Welcome back to our podcast HTN Let’s Talk!
For this episode, we interviewed Ayesha Rahim, clinical lead for digital mental health in the NHS England Transformation Directorate. We discussed what digital projects Ayesha has worked on throughout her career, the challenges that lie in digital mental health in relation to digital exclusion, and more.
To start off Ayesha spoke about her current role and career background.
Ayesha has worked in the NHS for nearly 20 years. “I work as a psychiatrist, treating people’s mental health. I spend about one day a week on that these days and in the rest of my time I’m focusing on other jobs, mostly in digital. Apart from my psychiatrist role, I also work in a mental health trust as their chief medical information officer, which means I’m their medical lead for digital transformation.” She explained that she works with her colleagues in the digital department to think about “how we can improve our digital services for staff and also therefore for patients as well.”
Ayesha’s other main role is with NHS England as the clinical lead for digital mental health. “I work with national teams around policy regarding mental health and digital, where those two things collide,” she said.
The impact of digital on mental health care
Ayesha noted that mental health wide spectrum – from people who may not be mentally ill but have some needs around their psychological wellbeing, to people with significant mental health conditions who are treated in a mental health trust or specialist service.
“There are opportunities to support people at every point in that journey with technology,” she added.
Ayesha highlighted that there is a lot of potential impact for digital in mental health care for children and young people. “We know that effectively treating the mental wellbeing of younger people not only improves their wellbeing at that point in time, but also reduces the risk of them going on to to develop longer term conditions.”
If we can get things right for young people in society, Ayesha said, then hopefully “they won’t need to make lots of use of mental health services when they are adults. It’s pretty clear at the moment that it’s really quite difficult for young people to access mental health services in a timely fashion and there are many different reasons for that.”
“A lot of the narrative around improving mental health and improving digital mental health often focuses on that early phase, around wellbeing, which is of course extremely important,” she said, adding that it is important to try and prevent problems before they get worse; however, she pointed out a need for more focus on people at the more severe end of the spectrum.
Something that could improve experience and outcomes for this group of people, Ayesha said, would be the ability to access their own notes and contribute to their own care plan. “That’s something that we’re not great at, currently, but we are making progress in that space.”
Key projects with digital mental health
Ayesha described how she is heavily involved with the electronic patient record at her mental health trust, and how it can be optimised.
This work includes focus on “how we can make that experience better for staff who are spending lots of time seeing patients, but also lots of time entering data into health records as well,” she said. “That can sometimes be quite an onerous, time-consuming task.” She explained that her colleagues are working together to ensure that the design of this system “makes it easy for people to do their jobs, spending more time seeing patients and less time entering notes and doing administration.”
Looking to her NHS England role, Ayesha commented on her passion around the Mental Health Act. “This is legislation that supports people who are at the most severe end of the spectrum of mental ill health. There is legislation to govern how people are admitted into hospital under those circumstances and we need to think about how we digitise that process, because at the moment that process largely relies on bits of paper.”
Ayesha highlighted another project around building the evidence base for digital mental health interventions, to help people have confidence that the products are effective and safe. She noted that if you search for an app about mental health, you will find hundreds of products out there, and emphasised that patients, citizens and staff need to know which of these products have met the thresholds for a good evidence base.
Key learnings and challenges
“I’ve had a very steep learning curve because I started off as a psychiatrist, as a doctor in mental health,” Ayesha said, “so the digital world has been one that I’ve had to get to grips with.”
One important thing to recognise when trying to improve digital services is “the importance of involving the people that are using those products,” she said. “It might be patients, it might be staff – and it goes for mental health and every other kind of digital transformation project that you’ve got.”
If you are implementing a digital product or platform, “you need to know that people feel comfortable and confident using it and they see it as an important thing that they can use in their day-to-day roles. You don’t want it to be something additional that somebody has asked them to do without any consideration of the impact that that has on their working life.”
This engagement can be a “real missed opportunity,” Ayesha said, “because what’s been neglected is that focus on helping people, managing people through change. And that’s what real transformation is about from me.”
Successful digital transformation in mental healthcare
“It’s really important that we try and address the challenge of people struggling to access mental healthcare in a timely fashion,” she stated.
She explained that instead of working harder, we must work smarter, and digital can support us in this. “I wouldn’t want to say or imply that digital care is a complete replacement to human touch – of course that’s always going to be needed and necessary.
“But digital is there to try and address some of the gaps that we have between demand for mental health care and our current resources. That’s what good transformation looks like, to me – meeting people’s needs so that they can access care quickly, helping them to feel better.”
Digital exclusion and the uptake of mental health services
“I often hear from people who aren’t in the digital health space about worries that technology and digital will exclude more and more people. It’s something we are very conscious of and absolutely want to avoid,” Ayesha said. “We can’t create digital channels that then act as a barrier.”
It’s about opening up the offer and increasing choice, she said. “One thing to be aware of is that it’s not always a case of not wanting it. There are a variety of reasons as to why people can’t access digital services – they might not have the connectivity, skills or confidence. It could be because they do not have the devices needed to access care, she suggested, or the data available to do so.
If you have issues with connectivity, it doesn’t matter “what kind of brilliant well-evidenced digital product or app you’ve got access to – if you can’t connect to the internet, you’re not going to be able to make use of it.”
On how to tackle these challenges, Ayesha highlighted that some places are working around this issue by offering a community space where people can access a digital service.
On the services themselves, Ayesha commented: “We know that there are many people out there who really struggled to use mental health services in the way that they are currently configured.”
Additionally, whilst it’s important to improve the quality and standard of services, “wouldn’t it be better if we’re trying to prevent people becoming unwell in the first place?”
Ayesha highlighted the need to support people with factors such as education, employment, finance and accommodation in order to support prevention work. “All of these things can impact on people’s wellbeing. If you have a vulnerability to developing a mental health condition, for example, then these circumstances might trigger a problem.”
Addressing these social determinants can have “a massively positive impact on people’s mental wellbeing, which will also then have a positive impact on the reducing the demand for mental health services,” she said. “We want to try and nip things in the bud and do our best to reduce the likelihood of people developing a mental health condition.”
Again, Ayesha said, accessing care in a timely fashion plays an important role in reducing health inequalities
“If we can think about what digital interventions we can provide for people who are on waiting lists, for example giving them some level of support whilst they are waiting for a formal appointment, I think that would be one space that we could really consider,” she said.
Another area to highlight is “being able to monitor people’s response to treatment in a really objective way.” She noted that her organisation is currently working to roll out a rating scale to support with this, whereby people can indicate what elements in their life are causing them the most distress, such as housing, mental health symptoms, medication or employment.
“That’s the dialogue plus scale that was developed by a mental health trust in London and it’s something that’s been rolled out in lots of different mental health organisations,” Ayesha said. This scale is then repeated at various points throughout the patient’s journey, to monitor the elements that are in place to support the individual. It allows health professionals to see whether those elements are effective, and if not, whether there is something else that can be put in place to help.
Many thanks to Ayesha for sharing her thoughts.