Dr Jamie Chiu, Mark Altosaar, and Cole Bailey are breaking new ground in the field of psychology as they strive for a more efficient method to reach out to teens suffering from mental health issues.
by Nikhil Sreekandan
For her doctorate research, Dr. Jamie Chiu designed a screening programme that would help connect students at risk of depression and suicide to early intervention support. Typically, determining whether someone is depressed is done with an in-person assessment. But because it is impractical to do that in scale across large numbers, “self-report” screening surveys that indicate depression risk are commonly used. And so that’s what she used as well.
Her supervisors loved her research, and as far as everyone was concerned, she was using the best “gold standard” clinical surveys. But Jamie started noticing problems.
The first problem was just how long it took to analyse and get the results back to schools – all the surveys were done on pen and paper, and it would take four weeks before the schools got anything back. Aside from inefficiency, there was another big issue. There would always be students who would return the surveys without answering anything.
And on one of those incomplete surveys, a student had scribbled a comment that read, “I hated these questions, they are so insensitive, do you expect me to just check the boxes that yes I want to kill myself?!” Jamie found herself quite embarrassed for having been so blind to have not realized how unfriendly and clinical the surveys were. That was when it really dawned on her that these “gold standard” surveys were actually not helpful in connecting or engaging with the students who really needed the help.
Today, she is the founder of The Brightly Project, a company dedicated to helping struggling teens connect to care and support so that no bright futures are lost to mental health issues. Dr. Jamie Chiu talks to INKLINE about The Brightly Project, how her mental health apps under LULIO began, the company’s change in direction, and the importance of technology in the field of psychology.
INKLINE: How did Mark Altosaar come into the picture and could you take us through the initial phase of setting up LULIO?
Dr. Jamie Chiu: At this point, all I knew was that the tools were old-fashioned and out-of-touch with today’s youth, and I was so frustrated with it, but I was also feeling stuck and didn’t know what could be done. You see, I was trained as a clinical psychologist, and in our field, technology doesn’t really play a role.
And that’s where Mark came in. He’s a Human-Computer Interaction specialist and former tech product manager, and he also happened to be my boyfriend. As couples usually do, I complained and vented to him about how crappy the tools I had to work with were.
And I still remember his reaction to the fact that the “gold standard” questionnaires were still done on pen and paper. In this day and age, for something like this to be done on paper is shockingly inefficient.
Mark really helped me to step back –instead of improving the surveys, he got me to think about how the elements that are examined during an in-person assessment could be measured on a larger scale. And that’s how we started to investigate how behavioural, cognitive, and non-obvious signs of depression that did not rely on self-reported symptoms could be measured with technology.
We had the idea of using video games as the vehicle to deliver our assessments because of how engrossed you get when you play a game, which allows us to really measure true behaviour. And it was about time that mental health could be seen as something fun!
I: Could you update us on how LULIO is doing?
J: We currently have two LULIO games. The first one is a puzzle game “Eat it all, Lemmy!” that tested for how fixated someone is to a particular way of thinking and how quickly they can solve problems using different perspectives (rigid thinking patterns are an indicator of depression). It is currently in a hospital trial where it is being evaluated against traditional measurement tools to examine the change in symptoms of teenagers who have been admitted to the hospital for severe depression. The study is ending soon and the preliminary results are positive. In fact, the feedback is that the teenagers in the trial all love our game the most out of all the other tools they have to use.
The second game is a text-based choose-your-own-adventure “Save Finley” that tested for coping strategies and help-seeking behaviours when encountering stress and challenges (unhelpful ways of coping is an indicator of depression). We examined the texting game in an observational field study and the results were very positive. We recruited teenagers who were diagnosed with depression to participate and we found that they showed particular tendencies in our game compared to other teenagers who had no prior mental health issues.
I: How did The Brightly Project come into the picture?
J: We’ve had a lot of ups and downs, twists and turns along the way, and a large part of it was our fixation (and excitement) on creating games when ultimately, our goal was always to better connect those who were struggling to care and support.
And to be honest, we got a lot of pushback, especially from schools in Hong Kong with the idea of games to detect depression. However, when we spoke with doctors and hospital staff, they were much more open to a new tool, because they could see the shortcomings of current assessment methods with youth.
And so we decided that the LULIO games will be targeted as assessment tools in hospitals and clinics with teens.
But because my passion has always been in helping the teens who are falling through the cracks at school and missing out on support, we decided to design a tool that could be used in schools (based on all of our research in behavioural and cognitive indicators of depression).
That was also around the same time where Cole Bailey joined us as CTO. He was super excited about our vision, and he was keen to take our analyses one step further with AI & machine learning.
We applied everything we knew and created a chatbot-style screening tool (which was inspired by our texting game) with a management dashboard and we named the system Know My Students. To schools, we positioned it as a “digital questionnaire”, which made it much more familiar and easier to understand. We also began looking for other patterns that were emerging and included the cognitive and behavioural analyses that were used in our LULIO games.
We then re-named our company to The Brightly Project, with LULIO and Know My Students as two product branches under it. And the name The Brightly Project was chosen because it reflected our vision, where people who struggle are connected to care and support so that no bright futures are lost to mental health issues.
I: It’s a very new field that you are trying to break into, where psychology meets technology. How much of the research has translated into real results?
J: We’ve begun pilot studies using the Know My Student tool in schools, and we’ve found that with every 100 students who converses with our screening tool, we would identify two students who were previously flying under the radar but actually at high risk for depression and suicidal thinking.
We just had a school counsellor tell us that because of our system, it helped her connect with three students who were at very high risk of suicide. She was able to intervene, and even accompanied two students to the hospital for support.
I think these results we are seeing from our pilot studies have been very powerful! I don’t want to imagine what may have happened had the school not used Know My Students.
I: You previously worked as a school counsellor, how much do you think that has helped the whole process?
J: My frontline experience has been fundamental to the whole process. Working in different schools has given me first-hand insight into how schools operate. Schools are extremely busy, there is constantly a million other things competing for attention and budget, and so any mental health solution needs to be flexible and super attractive in order for it to be used.
We’re also in a difficult position of building products for both the teens and the school administrators. But I think I gained the advantage of being in close contact with both sides.
And of course, a large part of the work we’re doing is to help the school counsellor better connect with the students who need support. Having been the school counsellor, I am able to draw from my experiences and knowledge in designing Know My Students.
Ultimately, it is important that in order to support at-risk students, schools make multiple avenues of intervention and support available because the way in which you reach one student may not work or be the best way to reach another.
I: If you had to give one bit of advice to the teenagers of today, what would that be?
J: Instead of giving advice to all teens, this is going out to the teens who feel like they are not good enough:
There’s a quote that’s often stuck in my head and it says, “In a society that profits from your self-doubt, liking yourself is a rebellious act.”
In today’s world, there are enough negative voices yelling at you. You need to fight back and be Team You. Like yourself, be a rebel. You are enough.
Nikhil Sreekandan is a journalist with a desire to explore life through the stories he chases. An engineer who found recluse in the world of words, he is a journalism post-graduate from Cardiff University. He works as a content editor at Nature inFocus, India’s leading platform for nature and wildlife. When not lost in cinema, contemporary literature or his earphones — there is a genuine attempt at ‘giving chase’, and it is beautiful.