Valuing Carers 2011: calculating the value of carers’ support, Carers UK and academics at the University of Leeds, May 2011.
 Putting patients first. The NHS England business plan for 2013/14 and 2015/16. https://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf
 Primary care working differently: Telehealth and telecare –a game changer for health and social care, Deloitte UK Centre for Health Solutions, December 2012. http://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-telehealth-telecare.pdf
 Medication Adherence: WHO Cares? Mayo Clinic 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/
 Aston Medication Adherence Study, Aston University. See also: http://www.aston.ac.uk/lhs/research/health/pharmacy/adherence/
 Mobile apps, fighting for patient adherence, Mobile health global, December 2014. See also http://www.mobilehealthglobal.com/in-the-news/news/109/mobile-apps-fighting-for-patient-adherence
 Psychological Therapies, Annual Report on the use of IAPT services: England – 2013/14 Experimental Statistics, Health and Social Care Information Centre, September 2014. http://www.hscic.gov.uk/catalogue/PUB14899/psyc-ther-ann-rep-2013-14.pdf