Although digital tools for mental health are fast becoming commonplace in primary care, secondary care is yet to adopt them in the same way. An HSJ webinar, in association with SilverCloud® by Amwell®, looked at why this is and how one trust was making progress in this area
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Mental health services are facing extraordinary strain. National statistics show almost 2 million people were in contact with mental health services at the end of September 2024 – the most recent data available – representing a 48 per cent increase compared with 1.3 million people five years ago in September 2019. Meanwhile, the Labour manifesto claimed the country was “suffering from a mental health epidemic that is paralysing lives”.
What role could digital play in easing this pressure? After all, among the government’s three big shifts for healthcare is a shift from analogue to digital, while Lord Darzi’s report on the state of the NHS urged for a “major tilt towards technology to unlock productivity”.
Douglas Hiscock, chartered occupational psychologist and Amwell behavioural health senior product manager, said tech for mental health “really took off” when NHS Talking Therapies services – then known as Improving Access to Psychological Therapies – started rolling out.
As a manager setting up an IAPT service, Mr Hiscock soon recognised delivering cognitive behavioural therapy at scale presented “a huge opportunity [to tackle] inefficiencies” – from the number of people needing regular in-person appointments to the amount of money spent posting documents.
While digital offerings were available, many simply replicated CBT’s rigid format. “That just isn’t how people work in the digital world,” said Mr Hiscock. “They like to be able to move around, like to be able to find their way through things at their own pace.”
With this in mind, SilverCloud® developed a platform that let people work through the CBT programme at their own pace, while reducing clinicians’ admin time by collecting patient information on their behalf.
Meanwhile, Faris Al-Ramadani, GP partner, St Wulfstan Surgery, Southam, pinpointed covid as a “generation-defining moment” for mental health services, as it triggered a rise in both demand – and therefore waiting times – and people’s digital literacy.
This prompted Dr Al-Ramadani’s primary care network to adopt SilverCloud®, which cut the waiting time to access treatment to “near immediately”.
He said: “That was a really great offer for a clinician to say, ‘Well, obviously you’re suffering symptoms of stress or anxiety, or worry. Well, why don’t I send you a link? You can start accessing this tool tonight. You can start your therapeutic journey immediately’, and that was a game changer.”
But, while digital tools have been used to treat less complex conditions – such as mild depression and anxiety – for several years, they are yet to take off in the same way for severe mental illness.
Emma Paveley, interim assistant director, NHS Confederation’s Mental Health Network, highlighted various barriers to using mental health digital tools at a secondary care level, including a lack of long-term funding, cynicism among staff about technology creating additional burdens, recent changes in the commissioning landscape, and the day-to-day pressures trusts faced preventing people from having the “headspace to think about that innovation and to take those risks”.
However, Ms Paveley also pointed out there was a low level of trust in digital tools for treating serious mental ill-health, along with a “lack of understanding about how digital can be therapeutic and a lack of understanding about how it can complement other types of interventions”.
She added: “There are concerns that people who are very ill will not be able to engage with digital tech and the level of risk that’s involved there, that clinicians don’t have that trust.”
One trust which is using digital tools for mental health care is Lincolnshire Partnership Foundation Trust (see box out below). However, reflecting on when the tools were introduced, Steve Skinner, the provider’s service development lead, said: “From a clinician perspective, I can’t say people were overly jumping up and down to say ‘Yes, please involve me’… there were some concerns about the risk [of using] digital products.”
Taking steps to address concerns
But important stakeholders can be won over. Ms Paveley said the most successful platforms “really embed themselves in teams. They take the time to work with them to take on the feedback to support them where there [are] issues.”
The panel also highlighted digital poverty among patients as another barrier. Ms Paveley stressed the importance of being “clear about the steps that are being taken to address any risks here, and also making sure that people with lived experience of mental health issues are involved right from the beginning of the development and across the pathway”.
However, Dr Al-Ramadani said: “We can sometimes perhaps overemphasise inequalities created by the use of digital tools… You just need to really be very careful to mitigate any risk. And what that means is you can’t deliver a digital-only option, because actually, you will leave people behind. So we need to have blended, mixed, perhaps hybrid approaches to the services that we’re delivering.”
Mr Hiscock agreed offering patients non-digital alongside digital options was important. However, he added that some organisations he had worked with who had discovered a cohort struggling with digital access also discovered “it’s not just their healthcare [they struggle with] – it’s everything. They’re struggling with banking, and they’re struggling with other areas. So they’ve actually implemented some skills-based learning stuff for their clients as well, which has been really beneficial for them… to get access to other areas… So it’s about services thinking very creatively about the client group”.
Overall, the panel was optimistic mental health’s digital journey was just beginning. Mr Hiscock said: “I think it’s a really good time for digital… it should start to flourish even more.
“But it’s still at the beginning. We still have to work some things out.”
How Lincolnshire Partnership FT has been using digital
Mr Skinner explained Lincolnshire Partnership FT’s digital journey started in 2008 with community settings but has evolved since then.
The trust has been working with SilverCloud® since 2018 and now offers a “blended” model across various services – including community rehab, personality and complex care, and older adults – to treat patients with a range of illnesses, such as severe depression and anxiety, schizophrenia, bipolar disorder, and complex trauma.
Mr Skinner said his team worked carefully with clinicians to gain buy-in and developed several new roles, mirroring those found in talking therapies, as part of this. He also credited “executive sponsors… having senior leaders within the organisation who are bought into the digital journey” for the transition’s smoothness.
To address access issues, the trust has set up “access booths” for those who would otherwise be unable to use the digital service.
Feedback has been positive. So far, 300 patients who have rated out of 10 how they felt they had progressed against their treatment goals gave an average rating of between six and eight by the end of their treatment.
While acknowledging the tech doesn’t meet every individual’s needs, Mr Skinner added: “It certainly helps move people in the right way towards meeting their overall objectives… people being worried around risk and not using it with a more severe and enduring cohort, really, we’ve disproved that a little bit and the patients have really benefited from it.”
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