Australia mental health; Nellie makes positive impact with COVID-19 response

Mental Health and COVID-19:

During this unprecedented time of uncertainty with the wide scale introduction of social distancing, and the requirement to reduce face-to-face clinical contact to that of the most urgent need, technology is playing a crucial role in enabling the continuation of safe health care provision during the COVID-19 pandemic around the world.

Flo’s next generation cousin ‘Nellie’ has been helping South Eastern Melbourne Primary Health Network (SEMPHN)’s patients in Australia for over two years now.  Recognising Nellie’s proven techniques in delivering a rapid public health response, SEMPHN clinicians were quick to identify the opportunity that Nellie provided to be able to extend their reach remotely, enabling clinicians to continue to provide high quality, safe healthcare.  Specific smart-messaging COVID-19 pathways were developed bringing the latest government guidance to life for community members with symptom monitoring (where there were Upper Respiratory Tract infection symptoms) and mental health and wellbeing messages (for any community members, even if they didn’t have symptoms).  Carol has kindly shared one patient’s experience about how Nellie improved her sense of wellbeing, reduced feelings of anxiety and stress and the wider quality of life impact that this brought.

Nina (anonomysed) reached out to us at SEMPHN to say that she wanted to give us some feedback about her experience of Nellie’s COVID-19 pathway.

I made contact with her and here is her story:

Nina is a lady in her early 60s who lives alone and has recently moved back into the suburb where she grew up.  Nina has been seeing her GP regularly as she has a history of mental ill health, and from a brochure at her GP surgery was initially introduced to how Nellie could support her wellbeing during COVID-19.

Designed with personalised tracking which adapts to each patient’s individual journey within the prescribed protocol at any particular time, the self-subscribe feature within Nellie was chosen for community members accessing this pathway to enable them to easily self-enrol and avoid the need to make contact with their clinician.  Therefore Nina was able to go home and look at information on the SEMPHN Nellie web page, and she could decide if the service was right for her.  Once Nina felt ready, she was able to activate the service by simply sending a designated keyword to Nellie’s specific mobile number to start receiving messages.

After Nina had been interacting with Nellie for two weeks, she spoke to her doctor and fed back that she was finding Nellie really helpful but explained that she was starting to feel sad because Nellie would be ending soon, as she knew that the service would end after 3 weeks.  Nina asked if Nellie’s service could be extended for her.  Nina’s personal situation was reviewed and it was agreed that due to the positive impact that Nellie interactions were having by supporting her to make positive steps towards her own wellbeing, that she would benefit further from using the service a little longer, albeit using a different, clinician-managed protocol.

Nina told us that she liked knowing that Nellie’s service was time-limited, as she thought that, given the purpose of Nellie’s use during COVID-19, that this would maintain engagement and interest.
Nina also liked that Nellie’s messages came at different times of the day.  She said that some people with a mental health diagnosis might become obsessive if they were anticipating a message at the same time each day.  She had noticed and appreciated the fact that this wasn’t the case for Nellie, because the messages were set up to be sent at varied times.  We hadn’t really thought about the timing of the messages in this way.  We had simply designed Nellie’s schedule with what time felt appropriate for a particular interaction.  It’s definitely something we’ve taken on board!

One of the initial concerns when introducing Nellie to a GP practice is that because of the psychology that underpins Nellie’s persona, some users may think that they are interacting with a real person.  However, we were reassured that patients were being introduced to Nellie appropriately at the practice and understood the Nellie service when Nina said, 

Wow, I know Nellie isn’t a real person (and that’s part of the magic).  It feels like it’s a real person who cares about you, but you don’t have to worry about them” 

Once again, we hadn’t fully considered the anxiety experienced by people in relation to their loved ones, and it was clear that it was comforting for Nina to know that Nellie is not a real person that she needs to worry about, but still receives the non-judgmental advice and reassurance she needed.

Nina also said that she had found Nellie really easy to use, and that she liked that she could reply to Nellie’s wellbeing check-in messages and get appropriate feedback and tips. However, she also said,

you didn’t have to reply at all if you didn’t want to and it didn’t matter which was important for this patient cohort.

Importantly Nina said that she felt that she could trust what Nellie was saying.  Even though she knew that Nellie wasn’t a real person, she knew that there were real health professionals who had approved the Nellie program and the information was based on the latest Government advice.

One of the things that Nina told me was that Nellie had a positive ripple effect in her family.  Nina explained that she would often call her brother when she was experiencing stress and anxiety, but Nellie’s guidance had helped her to feel calmer and more in control.  As Nina was feeling less stressed, she didn’t need to call her brother as often for support, but when they did speak, the conversations were more relaxed and positive which allowed her brother to feel confident that Nina was ok and didn’t get as worried when she did call.

Nina’s closing quote was, 

I like to think of Nellie as a special robot who is looking after me” 

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