Longitudinal Changes in Crisis and Broader Mental Health Service Use Following Access to Digital Support Tool Brain in Hand: An Observational Cohort Study

Background: Demand for mental health services continues to rise, placing increasing pressure on crisis and community-based care and prompting interest in digital tools as adjuncts to existing support pathways. However, evidence describing how engagement with such tools relates to patterns of mental health service use over time remains limited. This observational cohort study examined longitudinal changes in self-reported crisis and broader mental health service use following access to the Brain in Hand (BiH) digital support service. Methods: Adults accessing BiH (N = 149 at baseline) reported service use at baseline, three months, and six months. A high proportion of participants were autistic or had ADHD and/or were students. Crisis and expanded mental health service use were analysed using two-part (hurdle) models to estimate within-person change in the probability of any service contact and the expected number of contacts among users. Inverse probability weighting addressed attrition, and simulation-based inference was used to quantify uncertainty in derived outcomes. Results: Across both service-use definitions, reductions in service contact were observed over time, reflected in decreases in both the likelihood of accessing services and the frequency of contacts. Reductions were evident at three and six months, with clearer and larger absolute changes at six months. Reductions were substantial in absolute terms, particularly among those with higher baseline depressive symptoms, and were consistent with decreases in frequent or repeated service contacts. Conclusions: While causal inference is not possible, these findings provide real-world longitudinal evidence describing how patterns of crisis and broader mental health service engagement may shift in the context of adjunctive digital support, particularly among autistic/ADHD adults and students, with implications for service planning amid rising mental health need in the UK.