Tina Woods talks to Dr Nihara Krause – Consultant Clinical Psychologist and lecturer, Founder and Trustee of teenage mental health charity stem4, and Founder of the app Calm Harm – about women’s role in medtech
Dr Nihara Krause is a woman on the frontline of medical technology and her achievements are impressive. Having worked as an NHS Consultant, she now runs her own private practice and specialises in the treatment of anxiety and depression, eating disorders, self-harm, trauma and OCD. She has a particular interest in developing resilience in young people and in the psychological traits of high achievers. She is a visiting lecturer for the Clinical Psychology doctorate programme and the postgraduate Counselling Psychology course at Surrey University. She has also been involved in the development of the eating disorder teaching guidelines for Clinical Psychology for the British Psychological Society. She has been involved in input into the enquiry on technology and mental health at the House of Lords and is the mentor for mental health for the Youth Health Parliament. Nihara was awarded the Mayor of London Award 2014 for her voluntary work and the ‘Point of Light Award’ by David Cameron in 2015.
Calm Harm has been designed to help people resist or manage the urge to self-harm, which is available on the NHS Choices Apps Library. stem4 won the Digital Innovation award category for Calm Harm at the National Positive Practice in Mental Health Awards 2016 and was a finalist in the AXA PPP Health Tech & You Awards 2017.
NK: I started out in the NHS and worked with seriously unwell young people with a range of mental health issues, such as eating disorders. About seven years ago a girl died from an eating disorder at my daughter’s school. The school asked me to help them in a mental health capacity to provide information to teachers and parents to equip them with the tools to help young people suffering from this condition. Other schools were interested in accessing this information too – there was clearly a need that wasn’t being met elsewhere.
I decided this was an opportunity to set up an information hub with good resources to help teenagers suffering from mental health disorders. We set up as a charity and created a website. We started to do more workshops in schools and train more psychologists.
It soon became apparent that to really help larger numbers of people we needed to scale up somehow. Wearing my NHS hat, I knew there were many young people out there who were not being picked up by the NHS, and could be (and should be) identified at an earlier stage. Convinced of the huge unmet need out there, and using my professional expertise, I decided to develop an app as a solution. I asked teenagers whether they thought an app could work and the feedback was resoundingly positive. In a more formal process involving about 250 people, it became clear that an app to help address self-harm would be a good place to start.
I started fundraising through the charity to build the app and test the prototype. It was very basic and didn’t have the analytics to tell us where it was being used, so we decided to do another fundraising round and applied to NHS Choices to get more investment and traction. We’ve built awareness steadily from this base but over this Christmas period Calm Harm ‘went viral’. One tweet set off the train, and 124,000 re-tweets later we achieved 36,000 new installs on Christmas Day and 27,000 new installs on Boxing Day. Overall, we have achieved around 212,000 downloads in the apps lifetime of two years, with a 4.5 star rating. We have had floods of emails and Facebook messages from all over the world.
We’re really pleased with the interest but it demonstrates how great the need is. Why is that so? There’s no simple answer, but it’s probably a mixture of greater pressures on young people, including exam expectations, as well as less stigma and more awareness of mental health issues. There has always been an element of ‘self-damage’ in the teenage years but the way it is expressed as a distress signal has changed over the years.
The app provides a private and accessible way to quickly manage the urge to self-arm. I often use the analogy ‘ride the wave’ – the urge is highest at the crest of the wave but if you catch it on the way up, you can surf across the wave and avoid the temptation to crash out.
NK: There haven’t been a lot of role models for me to follow, so it’s been a little hit and miss. The biggest hurdle for me has been access to funding, though, and I have questioned whether this is because I am a woman.
There’s also the challenge of balancing work, business and family. On a more emotional level, I think there may be a general tendency for women to find it harder to ‘own the success’. I tend to use ‘we’ rather than ‘I’ – I think there is more modesty in women, which then makes it more difficult to self-promote as well. Men find it easier in general to stand up and talk about themselves. I think women are more focused on the detail and making sure they will make a complete success of it before they start.
NK: I would offer the following advice – do something you are passionate about and don’t compare yourself with others. Just be you. I say this having been being raised by an Asian family of doctors to think I had to be a doctor to be a success. I’d say to my ‘younger self’ now, ‘think outside your parents’ box and go for it!’
NK: I think the future is looking really good for women in digital health. Women have a lot to bring to the table, have a different way of thinking, and are creative. I’m looking to do many exciting things. I’m planning to take app development for stem4 into new mental health areas: anxiety first, then depression and specific eating disorders. I’m also planning more digital workshops and a digital library via the charity, and working with the Department of Education to include better mental health education as part of PHSE in the school curriculum. I have recently been gifted some office space, which means we can do more with volunteers too.
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