Thanks for intro. Thanks for having me here today to talk to you all. I’ve been asked to take the next 20 mins or so to talk about the broader policy environment, and how this may well help to drive further adoption and spread of the sorts of innovations we’re talking here today about.
In that time, I want to do a number of things. First of all, some of you will be aware of the organisation I work for – some of you won’t! For those of you who aren’t familiar with us, I want to briefly outline who we are and what we do – including some of the work I’ve been doing recently with Sarah, Jen – who spoke just now – and some other enthusiasts for e-mental health. Then I’m going to talk about the policy and wider strategic environment, and how this might drive further adoption and spread. I’m going to wrap up by talking about some future work I’m involved in that people in the room might want to get involved in. And, of course, we’ll have time for some questions and answers.
So, just to kick off, let me tell you about the organisation I work for. The Mental health Network is part of the NHS Confederation. The Confed is essentially *the* membership bodyfor all organisations that commission and provide NHS services. Around 90 / 95% of all NHS organisations – Trusts, Foundation Trusts, PCTs, SHAs – are in membership. We’re also, with the NHS Alliance and NAPC, have a membership body for CCGs. The MHN is the part of the Confed that represents providers of mental health services. We represent 70 providers of mental health services in England – including NHS Trusts, Foundation Trusts, voluntary sector and independent sector providers. Governed by a board of members – including Chief Executives, Chairs, Clinicians and service user and carer representatives.
This slide explains a little more about what we do. Firstly, like any other membership organisation, we lobby and influence national policy on behalf of our members. We keep people up to date on news affecting the sector, plus we have a busy events and publications programme throughout the year. We also run a number of development programmes in conjunction with other organisations. One example of that is the IMROC programme we run with the Centre for Mental Health, to help services focus on recovery. We also carry out pieces of original research, which are often pieces commissioned by government.
This slide just gives a flavour of some of the topics we’ve worked on over the past year and the publications we’ve put out – on housing, use of social media, outcomes and pbr. We’ve also done a lot of work with government on developing an implementation framework in support of the mental health strategy and on the NHS mandate. That’s been a particularly big focus for me over the past 12 months, and as people are starting to be appointed to the NHS commissioning board we’re beginning to have conversations there about the sorts of early priorities from the Board should be.
In terms of our work on e-mental health, some of you may have seen this paper that we published in January of this year. That was written by three people – myself, Jen Hyatt – who you heard form earlier – and Matthew Patrick, who’s Chief Exec of the Tavistock and Portman in London. That was the result of conversations we starting having last summer. Jen and Matthew have done so much in this area and are so knowledgeable – it wasn’t an area I could profess to having anything like the area of expertise that they do. But it had struck me for quite a long time that public services in general are – with some very notable and excellent exceptions – very much behind the curve when it comes to making use of technology in terms of the way services are delivered. What also struck me, when I started talking to our members about it and what their organisations were doing, was that there was actually a lot of interest in working out how they can exploit these opportunities – but most people had no idea where to start. The same sorts of questions kept coming up again and again – essentially they came down to wanting to figure out what service users actually want, and how they could make informed choices about what sorts of products and services can meet that need. There was also a big interest in hearing about where else in the NHS, and abroad, there was good practice that might be helpful to learn from. So all those things led to this paper. If you haven’t read it already, then it’s on our website – I hope you give it a look.
In it, we argue that there’s a powerful case for change. Firstly, in simple terms, this is the reality of the world we’re living in. We’re living in a totally different world, in terms of technology, to where we were 10 – 20 years ago. 74 % of households are online.
91 % of adults use a mobile phone. For young people, the rates of smartphone ownership are high, and increasing.It’s this reality, rather than any policy document or anything else, that is going to drive this change. The expectations of the public are changing, and through technology we have more opportunities than ever before to be more active, informed consumers of healthcare. It’s commonplace now for GPs to find their patients coming into surgeries readily armed with information about treatment options and NICE guidance they’ve gleaned from NHS Choices and other websites. People with long term conditions are also making the most of the opportunities presented by social media to get information, support and advice from other people going through the same thing – Big White Wall is one example of that, and there are others cited in the paper.
There’s a huge cultural transformation going on. People aren’t passive recipients of healthcare any more – and that applies to mental healthcare as much, if not more so, than any other sector. If the recovery movement is about empowering people and supporting them to recover on their own terms, then services have got to embrace the way people want to make use of technology. That can help support a more collaborative approach between professionals and service users.
But it’s also about the reality of the economic environment we’re in too. The rates of common mental health problems are increasing. And we know that only a relatively small proportion of people with anxiety and depression are in treatment. Stigma is probably a big factor in people not coming forward when they need help – and we know that attitudes are changing, albeit slowly. So, in the future, we’re only going to see the numbers go up. But we’re in a very tough economic climate. Whilst the NHS budget is flat, the proportion of that that’s spent on mental health services went down by 1% last year. And whilst none of us have a crystal ball, it’s unlikely you’re going to see big injections of cash into the health service for the foreseeable future. So, we all have to do a lot more with what we’ve got. Making the most of the opportunities presented by e-mental health might be able to go some way in addressing this resource challenge. In the paper, we talk about products and services can enable existing tasks and practices to be conducted in a more efficient way. That can include applications and programmes to monitor mood or medication compliance. Delivering interventions online is another examples – there’s certainly a growing interest in delivering CBT online and things like that.
So what of the policy context...... There’s a number of documents that have come out over the past two years that are certainly supportive of this direction.The mental health strategy came out 2 years ago – that has a number of objectives that are relevant to use of technology. Last year, the DH published an implementation framework for the strategy. I must confess an interest in that – I helped write it, along with colleagues at the DH and organisations like Mind, Rethink and Turning Point. That sets out a number of priorities for all sorts of public services, not just the NHS, but schools and social services too. The framework cites how mental health services should consider how technology can support self care and peer support. The information strategy came out last year from the Department of Health – again, that document supported this idea of using technology to support cultural transformation.
In December 2011 the DH published the innovation review led by Sir Ian Carruthers. That looked at how barriers to the adoption of innovations can be overcome – the contents of that and the actions taken as a result are all very relevant to the issue we’re talking about today. This idea of supporting choice is a really important one – before Christmas the Government announced that service users will have the same rights in terms of choice of provider by April 2014. That could be a really important driver in terms of changing the way services are delivered, and how responsive they are to the wants of the people who use them – in future, if they’re not happy, the may just simply choose to go elsewhere!Lastly, the NHS Mandate will be particularly key in terms of setting the priorities of the Commissioning Board as it becomes established. The Mandate does talk explicitly about increasing the use of technology to help people with long term conditions manage their health better.
So, what does all this mean for the future?In technology we have something that has the potential to help us support the cultural transformation we need, and also address the massive challenge around resources we have. We have a mental health strategy that supports that. As does the NHS Mandate. In them, we’ve got two documents by which the Commissioning Board are going to be held to account for delivering the kinds of change we all want to see. But that’s not going to be enough.
Back when I started I talked a bit about the conversations I was having with our members about this issue, and what they thought might be needed. The same questions remain - How can we build momentum and support real change, in partnership with service users?How can providers make sense of what is a rapidly evolving marketplace and make informed choices about which programmes and applications to use? How do we determine what ‘quality’ looks like? How can we ensure that innovations in this field are developed within appropriate governance frameworks? At a national level, how can we help spread knowledge and good practice about what works?
In the paper, we argue that there needs to be a national framework for e-mental health.That would take the form of two distinct phases. In the first phase, we’d want to map what people are already doing – do build a better picture about how technology is being used, what lessons we can learn from other sectors and countries, and also to discover what examples of good practice there are out there.
As a second phase, we want to design the actual framework. That would articulate a shared vision, from service users, professionals and managers, about where we want to get to and what actions different parts of the system need to take to enable us to get there. Whilst that might not be a process led by the Commissioning Board, I think it would certainly need the endorsement and support of the Board.
And that’s it from me. Thank you for listening, I hope that was a helpful canter through the policy context for this work, and also about what the MHN is doing in this area. I’d be really happy to take any questions anyone has at this point.
We live in a digital world that has transformed society to put consumers in control, but Public services (the NHS and mental health) have embraced technology for interventions, data management and medication BUT remain analogue in harnessing technology to empower consumers. In mental health, we have:Users who are often passive, not in control, not engaged with treatmentCulture of professionally-led carePaper-based user tools (mood diaries, help books, leaflets)
E mental Health Conference - Presentations
WELCOME E-Mental Health:Harnessing the Power of Digital for Better Mental Health NHS South of England (East) Monday 18th March 2013
Time Speaker & Topic10:00 Chair Welcome10:20 Ali Mousa Why Use Digital Technology in Mental Health?10:40 Paul Irwin – Director, TryLife The Role of Technology in Youth Services11:00 Jenny Hyatt – CEO, The Big White Wall Delivering Best Practice in E-Mental Health11:30 Refreshments and e-Mental Health Exhibition11:50 Rebecca Cotton -Deputy Director, Mental Health Network, NHS Confederation The Policy Context & Future of E-Mental Health12:10 James Seward – Managing Director, Buddy App Psychological therapies in the Digital World: The Buddy App12:30 Buffet Lunch in Main Foyer
Time13:00 E-Mental Health Exhibition, Live Computer-based Demonstrations Opportunity to View & Create Your E-Mental Health Videos13:45 Interactive Workshop Session (6 Questions on 6 Tables)15:00 Feedback & Postcard Pledges15:15 Question Time Debate with: Ali Mousa James Seward Paul Irwin Jenny Hyatt Rebecca Cotton16:00 Sarah Amani & Katrina Lake Closing Comments16:15 Closing
‘My Journey’ Mobile AppEarly Intervention in Psychosis Service
“Following a wide eyed collective gasp of realization, we were quickly swept up in a heady conversation abouthow useful it would be to have a designated EIIP mobileapp that could help people manage their mental health through reminders and trackers.”Sarah AmaniDH Maps & Apps Competition – 7th out of 500ideas submitted for health apps
77% of people have a mobile deviceor 5.3 billion at the end of 2010 – U.N. Telecommunications Agency, http://www.itu.int
This was ‘portable’... <10 years... Released: 1998 Released: 2007 CPU: 233 MHz CPU: 412 MHz RAM: 32 MB (512 MB max) RAM: 128 MB Storage: 4 GB (+ optical drive) Storage: 4 GB (8 GB max) Display: 38.1 cm Millions of colours Display: 8.9 cm Millions of colours Dimensions: 40.1 x 38.6 x 44.7 cm Dimensions: 11.4 x 6.1 x 1.2 cm Weight: 17.3 kgs Weight: 135 g
Your mobile phone hasmore computing power than all of NASA in 1969. http://www.ﬂickr.com/photos/43533334@N07/5153726732
“For kids like my 13 year-old, theboundaries between the internetand life are so porous as to bemeaningless.“Comment on the Guardian web site most will grow up connected http://www.ﬂickr.com/photos/tocaboca/5523598823
Public space distractions limited attention mobile usage can be this... glanceable? onehand simple? tedious input personal http://www.ﬂickr.com/photos/oimax/3800475934
1hr train ride Focused user privacy reliable network? comfy Unlimited wiﬁ? chair two handsReliable power source? or this...
comfy chair privacy One hand prone toReliable power interruptions source gravity ...or this? http://www.ﬂickr.com/photos/joeshlabotnik/2359224681
“ The most profound technologies are those that disappear. They weave themselves into the fabric of everyday life until they are indistinguishable from it…. Mark Weiser http://www.ﬂickr.com/photos/armaggeusa/3176297283
Our behaviour is changing, because devices are changing...
Mobile Opportunities touch screen tiny hybridscreen + keypad large input touch navipad screen many of these are now <£50 yesterday today
A big screen... web browser + application is now a highly customisable layer always on, always connected + blank canvas... APIsWith a button or two!
camera a big screen... work communication play sharing web browser learning + enabling users to choose application layer music their own experience + chat APIs navigationWith a button or two! discovery Health creativity video
Mobile App Costs, Benefits, Build vs. Buy Gauge the Opportunity Business Drivers Examples ROI DecisionCompare Mobile Platforms Mobile Market Overview Platform Analysis and Selection Focus Business Application Goals and Objectives Security and Privacy Requirements Requirements Development and Develop the Application Keys to Success Required Resources Testing Launch, Measure, Launch and Promotion Feedback and Metrics Future Releases Iterate
My Journey times have changed Person motivation Ce n’est pas unIntuitive al phone Usabl Responsi al Customiz eHelpf ve able ul
• 47 Adolescents & 6 clinicians• Outpatient Clinic• Self Reported Mental Health Outcomes for 4 weeks• First week - 91% entries completed• 88% said data reflected actual experiences• 92% adolescents found app ‘helpful’ in understanding their condition + collaborating with clinician in managing their health1. Reid et al (2011) A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial.2. Reid et al (2012) Using a Mobile Application in Youth Mental Healh Journal of Australian Family Physician http://www.ncbi.nlm.nih.gov/pubmed/22962650
http://speirs.org/blog/2011/4/1/stop-lying.htmlThis is the world we are living in and we can either lie to ourselves about it or we can dive headlong into the new forms and eﬀects that it produces. – James Bridle http://www.ﬂickr.com/photos/tijanav/4885088185
SafetyPrivacy PEOPLE Evidence Professional re- imagined
The Policy Context and Future of E-Mental HealthRebecca CottonActing Deputy Director, Mental Health Network
Today’s session• About the Mental Health Network.• Outline our work on e-mental health.• Outline some of the policy and strategic drivers that may help drive spread innovation in e-mental health.• Opportunity to get involved in future work.• Q&A
About the Mental Health Network• Part of the NHS Confederation – the membership body for all organisations that commission and provide NHS services.• We represent 70 providers of mental health services in England – including NHS Trusts, Foundation Trusts, voluntary sector and independent sector providers.• Governed by a board of members – including Chief Executives, Chairs, Clinicians and service user and carer representatives.
What we do• We help shape and challenge national policy and legislation affecting our members.• We provide members with up to date news and analysis, through briefings and events.• We also work to identify and spread good practice and innovation in the mental health sector, plus carry out original research.
Work over the last 12 months• Social media• Payment by Results in mental health• Measuring outcomes in mental health• Suicide prevention• Housing and mental health• Mental health and homelessness• Effectiveness of psychological interventions for patients with long-term conditions and MUS• Race equality in mental health
E-mental health – what’s all the fuss about?• Discussion paper launched 30th January• Asks how can the mental health sector make the most of opportunities offered by e-mental health to not only improve efficiency, but also to transform the nature of mental healthcare itself?• Asserts a national framework for e- mental health should be developed to provide a platform for change.
Policy contextNo Health Without Mental Health• Number of objectives are relevant to e-mental health, inc improving access, recovery rates and experience of using services.• Implementation framework highlights e-mental health.Information strategy• Published May 2012. Sets a ten-year framework for transforming information for the NHS, public health and social care.
Policy contextInnovation, health and wealth• Published December 2011. Sets out eight principles that could help frame a strategy for e-mental health.Choice, personalisation and Any Qualified Provider• Making choice work – in terms of choice of provider and choice of treatment – will depend on access to high-quality, comparable information.NHS Mandate• Sets an objective around increasing in the use of technology to help people manage their health and care.
Where do we go from here?1. How can we build momentum and support real change, in partnership with service users?2. How can providers make sense of what is a rapidly evolving marketplace and make informed choices about which programmes and applications to use?3. How do we determine what „quality‟ looks like?4. How can we ensure that innovations in this field are developed within appropriate governance frameworks?5. At a national level, how can we help spread knowledge and good practice about what works?
A national framework for e-mental health• In our view, a two-stage process is needed, culminating in the development of a national framework for e-mental health.Stage one: Comprehensive mapping exercise.• What are people already doing with technology – including service users, carers, members of the public, professionals (including clinicians, managers and informatics specialists), providers and commissioners?
A national framework for e-mental healthStage two: Designing the framework• Building on the mapping exercise, this would lead to a shared vision for what people would like to be able to do with technology, and set out clear actions for different parts of the system to enable that change to be brought about.• Broad engagement process – involving service users, carers, members of the public, professionals, providers and commissioners.
What happens next?• We have secured funding from the SHA mental health leads group to undertake the first stage of work – the mapping exercise.• Scoping work on this is currently underway – we would very much welcome input and involvement from MHN members, including any examples of current work in this area.• We will continue discussions with DH, NHSCB and others about future development of a framework for e-mental health.
BUDDY APP: SIMPLE PROPOSITION To use ubiquitous text-messaging to give users a tool for taking more control of their recovery and as a resource for collaborating with professionals to achieve their goals
BUDDY APP PROVIDESBuddy is a digital tool to support therapy services.It enables clients to: – Keep a daily diary via SMS – Spot patterns via a website – Be reminded about session appointments via SMS – Create their own session plans in advance – Set and receive behavioural activation goals via SMS
BENEFITS SERVICE USERS PROFESSIONALS MANAGERS Spot Patterns Rich Insight Improved DNA rateImproved Communication Make Time in Therapy Caseload management Create Control Focus on Goals Appointment reminders Happier users, enabled clinicians, and more efficient services
SLaM Service SERVICE USERS PROFESSIONALS MANAGERSImproved quality of life in 63% Compliance 7% DNA decrease 87.5% of users (from previous trial)57.1% of users reported 71% users felt it allowed decrease in CORE-10 for more open and honest discussion100% of users saidthey would use again * Published data from the SLaM EIS 100 week trial
USER FEEDBACK“Buddy helped me communicatebetter with my therapist, and ithelped me to spot patterns and seewhat I was doing or not doing.Buddy really felt like a friendchecking up on me at the end ofthe day. Sometimes it was the onlycontact I would have throughoutthe day. Its something that helpedpoint me in the direction ofchange, and which I then felt betterable to act on." Helena, Service user
CLINICIAN FEEDBACK Eric Morris, Clinical Director, EIS, SLaM"The idea of Buddy is to put the persons goals at the centre of their treatment. Ivenoticed that the ones who are using it have become more focused in what they wantto get out of our meetings. Early intervention service users usually have problemswith depression and anxiety and Buddy gives them support during the week whentheyre not seeing a therapist."
Stockport IAPT, Self Help Services SERVICE USERS PROFESSIONALS MANAGERS 100% of users satisfied 100% clinicians would use again in the future 4.5% DNA decrease with care received 63.8% reported 83% felt it allowed 4% canc. decrease decrease in PHQ9 and for more open and GAD7 scores honest discussion 500 additional clinical hours Improved quality of life in 89.2% of users £25k additional income (PbR)* Published data from the SHS Buddy Trial Outcome report* All data over historic baseline
CEO FEEDBACK Nicky Lidbetter, Chief Officer, Self Help Services“With the increasing demand for providers of mental health services todeliver more for less, Buddy contributes to system efficiency and enhancespatient experience by promoting the collaborative nature of therapy sessions.This enables patients to feel more in control of their interaction with theservice. ”
RETURN ON INVESTMENT• For service providers moving towards PbR, Buddy offers increased: – Throughput – Efficiency – Outcomes
CLINICAL FEEDBACK“Buddy is being used in a variety ofways in addition to routine activityand mood monitoring. Theseinclude: pain diary, alcoholdiary, monitoringflashbacks, monitoring fordissociation, promoting groundingtechniques and mindfulness suchas remember to notice where youare‟ and „what you are doing rightnow?” Regarding impact on DNAand CNA rates, it‟s also having apositive effect of reducing DNAs” Dr Alan Barrett, Clinical Lead
SUMMARY• Buddy has been designed to specifically support mental health pathways• Built to improve user engagement• Designed around everyday lives, and everyday technology• Improves the relationship between professional and service user• Empowering and non-stigmatising
ABOUT US• Incubated by Sidekick Studios, Buddy Enterprises Ltd brings together business, design, digital and mental health professionals• Developed in collaboration with SLaM‟s CMHTs & Early Intervention in Psychosis service & Rethink‟s NE Essex Health in Mind IAPT service• Current clients: – NW Regional IAPT for Military Veterans service (Pennine Healthcare NHS Trust) – Nottingham Healthcare NHS Trust – Self Help Services Stockport – Kent & Medway NHS Trust – West London Mental Health Trust – Sheffield Health and Social Care NHS Trust – Derbyshire Healthcare NHS Trust – Mental Health Matters
Awards / RecognitionGold Award Winner 2012 Finalist 2012Community & Social Mobile App Innovation in Mental Healthwww.lovieawards.eu