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Preventive measures for reduced mental illness

Mental illness among young people is increasing. Lack of access to child and adolescent psychiatry can lead to exclusion and high costs for society. Region Skåne, in collaboration with RISE, has worked on service innovation that tackles system failures in healthcare organisation. An upcoming result is the digital chatbot Coze, which can learn the unique emotions of the users and give them support.

Of Sweden's 1.1 million young people between 10 and 19 years of age, 110,000 suffer from mild mental illness in the form of depression, anxiety, nervousness, stress and mild eating disorders.

– Research has no reliable answers to what the increases are due to. Being more sedentary, stress at school and less social interaction are possible causes, says David Lindeby, project manager at RISE.

When the young people in studies have themselves offered reasons for the increase they mention, among other things, a need to independent, pressure from social media, appearance and body ideals, bullying and family financial status.

Preventive action has positive effects

According to David Lindeby, more preventative work in the field would have several positive effects. More people would get help before they need care, fewer would end up excluded and psychiatry could focus on those patients who really need care.

– Child and adolescent psychiatry should really only be taking on a tenth of the young people who seek help from them. The majority of people should have had preventative help, says David Lindeby.

Together with Region Skåne, RISE has looked at how today's services work from a system perspective. In the project, RISE has engaged NGOs, schools, sports clubs and communities that have activities where new system solutions for prevention can be scaled up and complement existing care systems.

– We also need to"flip the care pyramid”. The specialist care services should not be dealing with broad societal challenges. This is something that should be done by all the resources in the community and they must be used more efficiently, says David Lindeby.

Two root causes of the problem
Based on a socio-economic analysis carried out together with the company Prosper Social, a further hypothesis was formulated with two root causes for young people not getting preventative help:

* The help that actually exists can be difficult to find.
* Young people lack tools to interpret their own mood.

"Many young people who feel bad do not want to tell adults and definitely not their parents. Instead, they search online and that is where we must make contact with them, says David Lindeby.

Chatbot as a digital companion

Region Skåne and RISE have now together with young people, health care services, the voluntary sector and industry developed a new concept called Coze. Basically, it is a chatbot that will become a digital, health-promoting companion that children and young people can talk to in a safe environment at any time.

The chatbot learns each user's unique emotions, habits and routines. At the same time, the user learns how various interactions with the chat bot affects their own well-being, something that can be seen from so-called EPOIs (emotional points of interest) that measure emotions such as anger, stress, anxiety and joy. It is also possible to share experiences with other users.

The concept is now being transformed into a digital application and a first prototype is expected to be ready during 2019. Something that needs to be resolved before that is the ownership issue because the idea is based everyone in the system being able to contribute to the Coze platform, not just the health care services.

– It is very important that the tool can be used throughout the country and that more players should be able to participate and contribute content, says Camilla Evensson, project manager at RISE.

Preventive interventions reduce suffering and reduce costs

In addition to human suffering, mental illness among young people costs a lot of money. The project's economic analysis showed that approximately 35 percent (70,000) of young people suffering from mild mental illness receive help from healthcare services at a cost of SEK 1 billion per year. To provide everyone with help from the healthcare services would therefore cost about SEK 3 billion. This can be compared with, as is the case presently, leaving two-thirds of people without help at a cost of between 8 and 15 billion in terms of exclusion.

More preventative measures would both save a lot of money and reduce suffering.

– We must change the perspective and find the organisations that want to work preventatively and we have to meet the users digitally. The focus of the healthcare services is primarily on helping people that are already ill, and then mainly with physical illnesses, yet most of the money ends up there. RISE can definitely play a role in changing the system, says Jonas Matthing, a research manager within service innovation at RISE.


COZE - a health promoting digital companion for children and young people in their everyday lives.