Last week HTN attended an NHS workshop, “the future of digital in mental health and wellbeing”, in which NHS teams, innovators and suppliers gathered to discuss the current digital landscape for mental health within the NHS and what the future looks like.
Here we will take a look at some of the questions raised in the workshop, and some of the thoughts and experiences shared.
To start, the workshop hosts set a question for attendants to consider: where can digital have the greatest impact in transforming mental health care, and improving mental health and wellbeing outcomes?
Swift access to support and early intervention were key points for many in the audience, with one respondent highlighting that digital tools are best-placed to provide “in-the-moment support” for individuals who may be facing a crisis; another commented that digital tools can have the greatest impact by “monitoring mental health conditions to flag crisis to clinicians”, underlining digital’s ability to keep track of symptoms or reactions over an extended period of time, without the individual having to make repeat visits to see a healthcare professional in person.
On that note, digital’s ability to provide “access to highly specialised support without geographic restrictions” was also noted, along with its ability to provide tailored care. One respondent said that the greatest impact can be had by “providing personalised recommendations to different digital health technologies”; another noted that it provides “more choice to the public”.
Digital tools provide individuals with the opportunity to seek help discreetly, with an attendant commenting that they provide “de-stigmatised support for embarrassing conditions or minority groups”.
With the NHS backlog a hot topic across many if not all departments, it was pointed out that even if patients require complicated treatment or prefer in-person solutions, digital tools can help by providing support to people whilst they are on the waiting list – or they can at least be offered, making educational and self-help resources more widely available.
Another respondent felt that as digital tools can be embedded into an individual’s lifestyle and provide education and awareness, they are best-placed to help with “long-term behaviour change and relapse prevention support”.
Moving on, the next question posted by the workshop was: “In ten years’ time, how will transformed care feel for different service users, the public and the workforce? How can this benefit people who experience worse outcomes than the general population?”
Here, personalisation was a major theme. There will be “more digital and non-digital therapies available to patients in a personalised, precision manner,” said one respondent, with another agreeing that that they believe the future holds a “personalised NHS app that recommends prevention or therapeutic products to patients.”
Another key point was that of self-help. “When people visit their GP website they should see an array of self-help options before clicking that they need to see the GP,” said one workshop attendant. Another commented that the self-service opportunities should be “much broader in an ‘always on’ world”; broader opportunities also means “increased patient choice to reduce health inequalities.” On the same note, digitally-transformed care should provide “increased ownership”, according to one respondent, “shifting the balance from clinically-prescribed pathways and treatments to patient-managed journeys.”
It was widely agreed that in ten years, workshop attendants would expect to see digital tools making a significant difference to the speed at which mental health problems can be picked up and treated. We should see “immediate support for all patients”, said one, with another highlighting that a move away from standard GP hours, allowing people to contact healthcare professionals at the time that suits them, should also benefit this.
It was also agreed that respondents had high hopes for the future in terms of innovations, expecting to see “numerous new medical devices available for patients”. Additionally, they hoped that the process of distinguishing which devices would be suitable for which patients would be made simpler, with “clear registers of approved products for clinicians to recommend”.
One respondent said that they thought that earlier interventions would be made easier in the future, with better “understanding of how mental health is linked to physical health”. Another agreed that more awareness and better education in the coming years would change the delivery of services, adding that “mental health literacy improvements” were key.
Finally, a respondent commented that they hoped the future would hold “not just reduced stigma, but reduced severity”.
Next, looking at the hopes for the future, the workshop asked, “What needs to be in place for this to be achieved?”
For some, it all came down to data. One attendant commented on a need for “secure, linked datasets in a trusted research environment, with tools for analysis to develop new therapies”, whilst another agreed that “quality and clean datasets, with standardisation of core data points that are leading indicators” are required in order to bring the aforementioned hopes to fruition. Additionally, “understanding across multiple sectors in the ethics around research and data sharing to innovate for digital mental health” was raised as a key point.
A change in NHS culture was highlighted as necessary, with someone commenting that “buy-in from all stakeholders” is necessary before change can happen. A respondent said that the NHS needs to focus on “joined-up working and shared vision”; another added that “understanding from commissioners” is vital, with a need for them to understand “the benefit of digital, rather than [displaying] scepticism”.
For others, change needs to focus on the make-up of the NHS itself and how it works with others. A respondent said that “streamlined buying processes across the NHS with clear success KPIs” are needed to bring in the variety of digital tools that people hope to see. Similarly, somebody else said that a “clear agenda from the NHS for how digital services will be commissioned” is needed, “so that services can work towards developing the tools the NHS want”. Within the NHS itself, one respondent said that more learning and development teams are needed to make digital services a success, with “core infrastructure to support digital methods” needing to be in place across the board.
Another said that the NHS needs to ensure “more collaboration between practitioners and digital tech providers”; on the other hand, the need to “co-design with users” was highlighted. One attendant also commented on the possibility of “integration between [mental health] services with charities and private organisations”, to try and maximise the pooling of resources.
In order for digital mental health to have the wide reach it needs in order to succeed, the importance of reducing digital inequality was raised. To try and tackle this, one respondent suggested that “skillsets need to be taught through schools on use of digital tools”.
The final question set by the workshop was, “What do you think is the most important issue that a new, ten-year national mental health and wellbeing plan needs to address?”
Following on from the last topic, addressing digital inequality was high up on the agenda for the new ten-year plan.
So was the need to focus on how standards affect the development of new products and their usages. Respondents said that the plan needs to highlight “data standards”, “ethics standards” and “quality/outcomes standards”. In addition, respondents noted that attention should be paid to “breaking down data siloes” and working on “short and long-term impact evidence expectations”.
Again, the framework for how products are developed and make their way into the NHS was considered something that needs fixing and streamlining in the new plan, with an attendant commenting on the need for “clarity on market pathways” and “a set of standardised minimum criteria for a product to be available in the NHS’, and the development of “a gold, silver and bronze framework for what makes a good product”, which covers “science, data, impact and outcomes”.
The plan should prioritise an “increase in social prescribing and joined-up provision”, said one workshop attendant, pointing out that charities, the local NHS and private organisations all have a lot to offer people in need.
The issue of mental health in children was raised. The respondent said that the plan should take time to focus on the “prevention of issues”, suggesting that early intervention in young people could help ease some of the pressure on adult services whilst also providing the young people with the help they need without long timescales, which can “run into years”.
Finally, one respondent thought that artificial intelligence is the most important issue to address, emphasising that through taking time to explore its “uses, ethics and personalisation”, the NHS will be able to “increase trust in digital services”.