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In NHS IT, mental health is quite often overlooked. Primary care was the earliest sector of the health service to computerise, and the failures and successes of acute hospitals since then have grabbed the most attention. Mental health, meanwhile, has taken a firm back seat.
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But the potential for IT in mental health is gaining recognition. NHS England will highlight the sector in its next round of digital exemplars, due out in the next few weeks.
This year’s EHI Live conference even went as far as adding a specific stream of presentations on the topic, as well as a keynote speech from former health minister Norman Lamb.
Lamb highlighted the NHS’s lack of progress on treating mental health compared with other diseases. “It is, in my view, the enduring scandal of our time that people with mental health problems die on average 15 to 20 years before anyone else,” he said, adding this was partly due to a failure to treat the physical complaints that often accompany poor mental health and partly due to suicides.
IT can play a significant role in both of these, said Lamb, citing a clinic in Harlem, New York, which screens patients for mental health risks using electronic health records and then provides preventative treatment.
The clinic aims for zero suicides. “You challenge the assumption that a certain proportion of people with mental health issues will take their own lives,” said Lamb.
For most other diseases, mortality rates have fallen steadily: “Then you get to suicide, where the rate is stubbornly static. We have to be more ambitious,” he added.
Improving mental health data
NHS Digital, which provides data and technology services across England, is working to improve its data collection to support mental health work. Dave Roberts, its head of primary care information, said its analysis found one person who had been referred 26 times to 18 teams at eight different NHS trusts. The centre is working on how such individuals can be identified in future.
Lamb said NHS should be using video consultations for mental health, but these are rare because organisations feel overwhelmed by the demand and cuts. “Quite often, it’s difficult for them to see the wood for the trees,” he said. While there was great innovation in places, “too often there is a mindset that carries on with business as usual”.
Birmingham and Solihull Mental Health NHS Foundation Trust has started to break that mindset with its own small in-house team of developers. They have written form functionality for the RiO patient record software, used by many NHS mental health trusts, which records consultants granting patients permission to leave acute mental health wards.
“It means we’ve been able to completely dispense with all of the paper forms,” said chief clinical information officer (CCIO) James Reed. Staff can better manage the trust’s responsibilities under section 17 of the Mental Health Act, and are able to see when patients are due back and who signed them out.
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Birmingham and Solihull has also written software to record therapeutic nursing observations on mobile devices, previously recorded on clipboards, with some patients checked every five minutes.
The software, which again integrates with RiO, tells ward managers whether patient observations are being made properly, and nurses which medications a patient is on and how long it is until the next observation. “You can put a lot of information in the hands of the observing staff,” said Reed. “They’re better informed about the observations they are doing and there will be more accountability.”
The trust is about to start piloting the nursing observation software’s use. It issues staff with BlackBerry devices for work rather than allowing them to use their own under a bring your on device (BYOD) policy, which is becoming rather fashionable in the NHS. Reed said it is likely to stick to this policy for the new software.
“It’s a little bit old fashioned in some ways, but they do have the advantage of quite a robust technical platform. For me, it really makes the point that having in-house developers gives you a huge amount of opportunity to do what, for them, is relatively simple work, but can have huge benefits,” he added.
Birmingham and Solihull is in the process of moving to electronic prescribing on all its wards and plans to add community work in spring 2017. Reed said such software is relatively unused in mental health trusts because of their specific additional requirements compared with general acute hospitals. These include having to obtain patients’ consent under the Mental Health Act for some treatments and providing services both in hospitals and in communities.
Aside from computerising processes, some organisations are using IT to support mental health patients in staying well, according to Rebecca Cotton, director of mental health policy for the NHS Confederation. ClinTouch, an app developed by the University of Manchester and Manchester Mental Health and Social Care Trust, allows users with psychosis to record symptoms daily on a smartphone and for clinicians to get in touch when the data indicates problems rather than waiting for a crisis.
Patient access to records
South London and Maudsley NHS Foundation Trust, which has previously established access to patients’ own data through its MyHealthLocker website, opened its centre for translational informatics in June 2016. Cotton said it is looking at the potential for using virtual reality and wearable technologies.
She added that the UK should look at other countries’ work, such as Australia’s government-funded MindSpot anxiety and depression clinic. More than 50,000 Australians have undertaken free online screenings, which are used by the clinic to produce assessments.
The clinic also offers online courses backed up by telephone support from trained therapists. “As a population, they have phenomenal challenges around remote access,” said Cotton.
“There is a cohort of people who will always want face-to-face contact, and that’s fine,” she said. “But I think people are increasingly going to want to access services with no waiting, in a time and a place that suits them.”
Some NHS mental health trusts are providing online services themselves, or through organisations such as BigWhiteWall, while others are computerising paper processes. But with mental health lagging behind other parts of the NHS in its use of IT, which itself lags in many parts of the public and private sector, there is a lot of ground to make up.