My presentation for the 15th European symposium of suicide and Suicidal behaviour. It describes the background for "psy apps" and SuperEgos development of two apps for the Estonian-Swedish institute of mental health and suicide prevention.

1. Development and selection of
content and functionalities for
AppsTerv suicide prevention app
Svein Øverland
svein@superego.as
www.superego.as

2. The expanding world of digital health
Digital health solutions
Sensor technology
M-health
Psy-apps
Online therapy
Health 2.0
E-health
welfare technology

3. Definitions
• “Online therapy is the use of computers as
tools to enable and/or enhance the provision
of therapeutic services”. (Abraham Wolf, 2003)
• Digital health solutions is the use of digital
tools (for instance telephone, internet,
computers, sensors or mobile applications) as
means for delivering health services or
enhance existing health services
(Svein Øverland, 2012).

5. "Many are called but few are
chosen"
• There are 35 000 health
apps available in Google
play and 43 000 in
Appstore
• 5 of these account for
15 percent of all
downloads
• Take a guess, what kind
of apps do you think
they are?

6. Percentage of apps per category (2014)

7. Apps for suicide prevention
• The review included 27 suicide prevention apps for
both iOS and Android platforms.
• ”In regards to whether ongoing evaluations of the
applications are in process, only one, Guard Your
Buddy, comes close to having an evaluation process
beyond star ratings in the app stores.”
Aguirre, McCoy and Roan (2013)

8. Ipochondria
• It is a growing concern that the “appification”
makes us more narcissistic and disease
oriented
• This should especially be a concern for the
development and use of mental health apps in
general and for suicide prevention apps in
particular

10. App developers per category

11. Finding them where they are
• “If One Is Truly to
Succeed in Leading a
Person to a Specific
Place, One Must First
and Foremost Take Care
to Find Him Where He is
and Begin There. This is
the Secret in the True
Art of Helping”.
Søren Kierkegaard
(1863)

12. Apps are interactive
rather than reactive
• “Working with individuals contemplating suicide is
undoubtedly a vital facet of prevention, but these
crisis call lines and centers are quite reactive by
nature, and therefore are not intended to provide
services far in advance of the point of crisis. Reactive
models of care only work if an individual is aware of
how to call their local or national hotline or
otherwise seek help”.
Aguirre, R. T. P., McCoy, M. K., Roan, M. (2013)

13. The Superego "stop"serie

14. Feedback should result in upgrading

15. The difference between apps and "old
fashioned" internet is diminishing

16. The development of Ära tee!
• A collaboration
between ERSI and
SuperEgo (Estonia and
Norway) as part of the
EEA grants programme
• Meetings and
brainstorming with the
aim of making effective
and innovative apps to
reach persons in risk for
self harm and suicide

17. Fuctionalities and Content

18. Simple in design and function,
but filled with content

19. App development is a process
• Sharing expectations
• Brainstorming
• Checking with the tech guys
• Cultural sensitivity
• Testing ideas with reference group
• Making a pilot
• Thinking about colours and design
• Making, choosing and uploading content
• Making the app available and interesting

20. The promise of Gamefication
• “Its no point in
delivering good therapy
if the patients dies”
(Marsha Linehan, during
DBT-training)
• Therapy doesnt have to
be scary or boring
• We can learn a lot from
games and how they
train and motivate
players

21. A work in progress
• The SuperEgo admin panel makes the clinicians the
master of content
• The clinicians can decide what and when to upload the
content they choose, and thereby update even the
apps already downloaded
• The app users can contact the app owner and advice
what content to upload
• This makes the app development an ongoing creative
and user friendly process

22. Take Home Message
• There is a growing number of digital health solutions
and apps, but few are developed based upon clinical
experience or empirical data
• "Psy apps" should be developed in close contact with
mental health professionals and patient groups
• The development of Are tee! has focused on the
interaction between functionalities and content
• Hopefully we will soon have feedback and research
that will improve the apps availability and effect

23. Conluding remarks
• “Hopefully this emerging understanding about why
people choose suicide and development of more
effective ways to prevent suicide will soon find their
way into technologies that can be readily available
and accessible like mobile apps and Web-based
tools. While I hope you may never be in a
circumstance where you would need to use such a
mobile app, it wouldn’t be a bad idea to have this
information within hands-reach, installed on your
smartphone or tablet”.
(Osenbach) 2013

24. An advice from the past to the future