Key Findings

• The Scottish Government’s Mental Health Strategy 2017–2027¹ aims to improve access to appropriate support and effective care for all. The Digital Health and Care Strategy, 2021² sets out the role of digital technologies in supporting this aim. The digital strategy makes a commitment to increase access to evidence-based digital mental health treatments, products and services.
• As a digital mental health app, the Feeling Good app has the potential to reduce some aspects of inequalities by widening access, providing support for those who may not necessarily be comfortable seeking help through existing conventional services, and improving self-management of mental health. Reading difficulties do not impede use of the app as the programme is delivered via audio files.
• Assessment of the digital aspects of this technology (assurance, data security, protection and privacy) as assessed using the NHS England DTAC and by ORCHA (clinical, data and usability standards) found no issues of concern.
• The published evidence base was examined and was insufficient to gauge the clinical effectiveness of the Feeling Good app. A published feasibility study which looked at clinical effectiveness, and one linked economic evaluation, were identified. Several unpublished descriptive reports, produced by the developer which evaluated use, engagement, change in mood scores and free-text feedback among different population groups were also identified.
• The cost effectiveness of Feeling Good remains highly uncertain due to the limiting model assumptions in the one linked economic evaluation that was identified.
• Further research into the effectiveness of the Feeling Good app is required to demonstrate the impact of Feeling Good on clinical outcomes and patient benefits.
• Suggestions for further evidence collection include:
  • An adequately-powered prospective study with a control group, and recording and reporting a description of all relevant baseline characteristics of users. Changes in mood score for each individual from baseline to the assessment time points should be measured in order that clinical and statistical significance of any impact can be assessed. Reporting should be clear and comprehensive to allow robust assessment of data gathered.
  • An updated economic evaluation should be conducted. It should incorporate an adequate time horizon in order to capture all meaningful differences between costs and effects of the considered alternatives. Potential bias should be avoided through the use of direct or adequately adjusted indirect comparative efficacy data showing clinically meaningful differences in depression scores. Long-term outcomes such as probability of relapse and mortality should also be captured. Health-related quality of life should be preferably measured using the EuroQol–5 Dimension 3 level (EQ-5 D-3 L) questionnaire with health state utility weights derived using the latest UK-specific value set. Healthcare resource use reflecting current Scottish clinical practice should also be included in the model.

1. Scottish Government. Mental Health Strategy: 2017-2027. 2017
2. Scottish Government. Enabling, Connecting and Empowering: Care in the Digital Age. 2021

What were we asked to look at

Feeling Good app

Feeling good is an audio programme delivered via an app. It consists of a training video and 12 audio tracks each lasting 18 minutes. The app delivers ‘positive mental training’ (PosMT) which includes ‘therapeutic techniques from relaxation, mindfulness and positive psychology’. The tracks cover relaxation, breathing, setting up a trigger, learning to visualise, cognitive exercises including positive future visualisation and desensitisation.

Why is this important

Mental health and well-being is a major public health challenge in Scotland, with around one in four people experiencing mental ill-health each year. Services struggle to cope with demand, with many people not receiving the support they require. The COVID-19 pandemic has exacerbated mental health pressures across the country.

An app to improve mental health offers the potential to reach individuals in greater numbers, and at a population level if desired. Through the convenience and reduction in stigma offered by remote access, a digital platform may also reach people who have not previously engaged with services.

Referred by

Manufacturer: Feeling Good app