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Nihara Krause, Founder and Trustee of stem4, Founder of Calm Harm
This interview is one of a series of inspirational women leaders in health technology being profiled as part of the Women Entrepreneurs category of the AXA Health Tech & You Awards programme. Tina Woods, Founder and CEO of Collider Health, is the interviewer.
I caught up with Dr Nihara Krause, a Consultant Clinical Psychologist and lecturer with over 25 years of clinical experience working in teenage and adult mental health. She is Founder and Trustee of stem4, teenage mental health charity aimed at improving teenage mental health by stemming commonly occurring mental health issues at an early stage.
Nihara is also the mastermind behind Calm Harm, an app designed to help people resist or manage the urge to self-harm and 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. Calm Harm is also a finalist in the Northern Digital Awards 2018 Best App category, with finals on the 31st January 2018. Calm Harm was featured in UK e-Health week 2017 at London Olympia and Nihara gave talks on Calm Harm both at the NHS Digital stand and for 2020 Health.
I asked Nihara the following questions:
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 7 years ago a girl died from an eating disorder at my daughter’s local school. The school asked me to come in and 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 for education that was not being met elsewhere.
From there I decided this was a good opportunity to set up an information hub with good resources to help inform and train more people 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 (more than we could manage within the resources of the charity) 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 - this is how we got Calm Harm off the ground. It was very basic and did not 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 have built awareness steadily from this base but just over this Christmas period Calm Harm ‘went viral’. One tweet set off the train, and 124,000 retweets 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 are really pleased with the interest but it shows how much there is the need. Why is there such a need? There is no evidence that clearly spells this out, but it is probably a mixture of greater pressures on young people, including exam expectations, as well as less stigma and more awareness of mental health issues (‘trend to express distress’).
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.
There haven’t been a lot of role models for me to follow- so it has 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 is 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 focussed on the detail and making sure before they start they will make a complete success of it.
Probably persistence, bordering on stubbornness, as well as a deep curiosity!
I spend time with my family. I like boxing, and have a personal trainer for this. I also like to sing- it is ‘good for the soul’.
I would offer the following advice:
1) Do something you are passionate about
2) 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!’
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 am looking to do many exciting things ahead. I am planning to take app development for stem4 into new mental health areas: anxiety first, then depression and specific eating disorders. I am 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.
Nihara Krause’ Biography
Dr Krause is a Consultant Clinical Psychologist and lecturer with over 25 years of clinical experience working in teenage and adult mental health. 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 obsessive-compulsive disorders. She has a particular interest in developing resilience in young people and in the psychological traits of high achievers. Her last NHS post was as a consultant for eating disorders, setting up a specialist out-patient and day service. 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 is an accredited Youth Mental Health First Aid trainer. Nihara has offered talks and lectures at UCL and Imperial, and has spoken at a variety of conferences across the country. 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. She has been quoted in a variety of newspapers and magazines, appeared as an expert on SKY, C4 news and on ‘This Morning' has been on several radio shows and is a regular guest on Chrissie B. She has been involved in productions with the BBC, Dragonfly TV, Minnow, etc. She is the CEO and founder of stem4 a charity aimed at stemming teenage mental illness and is the creator of MINDYOUR5 a well-being programme for schools and has developed a clinical self-help app Calm Harm for stem4. Nihara was awarded the Mayor of London Award 2014 for her voluntary work and the 'Point of Light Award' by David Cameron in 2015. She was also awarded the Positive Practice Award 2017 for her outstanding work.
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