Feature Content, Interview

Interview: Bryan Walker of InterSystems on digital mental health

To explore the topic of digital mental health we spoke to Bryan Walker, Application Specialist at InterSystems.

Bryan shared his thoughts on the role digital has to play in mental health, what success in digital transformation looks like to him, his current focus and more.

Read on to find out what Bryan had to say…

Can you tell us a bit about your background and your role?

I started in mental health nursing as a Health Care Assistant working on both acute mental health and forensic inpatient wards. Having found an interest and affinity for the work, I applied for and was granted a secondment to complete my Mental Health Nurse training at the University of Huddersfield.

My nurse training gave me opportunity to experience mental health nursing in different care settings and for different conditions. After I qualified, I returned to working with forensic mental health inpatients for several years, before transferring to a crisis intervention/intensive home-based treatment team.

Whilst I was working with the crisis team, the NHS trust that I worked for implemented their electronic patient record (EPR), which took us from an entirely paper-based organisation to one where clinical notes were recorded electronically and shared across the organisation. Having experienced the transformation first-hand, I knew quickly that this was a direction I wanted my career to go.

It might sound corny, but I believed that as a clinician I could only help one patient at a time – by empowering more clinicians, I could indirectly help improve more patients’ care.

Since moving into healthcare IT, I have implemented both best of breed and enterprise level EPRs. I currently work as an Application Specialist with InterSystems, implementing TrakCare into a variety of clinical settings, including mental health.

Where and how do you think digital can have the greatest impact when it comes to mental health care?

In my opinion, digital can have the greatest impact in ensuring seamless multi-agency collaboration in the delivery of care. A person suffering from a complex mental illness will often require not just multi-disciplinary input from within the treating organisation, but also multi-agency input from across the health and social care spectrum. Timely distribution of information between these organisations can help remove any blockers to accessing services.

For example, if the police engage with a member of the public that is suspected of suffering from a mental illness, then taking them to a 136 suite for assessment may seem like the only option. But if the police were able to remotely access an information exchange that provided the contact details for the individual’s regular care team, this could potentially avoid the need for an assessment and ultimately a detention.

My own experience of working in crisis intervention taught me that information is critical to successful interventions. When a person in acute distress reaches out for support, any information that can help identify what may be triggering or causing the distress helps you to hone in on the problems. For example, the patient may have difficulty accessing their medication and this could be evident from their medication record. Or the patient may not be taking their medication as prescribed, and an integrated digital pill box could identify this. Of course, this may be evident from discussions with the person, but they may not always be aware of the source of their distress. Being able to access information from all of those involved in the person’s care – be it healthcare professionals, relatives, carers, or the person themselves (potentially in the form of advanced directives) can help to piece together the puzzle.

What projects relating to digital mental health are you working on at the moment?

My current project is to implement TrakCare into the National Forensic Mental Health Service in Dublin, Ireland. This is a particularly exciting project for me, as I can draw heavily on my own clinical experience. I think it is fair to say that the service is just at the start of their digital transformation journey, but equally fair to say they are ambitious and determined to deliver significant benefit. Having been a clinician and experienced that transition, I know that those benefits will translate into improved patient care. Just recently I have been working with the lead psychologist on the project, who is looking to harness the analytical capabilities of the system to assess the success of therapeutic interventions. These insights will allow him to identify which interventions are resulting in clinical benefit, both individually and across the cohort, and adjust clinical practice accordingly.

The hospital is a brand new purpose-built building, which will transform forensic mental health services in Ireland. The clinical team are looking to implement an EPR as advanced as the new building, in an effort to deliver a world class service.

What have been your key learnings and challenges?

In the early part of my career in health care IT, a key challenge was in the sharing of information. Clinicians still subscribed to the belief that mental health patient data needed to be kept ring fenced away from people outside of the treating organisation. Even within the treating organisation there were data sharing concerns. Fortunately, those barriers have started to come down as society works hard to de-stigmatise mental health, and mental health clinicians should be leading the way in breaking down this stigma, rather than re-enforcing it. Of course, there will always be a need to treat patient information in a secure and careful way, and access should be granted only where there is a legitimate reason to do so.

What would successful digital transformation in mental health care look like to you?

With my background in both forensic and crisis intervention, I am probably more focused than most on the “worst case scenarios”. Timely intervention can stop a crisis situation from occurring or spiralling out of control. As such, for me, successful digital transformation in mental health care would see information not just stored and reactively accessed, but proactively pushed to the relevant person or organisation. Utilising artificial intelligence to identify possible indicators of relapse or escalating risk, and then notifying the relevant person, could provide opportunity to intervene early. Numerous inquiries in the past have found that these opportunities to identify the problem and intervene have been missed, either because the information wasn’t shared with the appropriate person or that the indicators were simply missed. Digital transformation can hopefully focus the attention of mental health services on the people with the greatest need at any one point in time.

Of course, from the opposite end of the spectrum, digital technologies can provide opportunities to access treatment and therapies to those people who would previously be either on a long waiting list or deemed not meeting the threshold for limited resources. By helping organisations to deliver good evidence-based interventions to as many people as needed, digital can help transform mental health care for all.

Many thanks to Bryan for sharing his experiences with us – you can find out more about InterSystems’ work here.