Digital healthcare technology: mental health

Published 9 April 2019

How the mental health sector is leading the way in technology helping vulnerable patients.

Mental health remains a Cinderella service despite repeated Government promises to ensure parity with physical health. For technology it’s a two-edged sword: on the one hand limited resources means mental health services cannot afford to gamble on large infrastructure projects and expensive technology; but on the other, overstretched resources means there is a need to innovate to work smarter. As a result, mental health has embraced some of the opportunities around technology faster than acute hospitals.

“Although mental health trusts have been historically relatively underfunded, we have embraced some elements of technology far faster than the acute sector. You would struggle to find a mental health trust that doesn’t have a very well-established electronic patient record system,” says Christopher Hilton, Director of Strategy and Clinical Director for Integrated Care at West London NHS Trust.

Engaging patients digitally

Mental health service providers in north-west London have been piloting allowing some patients – those experiencing their first episode of psychosis – access to part of their mental health record. Previously, there has been a nervousness about sharing that information with patients, but that is changing, according to Hilton.

Patients can refer themselves for psychological therapy provided online or through mobile applications, with the support of a therapist (in addition to the traditional face-to-face modalities), through the NHS Improving Access to Psychological Therapies (IAPT) programme. NHS England is working with the National Institute for Health and Care Excellence to support a new, digitally-enabled therapy assessment programme, where up to 14 digital therapy products will be assessed for use in IAPT services by 2020. Five therapies have been evaluated and accepted so far.

Therapists providing digitally-enabled therapy through West London’s Back on Track IAPT service in north-west London, have contact with patients through the portal, and are exploring offering remote face-to-face video consultations, explains Hilton, who is a consultant psychiatrist. “You could hypothesise that mental health interventions, which rely on verbal communication rather than physical contact, may more readily lend themselves to remote consultation.”

South London and Maudsley NHS Foundation Trust is already using video consultations to assess patients’ suitability for highly-specialised mental health services. Previously, many patients travelled a long distance for an assessment and then found they were not suitable for the service.

Monitoring vulnerable patients

Several sectors within the health and care system are faced with what is known as the corridor problem – how to monitor vulnerable patients, such as those who might self-harm, get out of bed in the night and fall, stop breathing, or experience other difficulties, when they are in their own rooms. And mental health is now taking the lead in using a piece of technology called the Digital Care Assistant (DCA), developed by Oxehealth, to solve it.

Traditionally, a staff member would have to go and check on a vulnerable patient by doing a risk assessment at regular intervals – sometimes as frequently as every 15 minutes in mental health. This is both labour intensive and disturbing for the patient, and only picks up problems at the specific times patients are assessed.

The DCA is able to monitor patients using the digital feed generated from an optical sensor in the patient’s room that picks up light and movement. The system can determine the patient’s pulse and breathing rate, and alert staff if the patient gets out of bed, leaves the room or spends longer than normal in the bathroom. Staff can then go and check on the patient or switch on the video feed.

The system is also able to automatically generate reports on whether the patient got out of bed and how frequently they visited the bathroom, which can give insights into the patient’s behaviour that might aid their care.

“We are developing outcomes data in working age adults and older adults in mental health and that is showing a very significant reduction in injuries and reducing staff time spent on safety observations instead of healthcare delivery, and therefore improvements in patient outcomes and staff experience and cost,” says Hugh Lloyd-Jukes, Chief Executive of Oxehealth.

In England, the system is being used by 16% of mental health trusts, and some prisons and police custody services. Gill Weatherill, Partner and specialist in mental health law at DAC Beachcroft notes that: “Patients in mental health services often present with complex physical needs. The CQC has repeatedly identified the need for improved monitoring and escalation to address those needs. Technology offers clear opportunities in this area, whether in improving information sharing between providers (which will in turn improve quality and reduce risk), or in facilitating resource intensive observations.

“However, any reliance on technology as an alternative to well-established staffing expectations will be subject to regulator and public scrutiny and will require robust governance processes to minimise any risk of patient safety failures.”  

Any slowness of uptake of innovation is mostly related to the challenge of a lack of funding rather than regulation, Lloyd-Jukes says. “We are not held back by regulation. We actually like the rigour of the Caldicott Guardian system; we value that, we require our customers to review and agree our detailed privacy impact assessment as part of our contract.”

In Sweden, the system is being used in care homes and will also be tested in some private homes where there is well-developed homecare.

“We put it where there is a professional who is going to be able to intervene, because we don’t want lots of information and no one able to respond to it,” says Lloyd-Jukes.

“Homecare is absolutely a place where this technology could go, but in the UK monitoring services are not set up to respond to this information. That is why we are developing our care home solution in Sweden, because municipal health and social care budgets are connected.

“The challenge in the UK is that the health and social care systems are separate, whereas in Sweden there is an integrated approach. If you get somebody out of hospital earlier, you get the saving in the budget where you have to spend to look after them at home. They have monitoring centres and they have teams of care workers to provide help in the home.”

West London NHS Trust tested the DCA system in Broadmoor Hospital, and found them promising, Hilton says. As a result, they are now piloting the use of the devices in clinical areas and exploring opportunities to deploy them more widely in the new purpose-built facilities that will open in the next few months. “These devices offer additional support for nursing staff to maintain safe care, by allowing improved monitoring of patients whilst reducing the need to disturb their rest,” explains Hilton.

Using analytics to improve care

Analytics are being used increasingly in mental health to improve care. For example, in north-west London, primary care, acute and mental health providers are feeding data into dashboards. One dashboard enables clinicians to determine whether the physical health needs of mental health patients, who die on average 20 years prematurely and may not engage regularly with other services, are being met. Clinicians in mental health services can check whether the patient has been assessed for diabetes or for smoking status, for example, and then act on it.

Even when the data is billing rather than clinical, it allows clinicians to see a patient’s overall health service utilisation, which tells a story. “You can see that very often there has been very limited healthcare utilisation and suddenly it has increased. You can hypothesise that something happened in their life,” explains Hilton.

Improving care for patients in crisis

Ambulance staff and paramedics are frequently the first point of contact for patients with mental health issues, especially at times of crisis. Yet A&E is rarely the place where they will receive the best tailored care to their immediate needs.

In November 2018, NHS Digital launched a National Record Locator (NRL), which will eventually allow health and care professionals and providers to securely locate and identify patient records elsewhere in the health system. The first phase of the project is trialling the service with local shared record providers, ambulance services and mental health trusts in the North West, North East, Yorkshire and London.

Murat Soncul, Head of Information Governance at South London and Maudsley NHS Foundation Trust explains: “When called out, ambulance staff can see if that person has engaged with the mental health service in the past, so they don’t automatically take that person to A&E. Instead they can take them to a psychiatric facility, which will save a lot time and be better for the patient.” 

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