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Mindset XR: Introducing Round 2 Companies for the Programme

Published and last updated by Michael Mbanunu

The Health Innovation Network (HIN) South London and UKRI recently announced a multi-year innovator support programme focused on immersive therapeutics for mental health. We are excited to introduce the second round of companies joining the Mindset-XR Innovation Support Programme. These projects will receive our support as part of this initiative.

Below you can find out more about the companies we're supporting for this round:

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Mindset XR: Introducing Round 1 Companies for the Programme

Published and last updated by Michael Mbanunu

The Health Innovation Network (HIN) South London and UKRI recently announced a multi-year innovator support programme focused on immersive therapeutics for mental health. As part of this initiative, we're supporting 29 projects that are seeking to revolutionise mental health care in the UK through immersive digital mental health therapeutic innovations.

These companies are part of the first strand of the programme. Additionally, you can learn about the companies we're supporting in the second strand. Below you can find out more about the companies we're supporting for this round:

Sign up to our newsletter to learn more about the Mindset Programme and get the latest updates.

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Find support for your innovation

Get in touch with our Mindset-XR team to find out how we can help you make an impact.

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Immersive technology for mental health: understanding the evidence-generation landscape

Published and last updated by Sharon Farnley

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Building a reliable evidence base is an important consideration for any innovator in the healthcare space. In this blog, HIN Head of Insights Dr Andrew Walker provides a high-level introduction to evaluation and evidence-generation in the context of the Innovate UK Mindset-XR Innovation Support Programme.

One of the most exciting things about the Mindset-XR programme is how we are bringing together experts from so many different fields to make a difference to mental health; This includes supporting innovators with backgrounds in technology, the creative arts, education, media and gaming.

While this diversity of thought and perspective is a strength when it comes to finding creative solutions, it also poses some challenges for people less familiar with healthcare as a sector. One of the biggest challenges – and something which we’ve already heard investors flag – is around innovators understanding the importance of robust and compelling evidence for the safety and effectiveness of their XR-based intervention.

Without the right types of high-quality evidence, scale and spread of any commercial innovation is nigh-on impossible. This is especially true in the current economic environment. Commissioners, payers and patients need to be highly confident they understand how a technology will perform before they even consider paying for it.

As a result, the team that I head up at the HIN – covering evaluation, informatics and health economics – is extremely busy. We’re also involved in delivering DigitalHealth.London’s Evidence Generator Bootcamp, which has seen an explosion in interest recently.

Evaluation and evidence generation is a complex field, and the HIN south London Mindset XR Innovator Support Programme  will be providing bespoke support for innovators taking part, along with in-depth online learning resources. The purpose of this blog is to  provide a very brief overview of what the evidence generation landscape looks like in the UK, and start innovators down the right path when it comes to collecting the evidence they need for their work to succeed.

What do we mean by evidence and evaluation?

Although specialists working in the field have strict definitions for what these terms mean, you might hear them used interchangeably. Broadly speaking, it can be helpful to think of them as the below:

  • Evaluation: judging the worth or value of something, often in comparison to other available options. For example, you might seek to evaluate whether your innovation delivers better clinical outcomes than the current treatment approach.
  • Evidence: the sources of information that you might use to make a decision about something. This could include evaluations, feedback from patients or users, analytics or analyses of population health.

Within health and care innovation, it is generally considered best practice to integrate evaluation and evidence-related activities into every stage of your projects. Your stakeholders will want to see that you have used evidence to understand a particular disease area to specialise your solution for; there will be an expectation that you have methods for measuring how your innovation works with users (such as analytics within your XR software); to drive widespread adoption will eventually need to have compelling evidence that your innovation provides advantages over what is out there already.

As you start to look at what evidence and evaluation might mean for your innovation, the complexity and costs associated might begin to look quite daunting quite quickly – especially for more complex formal evaluations with patients such as clinical trials.

Luckily, in recent years, the path for developing good-quality evidence for digital health interventions has become much clearer.

The role of NICE and the MHRA

There are two key organisations who immersive technology innovators need to be aware of when it comes to defining national standards for evidence:

  • The National Institute for Health and Care Excellence (NICE)
  • The Medicines and Healthcare Regulatory Agency (MHRA)

Probably the best starting point for most digital innovators is to look at NICE’s Evidence Standards Framework (ESF). The ESF is intended to be a shared framework which allows innovators and commissioners to understand the most important types of evidence for different digital health technologies (DHTs).

Using the ESF, DHTs are grouped into three tiers based on the intended use of the innovation. While the range of applications for XR in mental health is almost limitless, we anticipate most innovations we come across during the Mindset programme will fit into Tier C (DHTs for treating or diagnosing medical conditions) or Tier B (DHTs which help people to manage their own health and wellness).

After the correct tier has been identified, the ESF lays out 21 standards for consideration, ranging from clinical effectiveness to environmental sustainability.

Because the ESF is a framework rather than a formal assessment, it does not prescribe exact evidence requirements for each of these standards. Instead, it provides a comprehensive overview of all the different evidence areas which are likely to need to be considered. Within these, companies can develop their evidence base over time as their innovation scales.

The MHRA’s role is different – they regulate (by law) all medical devices in Great Britain and Northern Ireland.

Defining what is and is not a medical device in the world of DHTs is not always straightforward; the MHRA have produced guidance on digital apps which may help to establish whether your technology falls under their remit. You can also contact them for additional guidance.

If your immersive technology is classed as a medical device, you will need to meet strict standards around safety and efficacy, including carrying out a clinical investigation. Meeting these standards is a significant undertaking and you should begin planning to meet MHRA certification criteria as early as possible in the development of your product.

Stay informed

Although evaluation can seem like a highly complex area of innovation to navigate, there is support available.

The Mindset-XR Innovator Support Programme provides specialist support – including advice on evaluation – to companies on our programmes. The team will also be producing publicly available learning materials about regulation and evidence generation for immersive technologies in the coming months; please do sign up to our newsletter if you want to be the first to get access to them.

Elsewhere, regional health innovation networks also provide support for innovators and can give you impartial advice on evaluation, as well as helping with connections to evaluation specialists.

Another useful resource for getting practical information on how to approach evaluation/evidence generation is a collection of resources on evaluating digital health products produced by the Office for Health Improvement and Disparities.

Understanding investor attitudes to immersive technology for mental health: a look behind the curtain

Published and last updated by Michael Mbanunu

Hitesh Thakrar is Chair of the Health Innovation Network, South London and an experienced investor in the technology sector, having spent over 25 years investing in public equities in the life sciences, information technology and innovation sectors.

Since 2015, he has moved into early stage venture investing, and is currently a Partner at Syncona Limited (a Wellcome Trust backed early stage venture fund), a Governance Board Member of KQ Labs at the Francis Crick Institute, an accelerator with the Turing supporting next generation businesses in data science and life sciences, and the Chair of the Investment Committee for Newable Ventures (a pre-Series A deep tech fund).

As someone who has led investment into immersive technology myself, I was delighted to chair a recent roundtable event bringing together investors with an interest in immersive technology in mental health.

In the competitive world of investing, these types of open and honest conversations between experts can be few and far between. I would like to extend my thanks to all our attendees for their candour and enthusiasm – and I look forward to their contributions to the project in the future.

The event was an important early milestone for the Innovate UK Mindset-XR Support Programme which the Health Innovation Network South London (HIN) is delivering. My colleague Amanda, HIN Director of Digital Transformation and Technology, recently wrote an excellent blog giving some of the background on the Mindset programme and the pressing need for transformative change in mental health. If you haven’t already, it is well worth a read to learn about the programme and why we are placing such importance on this work.

What was clear right from the outset of our event is that investors are very much on the same page as Amanda and the Mindset team when it comes to embracing the potential of technology to tackle the nation’s mental health crisis.

The fact though, is that virtual, augmented and extended reality aren’t the only games in town when it comes to MedTech for mental health. And, indeed, mental health is far from the simplest potential application for the next generation of immersive technologies.

So – what are the barriers and opportunities for investment in this area?

Some good news is that immersive technology and mental health are both areas where passion, excitement and personal interest play a role in decision making for investors. Investors are humans rather than robots; some of those who joined us at our roundtable spoke bravely of their desire to improve mental health following lived experiences of mental illness, others of the exciting vision that they saw for technology used in computer games making a difference to society.

Those passion points might be enough to pique initial interest among fund managers and sway the odd marginal decision, but sustainable funding inevitably depends on being able to build confidence around return on investment (ROI).

While the consensus in the room was that reliably realising ROI in this area is far from a given today, the mood was optimistic about prospects for the future. To that end, we identified a number of development areas which will help to shape the commercial counsel we provide to the innovators on our Mindset-XR programme.

Those priorities were:

Helping innovators, clinicians and investors to pull in the same direction

Immersive technology brings together experts from a wide spectrum of different fields; medicine, gaming, visual arts, engineering and artificial intelligence to name but a few. Regardless of their background, for innovators to thrive they need to be confident navigating the complex world of health and care.

Finding a common language and understanding the cornerstones which must be in place for healthcare success in terms of patient safety, clinical oversight and regulatory approvals are key. Given our experience delivering the award-winning DigitalHealth.London innovator support programmes, this upskilling feels like exactly the sort of challenge we are particularly well-suited to rise to.

Prioritising innovation based on clinical need

At a time where mental health services are universally stretched, there are no end of possible problems to try and tackle. However, the scale, complexity and urgency to solve these problems varies enormously.

To be successful, innovators need a clear view of the condition(s) they are targeting, current approaches to treatment, and how their innovation might fit into existing clinical pathways. This makes early clinical and commissioner engagement essential to avoid building “white elephant” innovations – technically impressive but out-of-sync with what the system really needs.

Having attendees at the roundtable representing local and national mental health systems felt like a great start to this work, and we look forward to forging meaningful partnerships between innovators and clinicians throughout the course of the programme.

Exploring different funding models and mechanisms

One of the areas we explored during the roundtable was the disparity in progress between work happening in immersive mental health technology on either side of the Atlantic, and what could be learned from our American cousins about supporting innovation through different funding models.

Understandably, many innovators are focused on the NHS as the primary buyers for immersive mental health innovations. While the NHS is a huge market, access is complex and for nascent and potentially expensive technologies such as VR, AR and XR for mental health there may be other options worth exploring. These include working with insurers, targeting the self-funding market and developing innovative partnerships with pharmaceutical companies.

I left the roundtable discussion full of ideas and enthusiasm for the work that we are leading. While we are in the early stages – both of our programme and of realising the potential of immersive technology for mental health – we are already developing a formidable alliance of innovators, clinicians and investors determined to make a difference.

We want to send a special thanks to the following for their support and attendance:

I look forward to our next events. Please do get in touch with the team if you would be interested in joining us.

To find our more, visit our Mindset-XR Innovator Support Programme webpage.

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For more information about Innovate UK's Mindset-XR Innovation Support programme, delivered by the Health Innovation Network, South London, please get in touch.

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Moving past the physical – how tech can help our mental health.

Published and last updated by Michael Mbanunu

Medtech often has a focus on physical health or issues directly related such as wait list management for elective care. So Jill Owens, senior project manager in the mental health team at the Health Innovation Network, the AHSN for south London, was pleasantly surprised to find more companies developing products for the mental health sector. Here she discusses what she found and why it’s important.

I have been attending HETT, the Healthcare Excellence Through Technology conference where innovators and healthcare professionals share the best of themselves in London since its very first show.  This year I was looking forward to seeing colleagues old and new but - with a good deal of focus being on wait list management in elective care - I was prepared not to find radical development in the mental health arena.  I was delighted to be completely wrong and to meet several companies making exciting strides in supporting people with their mental health.

These included well-known companies developing their offer, such as Kooth.  Kooth has been supporting young people’s mental health since 2004 and claims to be the largest mental health platform for young people, working with services across England and the US.  Simeon on the Kooth stand was brimming with ideas for development of Kooth, including how it can be used to tackle the needs of specific groups such as young black men, and how we can have a joined-up approach to mental health crisis.  We had an energetic discussion about how to engage system leaders and get data to support future action.

It was also great to learn how other established companies, such as DrDoctor, are actively looking to expand their offer to mental health services.

There was emerging innovation, such as CareLoop Health, an AI driven tool which has been developed by the University of Manchester and partners to prevent relapse of psychosis and schizophrenia by alerting care teams to its signs, which offers a critical treatment window for delay or prevention. Each year a person with psychosis has a one in four chance of relapse. Studies such as one published in the Lancet in 2022, show a reduction in full relapse with use of CareLoop as well as additional care benefits.  It was exciting to speak to Ben at the CareLoop stand about the team’s ambitions to spread this innovation more widely.

Extended reality (XR) is also becoming big news in health innovation. SynchVR Medical already has established tools to address pain management and anxiety in children and adults. At its HETT stand I was able to have a demo of its technology which has been adapted to include exposure therapy for phobias and anger management. The demo involved popping on the headset and selecting from a variety of examples, including road rage and even an office!  The experience was quite unique and can truly be described as immersive.

We know that since the COVID-19 pandemic there has been an exponential rise in the severity and number of people seeking help for their mental health (NHSconfed, 2022), and an associated rise in wait lists. There still needs to be more discussion around how investment in technology can support mental health.  But speaking to the innovators at 2023 HETT conference I am confident that there is a great deal of energy at hand to develop ways innovation can be used to improve the lives of people with mental health issues.

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Culture is everything: reflections on reducing restrictive practice at Lesney Ward

Published and last updated by Michael Mbanunu

Restrictive practices are techniques such as physical restraint, seclusion and rapid tranquilisation used to limit a person’s liberties, movements or freedom to act independently in potentially dangerous situations.

The inappropriate or overuse of restrictive practice in mental health services has been identified as an area of concern in healthcare since at least 2015.

Beginning in 2021, the Health Innovation Network has been involved in local efforts to reduce restrictive practice based on the findings of a successful pilot led by the National Collaborating Centre for Mental Health.

We speak to HIN Patient Safety Project Manager Ayobola Chike-Michael and Ward Manager James Njoki about the programme team’s recent visit to Lesney Ward, an acute adult mental health ward which is part of Oxleas NHS Foundation Trust. Read reflections from previous visits here.

Ayo

In my role of supporting mental health wards to reduce restrictive practices in south London, I recently had the privilege of visiting Lesney Ward, which is part of Oxleas NHS Foundation Trust.

Lesney is a 20-bed mixed adult mental health inpatient ward, and I was eager to explore the ward’s efforts to create a therapeutic environment with minimal use of restraints.

Upon arrival, I was delighted to find that Lesney Ward had recently undergone refurbishment. The ward now boasts a fully functioning gym, a sensory room and therapeutic garden among other enhancements.

During my visit, I met the ward manager, two other members of staff and a QI lead from the Trust. Engaging in meaningful discussions, we exchanged ideas on how to promote positive change and minimise restrictive practices within the ward.

One remarkable aspect of Lesney ward is its commitment to establishing a culture of no restraint as the default approach. As a result, the ward does not have any seclusion rooms. The primary method used to reduce the use of restrictive practice is the de-escalation method, which was commended at a CQC inspection in February 2023.

I was impressed by the variety of successful de-escalation methods employed by the ward. Apart from the verbal de-escalation methods, there were other successful change ideas the team shared with me:

  • Patient Engagement Time (PET). PET is a 7-day activity timetable with flexibilities where each staff spends 30 minutes with their assigned service user to build rapport and provide reassurance.
  • Daily community meeting. Held Monday to Friday, this meeting involves patients, staff, healthcare assistants, occupational therapists, activity coordinators and others. This could be led by patients or staff.
  • Relational security. The ward makes active use of the ‘See Think Act’ framework.
  • Simplification of language. For example using terms such as ‘physical health check’ instead of ‘vital signs’, which enhances communication between staff and service users.
  • Being proactive about giving information to service users.
  • Diverse activities. Activities on offer include arts and craft, walking group, sensory group, therapeutic garden visit, orientating to ward, gym induction and physical health competency.
  • Appropriate interventions and medications. Ensuring patients receive the right interventions and medications to prevent transfers to psychiatric intensive care units whenever possible.
  • Inclusive safety huddles. These huddles involve all stakeholders including domestic staff
  • Nutritious food. Food is sourced from reputable providers, with careful planning going into making sure that it provides the right nutrition for service users. Taster sessions were organised for both staff and service users, and a variety of fruit is available throughout the week.
  • Promoting decaffeinated beverages while maintaining flexibility
  • De-escalation for smoking demands. Employing de-escalation techniques to address service user requests to smoke, directing them to e-cigarettes.

My visit to Lesney Ward was an inspiring and enlightening experience. The recent refurbishments have enhanced the ward’s facilities and contributed to a more holistic approach to care.

The ward’s commitment to creating a therapeutic environment with minimal use of restraints is truly commendable. By prioritising patient engagement, promoting positive change, and implementing innovative strategies, they show us the possibility of creating a mental health system that values dignity, respect and recovery for all.

James

The culture of doing everything we can to deliver the best care at Lesney Ward is something that is quite special; it is something that predates my time here but which every staff member believes in.

We take a lot of pride in having very low levels of restraint and very rarely needing to refer our service users to Psychiatric Intensive Care Units (PICUs).

Whilst developing a culture takes years, we hope that our service users feel the benefits of our culture as soon as we start caring for them.

We are big believers in starting things off on the right foot. We make sure that all the people entering our care have their medicines reviewed as soon as possible, and we spend time with service users helping them get oriented to the ward and understanding the support we can offer them.

We hope that this helps us build bonds between service users and the staff and helps everyone to understand that we want to do everything possible to support our service users.

In the longer-term, having such a proactive culture has meant that we have been able to improve the environment we provide care within, which in turn has meant better outcomes.

Where it might have been easy for our old gym to have quietly closed when it fell into disrepair, the attitude of the team here meant that we saw it as an opportunity for improvement. Now, the gym is better than ever, and it provides a positive space for our service users.

Likewise, our garden is something that people might dismiss as being a bit of a luxury – in today’s NHS how can you justify spending time and money on greenery?

The reality is that those small things, those moments of going above and beyond the basics, can make a big difference to health outcomes and reduce the need for restrictive practice.

For example, a few weeks ago we had a new service user who was very unwell. It was very difficult for us to safely provide the care he needed as he was distressed about his new surroundings. It would have been an easy option to “escalate” this service user to PICU.

However, through going through the records of the service user, we found that they had an affinity for being outside. We tried moving some of our time with them into our garden, and we saw a huge transformation.

That sort of outcome isn’t something that comes from a moment’s work, or even a month’s work. But it shows that persistence and creating the right culture will pay off in the long term. From the first step to the last step, make sure every one has the right intention!

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Get in touch to find out more about the Mental Health Safety Improvement Programme and our work to help reduce the use of restrictive practice.

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Early Intervention Eating Disorders (FREED) National Spread Programme has been shortlisted for an HSJ Award 2023

Published and last updated by Michael Mbanunu

A mental health programme which has benefitted 1000s of young people with eating disorders has been shortlisted for a prestigious national HSJ Award.

An early intervention eating disorder model which originated in south London has helped over 2,000 young people has received national recognition today (Monday, August 14).

It has been announced that the First episode Rapid Early intervention for Eating Disorders (FREED) model aimed at 16 to 25-year-olds developed by South London and Maudsley NHS Foundation Trust (SLaM) and King’s College London (KCL) has been shortlisted for a 2023 HSJ Award.

The model provides swift access to specialised, evidence-based treatments tailored to youth, incorporating developmental considerations with a focus on early intervention. In 2020, it was selected by the Academic Health Science Network as a national programme, with the Health Innovation Network, the AHSN for south London, managing the rollout. To date, the programme has benefited 2,722 young people, leading to full early recovery in approximately 65% and halving the need for costly and disruptive in-patient treatment. The model has now been implemented in over 50 eligible mental health trusts in England, leading to estimated NHS savings of £12.1 million.

Dr Rishi Das-Gupta, the Chief Executive of the Health Innovation Network (HIN) said: "I’m pleased that the HIN has been able to support the spread of FREED. We know that eating disorders impact the lives of many young people and that intervening early is extremely helpful. This programme exemplifies how we can innovate in care delivery to reduce health inequalities and enhance access to services for our local communities - and reaching over 2,000 patients since the start of the programme is a mark of the impact of the teams delivering the service."

Ulrike Schmidt, Professor of Eating Disorders at KCL and Consultant Psychiatrist at SLaM who has led development and evaluation of FREED said: “Adoption of our programme by the AHSN/HIN has turbo-charged our ability to make FREED available to young people in all parts of England. We are now working to spread and improve the evidence-base for FREED further, both nationally and internationally.”

Danielle Glennon, Head of FREED and Head of Psychology & Psychotherapy at SLaM who alongside Professor Schmidt has been part of FREED’s story since the beginning, said: “The AHSN/HIN programme meant that despite the unrivalled challenges clinicians faced through COVID, we could continue to support teams in making FREED a reality for young people in their area. The commitment, creativity, and willingness to share, as the FREED network grew, is inspirational.”

Laura Semple the Director for National Programmes at the AHSN Network said: “Over the last three years, it has been an honour to collaborate with the 15 AHSNs on the FREED Programme. Clinical colleagues have worked diligently with their AHSN partners on the ground to get new FREED services up and running across England and it is excellent to see this achievement recognised. While we know there is much more to do to improve care for young people, the national availability of FREED is vitally important progress and we look forward to seeing the FREED network continue to thrive in the future.”

More than 1,400 entries were received for this year’s HSJ Awards, with 223 projects and individuals reaching the final shortlist, making it the biggest awards programme in the award’s 43-year history. The high volume - and exceptional quality – of applications once again mirrors the impressive levels of innovation and care continually being developed within the UK’s healthcare networks.

The winners will be announced during the awards ceremony at Evolution London on November 16, 2023.

Relationship building to reduce restrictive practice: a visit to Avery Ward

Published and last updated by Tash Hadley

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Restrictive practices are techniques such as physical restraint, seclusion and rapid tranquilisation used to limit a person’s liberties, movements or freedom to act independently in potentially dangerous situations.

The inappropriate or overuse of restrictive practice in mental health services has been identified as an area of concern in healthcare since at least 2015.

Beginning in 2021, the Health Innovation Network has been involved in local efforts to reduce restrictive practice based on the findings of a successful pilot led by the National Collaborating Centre for Mental Health.

We speak to HIN Patient Safety Project Manager Ayobola Chike-Michael, Ward Manager Lola Bakare, and Expert by Experience Igoche Ikwue about the programme team’s recent visit to a female acute mental health ward and their reflections on how sharing personal experiences and perspectives are key for further reducing restrictive practice.

Ayo

In my capacity as project manager for the Mental Health Safety Improvement Programme at the Health Innovation Network, I have had the opportunity to visit a few mental health wards in south London with my colleague Igoche Ikwue, who is an expert by experience.

One of the wards I was privileged to visit was Avery Ward, an acute female psychiatric ward. Despite their busy schedule, the staff welcomed us and we had the chance to meet the ward manager Lola, who later introduced us to other busy members of staff including the clinical consultant.

We had a fruitful conversation about the Ward’s approach to minimising restrictive practice. It was notable that the ward manager makes herself accessible through an open-door policy to both service users and staff. She described her unique approach as ‘we discuss, negotiate and we agree’.

This seems to be a working solution, despite experiencing the same challenge of high staff turnover which is common across these types of services. Situated in a deprived borough, the ward also faces system strain, evident in the long waiting list and pressure for beds.

Despite the dedication of staff, we learned that instances of violence and aggression affect both staff and patients. However, the team employs a range of verbal de-escalation techniques and other activities to de-escalate such as taking fresh air in the garden, and facilitating escorted leave, to manage and defuse tensions.

It was acknowledged that the pressures surrounding the ward can contribute to relapses among patients. We observed that the absence of a sensory room or equipment in the gym and the garden was in need of refurbishment. Nevertheless, plans were already underway to address these improvements and refurbish the ward.

We were told that staff experience emotional trauma from insults and violence from the service users (particularly the male staff). However, body-worn cameras have now been introduced to help take recordings of real time events.

It was evident that the staff have to daily work through a maze of challenges while trying to give quality care to the service users. We were very grateful for the open and honest conversations we had with Lola the ward manager and noted their laudable commitment to providing a safe and collaborative environment for both staff and patients.

Igoche

When I arrived at the ward, I had a positive interaction with a young man who was being discharged. We had a pleasant conversation, and he expressed his excitement about returning to his music. It set a promising tone for my visit.

As I continued exploring the ward, I noticed a slight tension in the atmosphere. There was a central glass office where the staff members and administrators worked. However, it was evident that there was a shortage of staff, which understandably was causing some challenges. Despite this, the ward manager Lola demonstrated true dedication to their role, striving to provide the best care and support possible.

During our conversation with the ward manager, Ayo and I clarified that our purpose was to support the ward and its service users. We discussed several concerns, including issues with the quality of food and the need for improvements, such as the functionality of facilities. Additionally, we addressed the struggle to find bed space for service user babies as the facilities were not designed to accommodate both mother and baby. The manager also mentioned plans to relocate the facility to another building, along with a positive update on recent recruitment. There is a specialised service for mothers and babies, so patient who requires a mother and baby bed will have to be transferred out.

As someone with expertise through personal experience, I firmly believe that staff members play a crucial role in providing care and reducing restrictive practices. It is essential to prioritise the well-being of both the service users and the staff themselves. Creating a safe and open space for caregivers to express their concerns without fear of negative consequences is vital.

Despite the strain caused by system constraints, the dedication and commitment of the staff members were evident. I also observed that the ward manager maintained an open-door policy, encouraging collaboration and engagement among service users and staff.

One particular moment stood out during our visit. As we were leaving the ward, a service user approached me, expressing her strong desire to see her children. Recognising the urgency of her request, I directed her to speak with the ward manager, who promptly attended to her with responsiveness and compassion.

My experience at Avery ward highlighted the importance of providing comprehensive support and care to service users while prioritising the well-being of staff members. The ward manager and their team demonstrated a commitment to creating a safe and collaborative environment throughout our visit. I am grateful for the opportunity to contribute my expertise and be part of the ongoing efforts to improve the ward.

Lola

As a ward manager, my philosophy is that personal relationships are at the heart of creating a calm, safe and positive environment for staff and service users, where the use of restrictive practice is minimised.

I have found that building those personal relationships tends to rely on flexibility and trying to have an understanding of the whole person.

For example, I have my own ‘open door’ policy. Staff and service users can always come to me with their problems and we will do our best to figure out a solution.

Often that means negotiating; realising that both sides have to give and take in order to find a position that works for everyone.

Sometimes it is finding a way to be flexible about the small details which can make the biggest difference. Allowing more flexibility with meal times has been one way where we have seen really positive impact with service users – from a practical point of view it raised some challenges, but I am so glad we worked through them to achieve something that the people on our ward wanted.

We try and make the ward as close to home as possible, whether that means encouraging staff to make the time for escorted visits off site or building relationships with the other people who are important in the lives of our service users.

Often, we find that working with family to overcome challenges is a really effective tactic. We have multi family groups which run once a month. Family/carers and patients are invited to this meeting. Our aim is to try and create one team of people all working together for a positive outcome; that strong team is I think a big reason why we have reduced the level of complaints and of the use of restrictive practice.

Our ward – like many others – has experienced difficulties with staffing in recent years. Our staff are well trained and skilled to deliver job role. As part of my team, I have a professional nurse advocate, who provides restorative supervision for staff, and we offer monthly training days for staff.

The Ward Manager also acts as our See Think Act consultant, helping to develop relational security. This has improved the way we deliver care to our patients; our staff maintain safe and effective relationships with patients in a professional, therapeutic and purposeful way, with understood limits.

Despite the difficulties we sometimes face, I am so proud of my team; they understand how to deliver great care (including reducing the use of restrictive practice) and they are motivated and committed to continuing to get better.

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For more information on our Mental Health Safety Improvement Programme, please get in touch.

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My experiences of autism and mental health care: the bad, the good and the future

Published and last updated by Michael Mbanunu
Close up of young person sit on sofa hand holding mobil

There are more than 700,000 autistic people in the UK. Many autistic children and young adults experience a delayed diagnosis, which can have a significant negative impact on their mental health. 

We hear from Freddy Henderson (she/her) about her experiences being diagnosed with Autism Spectrum Disorder (ASD) and her reflections on what mental health services can do to care for autistic people in a more effective and person-centred way. 

Freddy also discusses how innovations such as Tellmi can provide valuable access to safe, anonymous peer support for autistic children and young people, who may often prefer to use digital channels. Tellmi is an innovative digital peer support app which is commissioned by the NHS and has been used by more than 80,000 young people to discuss their mental health.

Please note that this article contains some mentions of self-harm, suicide and eating disorders which some readers may find upsetting. 

I have 2 disabilities, Functional Neurological Disorder (FND) and ASD, although the latter is what I am going to be talking about today. I was diagnosed with autism six years ago, at age 17. That diagnosis came about after I was referred to the integrated neurodevelopmental team by Child & Adolescent Mental Health Services (CAMHS) as they suspected I was autistic. I had originally been referred to CAMHS when I was 15 by my school, as I was suffering a lot with my mental health and was grappling with self harm, depression and anxiety. I later developed anorexia and so was also under Child & Adolescent Eating Disorders Services (CAEDS) for about three months until I turned 18. Later at university I accessed NHS services in conjunction with the university resources to help me balance my mental health needs and medication for it.

I want to highlight that my ASD was not the direct reason I was using these services, but rather that I needed these services because the effects of my late diagnosis had become so catastrophic that it ‘broke’ my ability to cope with the world.

What I hope I can give an insight on in this blog is my own perspective what was helpful, what was not, and how I think services and treatment could be improved.

The bad

Let’s start with the worst of my experiences to get them out of the way.

My first therapist at CAMHS was terrible. They made me feel belittled and patronised, and their complete failure to understand my attempts at communicating what was going on meant that my health got actively worse.

I was very quiet and reserved in sessions and had flashes of anger when my therapist tried to make suggestions; I felt attacked and as though they were accusing me of not trying hard enough. I never shouted or expressed that anger outwardly, but it meant I was defensive and ardently against sharing information that I deemed to be too personal.

At the start of one session my therapist walked in and put a colouring book and pencils on the table and told me to colour. After a few minutes, I asked if we were going to talk. They replied with “well if you’re not willing to talk to me, why should I talk to you?”.

A couple of days later I was held overnight in hospital after a bad self-harm incident, which led to meeting my next therapist.

The next therapist made me feel much better. They were kind and patient with me and gave me practical help with how to formulate sentences expressing my thoughts and feelings. They would ask direct questions rather than open-ended ones, something that helped immensely.

We’ll come back to them later, but first let’s quickly talk about another bad experience.

It is now widely recognised that eating disorders are rife within the autistic community (especially young people) and I was no exception. What started as a desire to get “in shape” quickly morphed into a monster beyond my control.

I won’t describe any of my thoughts, actions or physical consequences as eating disorders are notoriously competitive and I don’t want to trigger other people who might be vulnerable themselves. The only part relevant to this story is that I was very unwell.

I was only in CAEDS treatment for about three months just before I turned 18, and so was transferred to the adult services where I promptly discharged myself after the therapist there criticised me for not making eye-contact with them.

Any readers with a vague understanding of autism may see the issue here. Eye contact is often difficult for autistic people and I don’t look at people’s eyes at any time, let alone when I’m feeling vulnerable. By this time, I had my diagnosis and the sheer disregard for my condition and the traits it presents as meant I rejected all additional treatment for my anorexia.

I am very pleased to say that I no longer have anorexia as I put in a lot of hard work and, with the help of some borrowed ideas from the fat acceptance movement, managed to overhaul the disease that controlled me for 3 years.

The (mostly) good

Now, onto the good experiences!

My second primary therapist was the person who helped me get an autism diagnosis, which turned out to be one of the biggest turning points in my mental health journey.

Up until that point I genuinely believed that I was fundamentally flawed as a human being and there was something intrinsically wrong with me. I considered myself nothing short of a complete waste of space and that my life would forever be spent in pursuit of a goal I would never achieve.

Getting my diagnosis put a stop to most of these thoughts, although it remains difficult to completely dismiss ideas you have held for the majority of your life.

It helped me come to terms with my differences and understand that I was not ineffectual as a human being, but rather I just operate a bit differently.

I was able to recognise my strengths for what they were, rather than consider them some minor penance for my otherwise catastrophic flaws. The diagnosis helped me to separate my brain from my mental health disorders. It helped me understand why I thought the way I thought and act the way I act.

It also helped explain why so much of the therapy I had had had been ineffective. Of course the CBT for panic attacks hadn’t worked; I wasn’t having panic attacks, I was having meltdowns.

Another type of support that helped hugely was when I met other autistic people.

At my university there was an autism support group. Granted, it was run by non-autistic staff members and in my third year it took such a drastic turn for the worse that I left after arguments with said staff, but still. I met a couple of good friends there who I miss dearly as we are no longer in the same city.

Meeting other people like me was amazing. We were able to connect on a level I hadn’t experienced before as we had an innate understanding of each other. That is not to say that my friendships with autistic people are inherently better than those with non-autistic people – they are just different.

Of course, autistic people are not a monolith and so there were some people there who I really disliked. Regardless of the ups and downs – being able to talk about our shared experiences was such a relief.

During my second year at university, the pandemic hit.

Covid-19 impacted every aspect of our lives, including the support services I was in. I got removed from the NHS community mental health service and the university wellbeing service as they wanted to free up capacity for people struggling to adjust to life in such a different world. The irony was not lost on me.

The ASD group was also moved online and let me tell you, trying to do a jigsaw puzzle over zoom presents some complications. I think it’s fair to say that aided in the breakdown of the group dynamic and made it quite difficult for the members who weren’t very confident to get to know the group.

We ended up doing activities such as a name-this-vegetable quiz, organised by one of the staff members. This quiz was later referenced when the whole group was arguing with the mentors that they were treating us like children.

The difference between in person support and digital support was stark. No one was ready for the pandemic and as everyone struggled to adjust, those accessing support services just plain struggled.

However, there was a definite silver lining to the switch to digital content and support: my university was online, which turned out to be an absolute godsend. By my second year I was still struggling with my mental health and processing a suicide attempt a year earlier. I had also started to develop what I now know is FND, although it would take roughly 4 years to get diagnosed.

In short, I was both physically and mentally really ill. Being able to do classes online was bizarre at first, but not having to expend energy getting to and from class and dealing with the sensory nightmare of being in public was amazing.

Lots of the pressure I had felt, both economically struggling at work and socially struggling on nights out, had been lifted. People found ways to socialise online, and jobs offered flexible working where possible. It hugely helped me.

The future

That is why going forward I am such a proponent of a hybrid approach to pretty much anything that can be hybridised. Whether it’s flexible office hours or the option of having therapy online, giving people the option to choose what suits them best hugely helped me and so many of my autistic and otherwise neurodivergent friends.

I still like going out with my friends, and having workplace banter is fun, but having seen the real benefits that digital services offer makes me very reluctant to go back to how things were.

And this is a key concept that I want to convey: when the world changed it was because it had to, but the effect was more surprising than anyone anticipated. All manner of people benefitted in unforeseen ways and thus having an open, flexible approach to resources and services is, in my humble opinion, the way forward.

Peer support does not have to be in person. Digital channels can be just as useful as in-person, and possibly more so when you consider factors such as geographical isolation, physical disability or time restrictions. Apps like Tellmi allow users to connect with others like them. Just as meeting my autistic friends was hugely helpful, having access to other people who may be experiencing similar issues is hugely helpful.

I’ve had the chance recently to speak with and work alongside the creators of the Tellmi app, and it seems clear that a lot of the reason why their service works for autistic people is because they put an emphasis on listening to and learning from autistic people to make their app better. Having people involved in the day-to-day running and development of the app who are neurodiverse is undoubtedly a good thing.

Consulting, engaging and co-producing with diverse groups of people will help build better solutions that work for all people. Just as neurodiverse people should be consulted about improving services for neurodiverse people, changes which have the potential to affect any group should be decided with the involvement of people who are representative of that population.

An underlying cause of the lack of effectiveness for many of the treatments I experienced was that they did not account for my autism. Autism is a fundamental part of me – and something I am very proud of – yet I was being funnelled through services not designed for people like me. As such, is it not surprising that they did not help me, and in some cases caused me harm?

Any support for autistic people needs the input of autistic people. And any services that might support autistic people also need the input of autistic people. You can have the best intentions in the world and be the brightest person alive, but if you haven’t lived as an autistic person, you will never build services which truly support autistic people alone.

Almost all the solutions I have found that have got me to where I am now have been of my own creation.

And where I am now is pretty darn great. I am happy, I am optimistic, and I am enjoying my life – which is much more than I could say when I was 15.

You might look at me, in my wheelchair with my headphones on and sunglasses blocking out external stimuli and think my existence is something which requires improvement. But I am at my best. Imposing one’s own ideas of how someone else should live is an issue for the ages, and that is precisely why it is imperative that we remove assumption and prejudice from the equation when we are trying to make services better for people.

I mostly don’t read work on autism by non-autistic authors. It is often derogatory, wrong or just plain offensive and I have no time for it.

My autism is a condition of which I take pride in and use to my advantage. I don’t have to be a genius like Einstein or a world changing advocate like Greta Thunberg in order to deserve the right to live as my authentic self.

I have no interest in support that hasn’t been developed by someone like me because it will be inherently steeped in presumptions and expectations that I don’t ascribe to. I will only ever be happy when I accept that I am not fundamentally flawed because of my condition and work alongside it to shape my life in the best way for me.

Interested in how digital technology can be used for mental health?

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Unintended impacts: using Equality Impact Assessments to understand how technology can impact mental health inequalities

Published and last updated by HIN SouthLondon

Innovations help us to tackle the biggest challenges in health and care, but it is not always obvious how the spread and adoption of new technology affects people in terms of widening or diminishing health inequalities.

In this blog, we hear from Karen West and Cameron Baker of patient monitoring company Oxehealth about how a Health Innovation Network-supported equality assessment helped them understand and improve the equity of their solution.

The inequality challenge for mental health care providers

Inequality in mental healthcare is nothing new. It’s been flagged as an issue since it was reported on over 50 years ago[1]. Recent reports show staggering rises in restraints of black people in NHS care, disproportionate levels of face-down restraints used with girls and women as well as overrepresentation of minority groups dealing with mental health challenges.

As a result, mental healthcare providers, and the integrated care systems they are now a part of, are focusing efforts to tackle inequality. By March 2024, providers will be required to draw up their own Patient and Carer Race Equality Framework (PCREF) and appoint an executive lead for PCREF at board level.  And they must report on their performance against core measures like detentions under the Mental Health Act, their provision of access to services for ethnic minorities, and the diversity of their workforce.

But the mental healthcare landscape is not static. Technology is rapidly emerging. For example, today there are an estimated 20,000 mental healthcare apps in existence.  Technology has the potential to transform the way healthcare is accessed and delivered, but what about its potential to impact inequality?

How technology can impact equality

As a technology provider, we recognise the tremendous impact technology can have when it comes to supporting staff to deliver better and safer patient care. Right from the start, we involved both patients and staff to help us develop products and services that not only addressed clear challenges in mental health but were broadly accessible. Oxehealth recognises that we need to be part of the solution to tackle inequality and this starts with taking responsibility to ensure our products and services create a positive impact, rather than exacerbate the problem.

Lord Victor Adebowale, Chair of NHS Confederation, takes this point further, amplifying the need for digital to be supportive of access and equity:



As far as I’m concerned, there are only 3 challenges facing most first world health systems; they are equity, access and digital - in that order. And the reason why they are in that order is that if digital isn’t helping you with the first two, then why are you using it?

Lord Victor Adebowale, Chair, NHS Confederation

Image showing equality and equity using different bikes as a metaphor - not everyone can ride the same bike in the same way

Those reading carefully will note the use of the word equity rather than equality. It's important to recognise the distinction as illustrated in the image (credit: Robert Wood Johnson Foundation) shown above. Although we often seek equality, this can lead to exclusion rather than inclusion: the same bike doesn’t fit everyone. But by providing a bike that fits their needs enables everyone to ride. What this means for us as technology providers is that we need to think not only about the aim of equality but also about how we make that happen by providing the “right bike” for everyone.

A little bit about Oxevision

Our patient monitoring technology - Oxevision - is designed to support clinicians in mental health inpatient settings and is currently deployed in half of NHS England’s mental health trusts. Oxevision uses an infrared-sensitive camera, which operates with regulated medical device software, to enable privacy-controlled vision into the room and contact-free measurements of pulse and breathing rate. This enables clinicians to check patients are well without disturbing them at night. The system also provides ward teams with actionable insights which can inform care planning and prompt staff to intervene proactively.

Oxevision is ideal in a space where wearable pulse oximeters would not be appropriate and provides a far wider range of benefits in comparison to these wearables. This includes consistent accuracy with different skin tones, a common and concerning issue with wearable pulse oximeters.

Assessing equality impact

Following a discussion with the Health Innovation Network, we realised we needed to understand the potential impacts of Oxevision on equality. This led to us conducting an Equality Impact Assessment (EQIA) which looked specifically at inequality impacts in relation to the nine protected characteristics covered by the Equality Act. This sort of evaluation is commonplace in the public sector, but is rarely carried out by private companies.

Our EQIA covers all aspects of the Oxevision product as well as Oxehealth’s implementation services, including training, engagement, service monitoring and benefits realisation. For each area of work, we analysed the impact across all protected characteristics, providing a clear assessment to show if implementing Oxevision might enhance or potentially adversely affect equality.

We also asked several NHS stakeholders, including the Health Innovation Network, to provide feedback and to challenge our assessment. The current assessment is very much a working document, subject to regular reviews to ensure it reflects the latest evidence.

A summary of our current findings is below:

How the assessment has impacted our work

As a result of the assessment, we have made several improvements, including:

  • improving the accessibility of documentation by creating easy read versions of staff and patient information on the technology and its use in inpatient settings
  • collecting more detailed evidence of staff and patient experience across different demographics; and
  • incorporating feature and design considerations into future product development plans

Taking a structured approach to equality

Equality has always been a fundamental consideration in developing and implementing our technology. But the EQIA enables us to think more broadly and in a structured way about equality. Before starting any new initiatives, we always think about the impact on equality. Using the EQIA framework helps us to identify how evidence of impact will be collected,  assessed and actioned to ensure we address any adverse impacts.



Technology partners in healthcare invariably have good intentions to help patients and staff, but understanding the real-world implications of their innovation in terms of how it might exacerbate or reduce inequalities requires proper consideration and analysis. Companies would do well to follow the path Oxehealth has set out; a process driven approach to creating positive social change. They exemplify how companies should take accountability beyond supplying a product and improve equality outcomes as part of their mission and in their business practices.

Aileen Jackson, Head of Mental Health, Health Innovation Network

Technology has a fantastic opportunity to transform healthcare, particularly in areas poorly served such as mental health. As part of that transformation, companies need to consider the wider impacts of change and play an active part in ensuring that change benefits everyone, equally.

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[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9746991/#:~:text=People%20from%20ethnic%20minority%20groups%20in%20the%20UK%20have%20poorer,reported%20for%20over%2050%20years.

Nipping it in the bud: helping the NHS treat eating disorders as early as possible

Published and last updated by Alex Chafey

To mark Eating Disorders Awareness Week, National Programme Manager Jill Owens reflects on the challenges of eating disorders, why it is crucial to treat them as early as possible and how early intervention services like First Episode Rapid Early Intervention for Eating Disorders (FREED) can help.

Eating disorders are on the rise, with referrals already increasing before the Covid-19 pandemic and particularly pronounced growth afterwards. Hospital admissions for eating disorders have increased by 84 per cent in the last five years, with children and young people especially affected with a rise of 90 per cent. They can affect anyone regardless of gender, ethnicity, age or body size. Tragically, eating disorders have the highest mortality of all mental health disorders.

I have personally seen how these disorders can fool people into thinking that it is a protective factor – providing either control or comfort. It can also be very secretive and isolate a person from those who want to help them. Recognising difficulties with eating and taking those first steps to find help takes courage and strength, but it is worth it because healthy eating habits help us live full and happy lives.

The phrase ‘prevention is better than cure’ - attributed to the 15th Century Dutch philosopher Erasmus - seems so logical that it’s hard to imagine a time when this sentiment wasn’t commonly used.

However, eating disorders are one group of illnesses where the causes and triggers can be so diverse that universally effective prevention is hard to find. If we can’t yet prevent people from developing eating disorders, what can we do?

We know that eating disorders cause changes in the way a person thinks and feels, which become harder to reverse over time.

Fortunately what we do have is the ability to tackle them as early as possible with the right tools, support and awareness. There is growing evidence that the earlier we act to provide help to people with eating disorders, the better their chances of recovering quickly and living their lives to their full potential.

We know that eating disorders cause changes in the way a person thinks and feels, which become harder to reverse over time. While recovery is possible and well worth aspiring to at any stage, a “golden window” for starting treatment of about three years from the onset of the disease seems to deliver the best long-term results. To get treatment as early as possible, people need to be able to spot the signs in themselves or others and know where to go for help.

At the HIN we have been proud to lead the spread and adoption programme for early intervention in eating disorders since 2020, a programme which has been coordinated by the AHSN Network. As National Programme Manager I have been thrilled to work with people who see the importance of early intervention, and to be part of a programme which has benefited so many people.

The model for the programme is First Episode Rapid Early Intervention for Eating Disorders (FREED). FREED supports early interventions for people aged 16-25, the most likely age to develop an eating disorder and a unique time of life where considerable changes take place. FREED uses innovative methods to address the challenges of emerging adulthood and the early stages of eating disorder development, reducing the duration of untreated illness.

FREED was developed by a team at South London and Maudsley NHS Foundation Trust (SLaM) and Kings College London (KCL) with support from the Health Foundation. The FREED team have been working hard to develop research and evidence to demonstrated the effectiveness of this approach, including studies that show:

  • 32 per cent reduction in wait time from referral to assessment in FREED patients;
  • 59 per cent of FREED patients with anorexia nervosa reached a healthy weight by 12 months, compared to 17 per cent of non-FREED patients;
  • duration of untreated eating disorder reduced from 19 to 13 months.

At the Health Innovation Network we are delighted that FREED services are now either active or developing across England. All 15 Academic Health Science Networks (AHSNs) have provided time and expertise to support local services in understanding the evidence behind FREED and work towards adoption. The programme is drawing to a close in March 2023, leaving a legacy of increased awareness of the benefits of early intervention, numerous resources to help eating disorder services set up early intervention services, and well over 2,000 young people having received treatment.

The work will continue to move forward with support from NHSE and leadership from the team at SLaM/KCL, as well as the many specialist FREED Champions and services throughout England.

If you are concerned about yourself or someone else, please contact your GP. You can also find more information through an eating disorders awareness and support charity, such as BEAT Eating Disorders.

Find Out More about FREED

FREED Website

Collaborating to reduce restrictive practice: reflections from a visit to an acute psychiatric mental health ward

Published and last updated by Tash Hadley
Image of Ayo, Nokuthula and Igoche at the Goddington site visit

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Restrictive practices are techniques such as physical restraint, seclusion and rapid tranquilisation used to limit a person’s liberties, movements or freedom to act independently in potentially dangerous situations.

The inappropriate or overuse of restrictive practice in mental health services has been identified as an area of concern in healthcare since at least 2015.

Beginning in 2021, the Health Innovation Network has been involved in local efforts to reduce restrictive practice based on the findings of a successful pilot led by the National Collaborating Centre for Mental Health. 

We speak to HIN Patient Safety Project Manager Ayobola Chike-Michael, Practice Development Nurse Nokuthula Marks, and Expert by Experience Igoche Ikwue about the programme team’s recent visit to an acute psychiatric mental health ward and their reflections on how sharing personal experiences and perspectives are key for further reducing restrictive practice.

Ayo

As a patient safety project manager, I know how important it is to involve people and communities in shaping health and care services. The experiences of service users and carers make them experts in their own right and they should be viewed as equal partners – “Experts by Experience” – in  improving services and treatments alongside healthcare professionals.

We have worked with Experts by Experience as part of our Reducing Restrictive Practice Quality Improvement Collaborative throughout the project.

Personal perspectives are always enlightening for people like me tasked with helping services to improve, but the insights that have been shared during this project have – being truthful – been emotionally challenging.

Some service users have recounted their experiences of restrictive practice with words like ‘powerless’, ‘dehumanised’, ‘traumatic’ or even ‘haunted’. These words evoke painful, negative experiences and feelings of being actively hurt by the very health and care system that is designed to keep them well.

With these raw emotions in mind, I was nervous about what our planned visit to a local mental health ward might entail.

My experience visiting the ward

During our visit, we met the Ward Manager, some members of staff and inpatients on the ward.

We spoke with the Ward Manager, Nokuthula, for over an hour, opening our eyes to the complex nature of the multidisciplinary team operating at the service and their efforts to look after people living with a range of mental health conditions.

We were taken on a tour around the ward to gain a better feel of how the dynamics of the ward came together; it was positive to see so much interaction between service users and staff.

The atmosphere was calm and peaceful. We observed some service users watching TV, some in the activity room and others in their rooms. We asked many questions as we walked around the ward – not least why anyone would be restrained at all in such an environment.

The ward manager shared some of their own successful change interventions which helped keep the use of restraints low. They talked us through initiatives such as the use of safety pods and the Bröset checklist for risk assessments. An important theme was reflection and evaluation – taking time each month for staff to consider and assess their use of restrictive practices in order to reduce them where possible.

We also talked about how important it was for both staff and service users to be encouraged to share their feelings about life on the ward. Personal relationships based on trust and understanding are vital for everyone involved in the service.

Restrictive practice is a complex issue and does not have one solution.Nokuthula Marks, Ward Manager

Reducing restrictive practice is a complex challenge, but the visit brought home to me that many of the practical interventions making a difference really boil down to doing more to understand and be compassionate towards the people involved, whether through motivating staff and providing staff wellbeing programmes, or creating a psychologically safe environment on the ward through looking at the physical space or ways in which people communicate.

Nokuthula 

I’ve spent eight years as a mental health nurse, and more than two-and-a-half as a Ward Manager. Working in acute inpatient settings is something that has always appealed to me; we see people who are very unwell and who have complex care needs, but showing the difference care and compassion can make to their recovery is incredibly rewarding.

Reducing restrictive practice is something that I think everyone involved in delivering mental health care wants to work towards, and over the past two years it has been a real focus for me personally.

The reality of working on a ward does mean it can be difficult to maintain perspective on restrictive practice. It takes conscious effort to avoid becoming “institutionalised” and treating interventions such as medication as being the only option. That is why projects such as the Reducing Restrictive Practice Quality Improvement Collaborative are so valuable – they allow for sharing best practice beyond our busy “day-to-day” lives, allowing us to gain inspiration and confidence from how other people are taking on this big, difficult challenge.

My experience welcoming Ayo and Igoche to the ward  

I understand that the view many people have of acute inpatient mental health wards can be quite negative. People worry that these are chaotic, dangerous places. That is why I love having the opportunity to show people first hand the hard work that goes in to making them a positive environment and a place that helps people to recover.

It was so nice to speak with Ayo and Igoche about life on our ward. We shared insights on the approaches that have worked for us such as de-escalation techniques and spotting the early signs of distress to allow for early interventions. We also discussed specific tactics which have helped to make a difference on our ward such as the safety cross, a visual tool for recording uses of restrictive practice and prompting us to think about how we might be able to reduce them going forward.

A common theme for making progress in reducing restrictive practice is building time for reflection into our work. On the ward that can mean scheduling regular time for multidisciplinary team staff to come together in “safety huddles” to discuss recent instances of restrictive practice. In some ways the ward visit itself was an extension of our commitment to reflective practice, and I hope our experiences can aid those working in other services.

I believe that my experiences can be used to help improve mental health services.Igoche Ikwue, Expert by Experience

Reducing restrictive practice is a journey and we still have a long way to go. Our ward is continuing to work hard to be the most supportive environment it can be for our service users; we have just moved to a new, brighter location, which our service users are enjoying. We have also invested in training in “See Think Act” relational security to enable us to use the knowledge and understanding that we have of our patients and apply this to planning and providing care.

As long as we strive to communicate and collaborate, I am confident we will keep on making positive progress in reducing restrictive practice.

Igoche

My experience of caring for a family member who was suffering from poor mental health was very challenging. I was isolated in my own home and it put immense strain on my own health; it was the most difficult time of my life. It makes me sad as I reflect back and recall the lack of support that I needed in times of crisis.

However, I believe that my experiences can be used to help improve mental health services – which is why I am a part of the Reducing Restrictive Practice Quality Improvement Collaborative.

My experience visiting the ward

Like Ayo, I was anxious as I walked through the door of the acute psychiatric ward we were visiting. Despite being an expert by experience, and wanting to help reduce restrictive practice, I had no idea of what to expect.

With that in mind, I was pleased and relieved that common themes running through our conversations on the ward included compassion, kindness, and humanity. We talked at length about the importance of listening and learning from service users.

My time speaking to service users and staff on the ward also made me think about my own experiences. Most service users on the ward have their own families and homes, and in many cases they will have sole carers who can be put under huge strain by the demands of looking after very unwell people. The support on offer from these services needs to extend to families – or else we risk a vicious cycle of mental ill-health and people having to spend more time as inpatients than they should need to.

The visit also gave me insight into the personal connections that underpin services, and how we could seek to improve them to reduce restrictive practice and enable better care for service users.

Whilst staff on the ward seemed to value personal relationships, I wondered if more could be done to “close the gap” between operational staff and senior leaders; understanding service user stories and experiences is of benefit to everyone and should inform decisions being made at all levels.

In the same vein, what else could be done to support staff to develop themselves and bring their best selves to work?

I was particularly struck by our discussions with Nokuthula about staff struggling with being assaulted by service users, and we discussed the importance of consistently and appropriately supporting staff wellbeing.

Personal relationships based on trust and understanding are vital for everyone involved in the service.Ayobola Chike-Michael, Project Manager, Health Innovation Network

Mentoring is another good way to help motivate and inspire staff and provide them with personal support to help to develop their confidence and willingness to try new things.

I also think more should be done to build confidence and skills in communication between team members. For example, activities like lunch-and-learns that showcase hidden talents and hobbies may be helpful, allowing team members to bond over shared or new interests. From my experience teams that engage in fun activities together have a stronger sense of trust and transparency.

Restrictive practice should always be a last resort. My visit to a ward reinforced that focusing on building understanding between staff and service users is really important in making sure it truly remains only a last resort – I hope that more effective communication, engagement and co-production of solutions between everyone involved in inpatient mental health services will continue to reduce its use.

This project is featured in our Annual Report 2022/23.

Find out more about this project in our Annual report 22/23.

SBRI Healthcare awards over £180,000 to HIN-backed innovations for autistic people and people with learning disability

Published by Alex Chafey

SBRI Healthcare has awarded over £180,000 to two HIN-supported projects that help narrow inequalities for autistic people and people with learning disability in south London.

The projects include an annual health check and health planning tool to improve access to services; and a software tool to help people with a learning disability or autism to capture their needs and tailor support accordingly.

SBRI Healthcare is an Accelerated Access Collaborative (AAC) initiative – a partnership between patient groups, government bodies, industry and the NHS hosted by NHS England – and is delivered in partnership with the Academic Health Science Networks (AHSNs).

It is estimated that about 1.5 million people have a learning disability in the UK, and about 800,000 people are autistic. Many people have both a learning disability and are autistic. There has been a rise in referrals for autism assessment, with systems under pressure to meet demand. Significant health inequalities can impact access to the right support for autistic people and people with a learning disability.

The Successful HIN-backed Projects

Maldaba

Improving annual health checks and design EMIS interoperability

Awarded £96,396 

This project will open up a digital communication pathway between primary care and service users so that annual health check (AHC) and health action planning (HAP) processes will be more inclusive and provide better access to health and care services, including health promotion.

RIX Software

RIX Multi Me Toolkit – for person-centred integrated health and care for people with learning disabilities and autism

Awarded £83,277

The RIX Multi Me Toolkit enables people with a learning disability and autistic people to capture their needs and share how best to provide them with support and healthcare, using simple multimedia apps and a secure online support network. This project will refine these tools in partnership with service-users and providers.

Background

‘Competition 20 – Autism and Learning Disabilities’ was launched in May 2022, as a Phase 1 development funding competition, funded by the Accelerated Access Collaborative, in partnership with the Academic Health Science Networks (AHSNs) and Autistica. It specifically sought innovations to help with early identification and diagnosis and equal access to effective support and care.

Alongside progress being made by the NHS Long Term Plan, NHS England’s Transforming Care Programme, and the Core20PLUS5 initiative, the new funding aims to accelerate change and use the best of cross-sector collaboration and technical expertise.

The competition was open to single companies or organisations from the private, public, and third sectors, including large corporates, small and medium enterprises, charities, universities and NHS providers.

The projects will run for up to six months, with the aim to demonstrate whether the innovations are technically feasible. Innovations that can prove their impact and potential will be able to seek further funding for prototype development and evaluation, with the aim for successful technologies to be adopted for use by the NHS.  

Matt Whitty, Director of Innovation, Research and Life Sciences at NHS England and CEO of the Accelerated Access Collaborative, said:

“Earlier this year our learning disability and autism demand signalling report identified the most important research questions and innovation challenges that need addressing to help deliver for those impacted and we’re delighted to build on that work by investing in the fantastic innovations we are announcing today.

“We have selected these innovations because they have the potential to make a big difference to tackling health inequalities in autism and learning disabilities – and by supporting the most promising innovations the NHS will continue to evolve, helping meet more patients needs and encouraging more innovators to come forward with ideas that make a difference.”

Dr Lorcan Kenny, National Research Lead for Autism, NHS England, said:

“NHS England remains committed to improving healthcare for autistic people and people with a learning disability, who can face significant health inequalities. Innovative technology along with good quality research about its effectiveness will be key in achieving some of the goals set out in the NHS Long Term Plan, such as reducing diagnosis waiting lists, delivering efficient services and improving coordination and quality of care.”

Dr Amanda Roestorf, Head of Research at Autistica, said:

“Autistica is delighted to be partnering with NHS England and Small Business Research Initiative Healthcare (SBRIH) to solve unmet needs of autistic people and people with learning disabilities. The SBRIH funding pathway will support the research initiatives to bring new technologies to the NHS as a crucial step to enabling autistic and other neurodivergent people to live happier, healthier, longer lives. These projects demonstrate that rapid innovation based on high-quality evidence and collaboration between industry, health and care services, and academic experts, is both possible and necessary to create practical solutions to improve the lives and outcomes of autistic people.”

Find out more

You can find out more about the other projects awarded by SBRI across England.

Find out more about the winning projects

Making mental health a priority starts with our workforce

Published and last updated by Michael Mbanunu

Andy Scott-Lee recently joined our Mental Health team, having spent most of his career with front-line mental health roles. We speak to him about his reflections on his first few months at the Health Innovation Network and what his experiences have made him think about how we could protect and improve the mental health of our nation.

Every week, so it seems, a new worry is added to the list of issues affecting society. Between the housing crisis, the climate crisis, and the cost-of-living crisis, there seem to be more factors than ever making life difficult for ordinary people.

In a world where everyone is affected by these issues differently, where do we start when it comes to finding common ground for improving our nation’s mental health and wellbeing?

In my opinion, it all begins with looking out for the people looking after our mental health.

Most clinical teams working in mental health are under significant pressure at the moment. I think awareness of those stresses probably peaked during Covid-19, where we saw a significant increase in mental health issues experienced by NHS staff, but it’s so important that we don’t slip into thinking those operational pressures have gone away.

People working in the NHS need to feel they are valued and that they and their services are supported by their organisation to do the job they were trained to do. I've worked on the front lines of mental health, and so often have found that the times where I delivered the best care were when I felt my health and wellbeing were being prioritised.

To be authentic and consistent in my care for others, I needed to first feel good about myself.

Making time to change our culture

Improving the way we look after our workforce is a responsibility for everyone working in mental health. 

Many mental health professionals already take a mindful approach to their own wellbeing, and I feel this is something we should continue to encourage. Certainly, the mantra of "be gentle on yourself" was something that I repeated to myself when treating many of my patients with trauma, and there is a wealth of insight and guidance on effective self-compassion dating back as far as Buddha. But self-help is only a part of the solution. 

One of the biggest things I’ve noticed since joining the HIN is that wellbeing isn’t just listed as an “organisational priority” – it is something that everyone actually invests time and effort into. 

Finding everyone represented in health and wellbeing conversations has been a relieving and refreshing experience. At all levels, it is acknowledged that the time and effort that goes into improving our wellbeing is reflected in the quality of the work that we do. Dedicated wellbeing champions lead the way, and it is great to see staff from all backgrounds and seniorities consistently taking advantage of activities designed to improve our physical and mental health. 

Of course, the HIN does have significant organisational differences to a Trust providing clinical care. But I think the essence of what we have here – senior leadership buy-in, dedicated champions and advocacy across the organisation for wellbeing as a priority – could be applied anywhere. 

Practical action, not policies 

Health and wellbeing isn’t a new topic within the NHS; NHS England’s People Plan from 2020 is full of sound thinking on the issue. 

But despite “islands of improvement” we haven’t made enough progress as a system, and perhaps we’ve fallen into the trap of talking too much and acting too little. 

So my challenge to people working in mental health is this – what can you do to improve the wellbeing of our workforce, and in turn improve the care that we provide? 

Can you find a way to reduce the workload of someone so that their “wellbeing champion” objective becomes part of their core responsibilities rather than an add-on to do in their personal time? 

Can you be the senior leader who always makes time to attend a wellbeing walk or other activity? 

Can you be the person who takes the initiative to learn from what’s working elsewhere? 

I believe you can. 

Evaluating remote consultations in mental health: creating a positive legacy from the pandemic

Published and last updated by Michael Mbanunu

Covid-19 catalysed huge changes for mental health services, with many appointments switched from face-to-face to video or telephone consultations almost overnight. More than two years on from the start of the pandemic Dr Stuart Adams (Consultant Psychiatrist and Chief Clinical Information Officer at South West London & St. George’s Mental Health NHS Trust) discusses the lasting legacy of these changes – and how a new evaluation tool will be a vital enabler for further improvements to the service user experience.

The pandemic has been exceptionally difficult for everyone involved in mental health – service users, clinicians and managers have all had to deal with situations that I think most of us hoped we would never experience.

Whilst nobody will look back on the past two years fondly, I think it is important that we do what we can to ensure that we learn from such testing times, and maintain momentum on some of the accelerated transformation work enforced by the pandemic. One of the areas where I think we have a real opportunity to create a positive legacy is the use of remote consultations in mental health.

Starting in 2021, we partnered with the Health Innovation Network, experts by experience, and other local stakeholders on a large-scale evaluation of the rapid adoption of remote consultation technologies. Over the course of that evaluation we spoke to thousands of mental health service users and staff about what the switch from face-to-face to telephone or video consultations had meant for them.

Whilst the evaluation identified some complex challenges around the adoption of remote consultations by mental health services – not least ensuring digitally excluded people were not “left behind” – there were also many positive themes in our final report.

People we spoke to in our evaluation often talked about the convenience of remote consultations, saving time and money on travel to appointments. Writing at a time of an emerging cost of living crisis and a renewed focus on making the NHS as environmentally sustainable as possible, the convenience factor seems more relevant than ever.

Managing the transition from transformation to business-as-usual

Two years on from the start of the pandemic, it has been positive to see that people are continuing to make the most of remote consultations as an option for accessing care. About 12% of all our consultations at South West London and St George’s are now conducted remotely, with much higher take-up in some services such as CAMHS.

So – with a robust evaluation in the books and uptake seemingly in a steady state, is this “mission accomplished” for remote consultations?

Not from where I’m standing, if we want to really make the most of the potential of these innovations.

We’ve come a long way in terms of technology from those first days of the pandemic, from shaky connections and clunky interfaces, through to more dependable solutions with functionality that helps rather than hinders the therapeutic alliance. But – anybody who has been a part of a remote consultation knows there’s still room for technological improvement.

We’re also still understanding the answers to some big questions around implementation – for example the benefits and drawbacks of phone versus video-based remote consultations.

And finally, as with any service, we must commit to interrogating our delivery of remote consultations to ensure we are providing service users with the best (and most effective) choices and services. This brave new world contains many exciting opportunities for Quality Improvement, and we have only just scratched the surface of what might be possible.

Meaningful evaluation underpins progress in all of those areas, which is why I am pleased that our partnership has produced a new appointment survey, designed to help Trusts understand service user experiences of remote consultations on an ongoing basis.

The free tool can be easily adopted by any NHS service and delivered through a variety of platforms. Along with other project resources from the partnership, we hope it will be useful for clinicians and managers hoping to further develop remote consultations as an option for their service users.

Here’s to continuing to drive progress that benefits services users, clinicians and systems – with robust evaluation illuminating the road ahead for all of us.

The importance of Patient and Public Involvement (PPI) in healthcare research and transformation

Published and last updated by Rahel Gerezgiher

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Covid-19 has led to significant changes in how mental health services in south London have been delivered. There has been a rapid shift from face-to-face to remote telephone and video consultations. Although remote consultations bring about many benefits for those using them, they can also be challenging.

As a key part of the Remote Consultations in Mental Health project, the Health Innovation Network (HIN) collaborated with King’s Improvement Science (KIS) at King’s College London who facilitated the set-up of our experts by experience team. This team have been part of the project’s Patient and Public Involvement (PPI) group to better understand the benefits and challenges of remote consultations in mental health settings.

Involving people with lived experience, including service users and carers,  through PPI is a vital part of healthcare research and transformation. For our Remote Consultations in Mental Health project, our PPI group is comprised of people with lived experience of physical and mental health conditions, as well as a variety of treatment experiences and ethnic and cultural backgrounds.

The Health Innovation Network would like to thank our PPI group collaborators – Mel, Lana, Paul, Sarah and the patient and public involvement co-ordinator from KIS Len, who also has lived experience of using mental health services - for sharing their reflections on the project with us through the blog that follows:

Why we got involved

Many of us in the project group have lived experience of how dramatically the changes brought about by Covid-19 have affected the provision of mental health services. For all of us, regardless of whether we come from a place of being a current service user or have been one in the past, we wanted to ensure that mental health services were fit for purpose given the scale of change that has happened very quickly.

We all have specific things that we want to bring to the project. For example, we have members of the group who have been inpatients during the pandemic and haven't had access to the internet – making them reliant on different methods of communication, and significantly changing their therapeutic relationships.

It's so important to have people talking about their own experiences of health care during these turbulent times. It can be easy to overlook people who are "digitally excluded" if they are just numbers on a page, but we think being able to talk about our experiences first-hand really helps clinicians understand the day-to-day complexities of living with a mental health condition.

We were determined to make sure that PPI was not about going through the motions. PPI is a term you hear a lot and isn’t always done right. The group has been involved in project meetings and work since September 2020 and, given the challenging situations we have worked through over the last 18 months, we are grateful to have been able to input and provide expertise to the project team. Although we strive for coproduction, what we achieved in this project was good PPI throughout the project timeline.

What we did

Working as part of the PPI group has provided a great opportunity for many of us to contribute experiences in order to better support the improvement of mental health services. We had the chance to get involved in a wide range of different activities with numerous goals.

Throughout the work, we have seen the power of bringing people with lived experience and health professionals together. Whilst we as the PPI group have been empowered to help shape the work of organisations, such as the HIN, we also hope that we empower the health professionals that we work with by providing them with a deeper level of understanding of the human side living with a mental health condition – not just from our own personal experiences, but reflecting the wider shared experiences within our communities.

One of the key elements we have worked on has been a series of infographics that are designed to be clear summaries of the latest research in this area which can be understood by everyone from public to clinicians and researchers. As well as deciding the content, we also shaped the visual look of the infographics and the language used, using our own experiences to make the final products inclusive and accessible for the widest possible audience. PPI can often seem like an abstract concept, but we were lucky enough to have something tangible that the group could see evolve in real time and have ownership over. The infographics provided us an opportunity to tap into our creative side and condense a lot of information in a succinct way, helping us to connect the wider service user population back to the work of the project.

We also felt we had a key part to play in highlighting the challenges with remote consultations in mental health settings, particularly around digital exclusion. For example, one important point that we discussed during the work was that there are easily overlooked groups, such as service users in the criminal justice system. This was interesting as it looks like many pieces of research about remote consultations weren’t necessarily including insights or experiences from such groups.

More symbolically, we think it is reassuring for the wider service user population that we are visibly involved in the work. Change can bring anxiety for many people and we hope that knowing the patient and service user voice is represented in these changes will let people know that it isn’t just clinicians or commissioners who are making decisions that will affect their treatments. 

Image

Pictured above: An infographic co-created with the PPI group.

Looking to the future

One of the big takeaways from all this work has been that remote consultations offer a useful choice for lots of people in how they access mental health services. For many people, having appointments remotely is beneficial– saving time and money and being more convenient.

We think the key point that we want to make sure is heard is that technology giving us more options is a positive thing, but letting an enthusiasm for technology run unchecked can be absolutely disastrous. We cannot let new technology cause harm through worsening digital exclusion, and we have to keep listening to service users when they say they want choices in how they access care – not just going with the latest and greatest technological solution.

More generally, we hope that this kind of involvement of service users, carers and public members within research continues and is strengthened in the future. We feel that the project has benefitted from PPI and we have in turn benefitted from our involvement – we are proud that the process has felt nothing like “ticking a box”!

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Delve deeper into this project by exploring our dedicated resource page.

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Innovating in mental health in an unequal world

Published and last updated by Rahel Gerezgiher

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Written by Aileen Jackson, Head of Mental Health at the Health Innovation Network.

Working in innovation in mental health can be exciting, and it is easy to get swept along with the thrill of implementing new ways of working through service design and technology. Between digital solutions that  can for example support the diagnosis of attention deficit hyperactivity disorder (ADHD) and service transformations that improve access to treatment , it can feel like we’re contributing to solving  many issues. And we are. But sadly, the harsh reality of the inequalities of our world can also mean we’re creating new ones too.  

According to the Kings Fund inequality is unfair and avoidable, yet 52 per cent of the LGTBQ+ population have experienced depression compared with 20 per cent of the general population, and three per cent of black men have experienced a psychotic disorder compared with less than one per cent of white men.  

This year’s theme of World Mental Health Day demands us to stop and ask, how do we make mental health services better in an unequal world? And on a personal level I ask, how do we ensure that innovation is a driving force in improving healthcare that meets the need of everyone, as per our founding NHS principles, and not exacerbating inequalities?

At the Health Innovation Network, we have a strong emphasis on both conducting an Equalities Impact Assessment and on addressing inequalities . Here are some of my recommendations on how we can all work together to put this into practice.

Be data informed

Eating Disorders is a prime example of where this can help. One of our national projects is Early Intervention in Eating Disorders. Our research revealed that historically, eating disorders have been perceived as disorders that affect only white women and that people of colour  are significantly less likely to receive help for their eating issues. Black teenagers are 50 per cent more likely than white teenagers to exhibit bulimic behaviour, such as binging and purging (Goeree, Sovinsky, & Iorio, 2011).Dig a bit deeper and this issue becomes more complex. People of colour with self-acknowledged eating and weight concerns are significantly less likely than white participants to have been asked by a doctor about eating disorder symptoms, despite similar rates of eating disorder symptoms across ethnic groups. (Becker, 2003).

Listen

Our approach to addressing the issue of inequalities in eating disorders recognition and treatment includes, services collecting demographic data on referrals and treatment outcomes, engaging directly with young black and Asian people to listen to their experiences, collating these experiences into a resource and sharing  with health care professionals. We are also creating a video to attract more diverse clinicians into this area of mental health .

Listening to staff and service users is even more important since the Covid-19 pandemic caused dramatic changes to the way we all interacted. In mental health, for example, there was a rapid shift from face-to-face consultations to remote consultations.

Offer Patients Choice

Together with our south London partners we have  gathering evidence on the impact of remote consultations in mental health. We have learned from academic reviews, staff and patient surveys and service evaluations of the inequalities that have arisen from this shift in service delivery .

We have discovered that patient choice is paramount, and that there are large gaps in evidence on digital exclusion. There are definitely some benefits for patients and staff, such as less travel, convenience, and more opportunity for family involvement, but there is also concern about private space to engage on digital platform for a consultation. Our evidence is showing us that a face-to-face appointment is preferred by many for a first appointment and that video consultations are emerging as more acceptable than a phone call. Remember always to put the person at the heart of making this choice, a phone call to an older person may be better received, where as an online chat will suit others. A letter to invite comments can still be viewed as a gift.

Challenge yourself

And challenge the innovators of digital technology and service redesign. Ask them how can the latest mental health app/innovation support more equitable access to treatment and recovery? Work with them to help them understand the barriers marginalised groups face so they can help you to find solutions.

Share your findings

A large part of our work at the Health Innovation Network is to spread and adopt innovation. We have made it our mission to share our learning from our work in remote consultations nationally so we can influence decision makers.  to date we have engaged with close to 2000 mental health stakeholders  through our learning webinars.  Join us at our next webinar on 27 October to hear directly from people with lived experience how together  we are promoting the patient voice  to influence the future of remote consultations in mental health, register to attend here

Further information

Explore more on our work around mental health at the Health Innovation Network.

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Hundreds of young people with eating disorders to benefit from ‘gold standard’ NHS treatment

Published and last updated by Simon Ellery
Clinician with woman

Rapid eating disorder intervention for young people developed in south London to be rolled out nationally.

The problem

Between 600,000 and 725,000 people in the United Kingdom have one or more eating disorders.

SOURCE: National Institute for Health and Care Excellence, 2015

Young people with eating disorders such as anorexia and bulimia are to get rapid access to specialist NHS treatment across England.

The NHS has announced that it will scale up an early intervention service developed by Health Innovation Network (HIN) members King’s College London and South London and Maudsley NHS Trust (SLaM).

The model supports young people in the early stages of eating disorders.

The new service to be rolled out in 18 sites across the country builds on a successful scheme shown to help 16-25 year olds in London, with one patient describing it as ‘the gold standard’ of care.

With eating disorders causing serious physical and mental health problems which can last decades, the expanded service will target care to those who have been living with a condition for fewer than three years, to tackle problems before they escalate.

Teens or young adults coming forward who would benefit from treatment can be contacted within 48 hours and with treatment beginning as soon as two weeks later.

The approach is based on a successful model developed and trialled at King’s College London and the South London and Maudsley NHS Foundation Trust, with support from the Health Foundation. It reduces wait times and improves patients’ outcomes.

The investment in the early intervention – First Episode Rapid Early Intervention for Eating Disorders (FREED) – service is part of the NHS Long Term Plan commitment to provide an additional £1 billion a year by 2023/24 to expand and improve community mental health care so adults, including those with an eating disorder, can get earlier access to care, as close to home as possible.

Professor Tim Kendall, NHS England’s National Clinical Director for Mental Health, said:

“Young people who are struggling with an eating disorder stand to benefit significantly with the roll out of this new NHS service which will provide access to early intervention, treatment and support.

“These services have already proven to be effective and the expansion in care we have announced today will support our ambition to meet the rising demand for support to tackle young people’s ill health.

“And although we are in the throes of a pandemic, the NHS continues to offer face-to-face appointments and inpatient care for patients with eating disorders when needed, while providing the option of phone and video consultations and online support where appropriate.”

Amanda Risino, Chief Operating Officer for Health Innovation Manchester and Academic Health Science Network Early Intervention in Eating Disorder National Programme Chair, said:

“We are delighted to see 18 new services across England receive funding to implement this NHS service for young people aged 16-25 years. Early intervention in eating disorders is shown to lead to substantial improvements in clinical outcomes at a critical time of transition and development, and is highly acceptable to both patients and families.

“The AHSN Network, through our National Early Intervention in Eating Disorders Programme will be supporting implementation at these 18 new sites, in addition to our work with all Eating Disorder services across England interested in adopting an early intervention model of care for this age group.”

Ulrike Schmidt, Professor of Eating Disorders at King’s College London and Consultant Psychiatrist at South London and Maudsley NHS Foundation Trust, said:

“Eating disorders are disabling and potentially deadly, and early treatment is essential.

“We are absolutely thrilled with this much needed investment and we hope that rolling out this NHS new service to 18 specialist eating disorder teams in England, will create the momentum needed to make early intervention a reality for all young people with eating disorders.”

“The new NHS service is highly recommended by patients and families and has helped many people including George and Sue.”

George moved to London when she was 21 and her eating disorder worsened as she moved to the capital on her own.

After persuasion from her family, George visited the GP who referred her to an eating disorders service delivering the NHS service. Within two weeks, she was meeting with a psychologist for a Cognitive Behavioural Therapy (CBT) session.

George was with the service for 18 months and recognises the service not only supported her to manage her eating disorder but also with other challenges she had to face including having surgery, changing jobs, moving homes and acclimatising to the new city.

George said: “My treatment was completely tailored to me and my lifestyle. After my treatment was finished, I left the programme so optimistic and grateful for everything they had given me.”

The service has also helped Sue support her 18-year-old daughter who was the first person outside of London to use it in her local eating disorder programme.

Sue says her daughter was a bit apprehensive at first, but she built a genuine bond with her psychotherapist. Sue witnessed how the service caused a positive change to her daughter’s approach to food and exercise. From the dedication from her support worker to the involvement of a dietitian, Sue watched her daughter’s life and eating disorder improve.

She said: “I totally trusted the professionals involved in my daughter’s care and that’s what helped me help her. Without any question this NHS service should be seen as the gold standard of eating disorders care.”

“Eating disorders are disabling and potentially deadly, and early treatment is essential.”
Ulrike Schmidt, Professor of Eating Disorders at King's College London and Consultant Psychiatrist at South London and Maudsley NHS Foundation Trust.

The new and expanding community-based mental health care will provide treatment and support for 370,000 adults, including those with eating disorders as part of the NHS Long Term Plan, and for anyone experiencing poor mental health, the NHS message remains the same: please help us help you, and come forward for the care you need.

The Academic Health Science Network (AHSN) is supporting the national adoption of evidenced based models including the NHS FREED expansion for the early identification of eating disorders in people aged 16 – 25.

A 2015 National Institute for Health and Care Excellence report estimated that between 600,000 and 725,000 people in the United Kingdom have one or more eating disorders.

Find out more about FREED

Find out more about FREED by clicking on the button below.

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Looking after your mental health and wellbeing: our staff and community Covid-19 resilience message

Published and last updated by Rita Mogaiji

Looking after your mental health and wellbeing: our staff and community Covid-19 resilience message

In these uncertain times following the outbreak of Covid-19, it is more important than ever that we exemplify our HIN value of ‘Together’ – not only among our own staff, but to our members, stakeholders, partners and the people we serve. There isn’t one “right” way to process and deal with a situation like this, but one thing that we can all do to make this time easier is to look after our own health and wellbeing and support others to do the same.

We have collaborated with King’s Health Partners to create the following practical tips for how to look after your mental health and wellbeing sustainably. To access the full resilience message, which includes resources and information for accessing additional support during this time, click the button below.

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Saved by social: can young people be helped to cope online with social networks

Published and last updated by Rita Mogaiji

Saved by social: supporting young people with mental health challenges using apps

By Rita Mogaji, Digital Marketing Manager at Health Innovation Network

I love social media. I love everything about it. I love that you can learn most things, connect with likeminded people, or even better, very different people from all over the globe. In that one click a whole world of interests, breaking news and funny memes is opened up to you. As Digital Marketing Manager of Health Innovation Network, I get a kick out of being able to share the latest digital innovations with healthcare professionals, connect with GPs on how they can bring Atrial Fibrillation (AF) checks to their clinics and – of course – stay up to date with the latest gifs, all through the power of social media.

But I appreciate that’s not everyone’s experience of the cyber world. And, while I am a lover of the online world, I am not ignorant to the darker side, where bullies troll and perfection is presented as a casual everyday occurrence. This is particularly saddening in the way that it is potentially affecting young people’s mental health.

In February, HIN hosted a Maximising Digital in Mental Health event, specifically aimed at discussing how we can maximise digital  opportunities in mental health for 0-25 year olds. At the event, leading children’s mental health expert and Professor of Contemporary Psychoanalysis and Developmental science and Head of the Division of Psychology and Language Sciences at University College London (UCL), Professor Peter Fonagy OBE, brought the problem to life in the statistics he presented. According to the first national review of children and young people’s mental health, the number of children and young people referred for mental health treatment has risen by two-thirds since 2012, university students reporting a mental health problem has risen five-fold.

The same report, titled “Impact of social media and screen-use on young people’s mental health”, published in 2018, found that despite there being a disappointing amount of robust research in this area, there was evidence of the potential negative impacts of social media, ranging from causing detrimental effects on sleep patterns and body image, through to cyberbullying, grooming and ‘sexting’. In these instances, social media was described as a facilitator to the risk, rather than the general root cause.

What if instead of carrying around trolls and bullies and anxieties in their pockets, young people were carrying around peer support and mental health professionals.

Harnessing the power of sharing

If social media is a facilitator to the risks, surely, it could also be a facilitator to a solution? While social media’s potential to be destructive and unkind cannot be denied, it also provides direct access to young people who otherwise are not accessing the professional help they need.

Research recently published by the Education Policy Institute (EPI) found that one in four children and young people referred to mental health services in England last year were not accepted for treatment, and those who are accepted have to wait an average of two months to begin treatment. What if we harnessed the power of social sharing? What if instead of carrying around trolls and bullies and anxieties in their pockets, young people were carrying around helpful advice through peer support and  mental health professionals. The same touch of a button that could see them post their latest adventure, is the same single-click with which they can access potentially life-saving help.

Facebook asks us what’s on our mind, LinkedIn asks us if we want to connect. What if we created bespoke social networks that used these mechanisms and approaches to help young people feel comfortable opening up to professionals who could help them? What if the technology for this already exists?

BESTIE, an app created by a team of young people, NHS professionals from Worcestershire Health and Care Trust and digital innovators, combines digital media, instant messaging, built-in games and supportive help and information within a safe, anonymous, online platform. Kooth is a digital tool that provides easy access to an online community of peers and a team of experienced counsellors, which more than 1,500 children and young people across England log in to everyday.  Calm Harm is a multiple award-winning app to help young people manage their urge to self-harm, which has been downloaded 1.13 million times worldwide and reports a 93 per cent reduction in self harm behaviour after each use.

The effectiveness of these innovations? They have taken the end user’s behaviours and preferences into account.

Time to listen

Time to Change, is actively campaigning to bring mental health to the public consciousness with its movement to get more discussions about our mental wellbeing out in the open – and that’s great. listening to the discussion at our digital mental health event it struck me that for young people it’s not only time to talk; it’s time for us to listen. Young people want to talk about their problems, we need to give them opportunities for exchanges they feel comfortable with.

Young people want anonymity. An irony that I’m sure isn’t wasted on anyone is young people’s desire for anonymity when it comes to mental health. When co-creating the Chat Health app with young people, the ability to be anonymous and create avatars was a much requested functionality. The same people who crave sharing their every dinner, dance move or new outfit, may want to remain faceless when talking about their personal challenges.

Young people want to text. During the Maximising Digital in Mental Health event we heard from different people about how young people felt that the telephone was too personal and they didn’t always feel comfortable talking to an ‘adult’ about the challenges they might be facing. But texting made it easier to talk and was more aligned with how they usually used their smartphones.

Young people want to be involved. Most of us are not digital natives, now most commonly determined by you having owned a smartphone from the age of 12. But most young people growing up are. The same way their feedback is adapted in every other app they interact with to personalise it to their specific preferences; they want co-design and to know they have helped shape and inform the end product.

Closing the gap

Deprivation heightens a young person’s propensity to experience mental health challenges. Dr Fonagy described how you can almost perfectly follow the underground line from east to west across south London, mapping the deteriorating outcomes and quality of care that children receive based on where they are from. On the face of it, investing in digital may serve to only increase this socio-economic divide. However, in the young person’s category access to technology is possibly less of  a concern with 96 per cent of 16-25 year olds own a smartphone, with tablet access expected to reach similar ownership in the next few years.

Younger generations will continue to become more digitally aware and savvy, and as a result, more susceptible to the negative sides of such digital maturity, and at an even younger age. So instead of all of our efforts going into stopping the rise of social media or preventing young people’s access, I believe we should  harness the power of social media to offer them support, help and – most importantly – the tools to manage their own mental wellbeing.

Young people want to talk about their problems, we need to give them opportunities for exchanges they feel comfortable with.

Check out the full list of digital tools presented at our Maximising Digital opportunities in mental health 0-25 years event, which also included tools to support new parents.

BESTIE is a mobile application that aims to help reduce the mental health risks of social media to children and young people. It combines digital media, instant messaging, built-in games and supportive help and information, all within an anonymous, safe online platform.

Baby Buddy is an award-winning, quality-assured pregnancy and parenting app, providing timely, relevant and personalised, bite-sized daily information for parents and families. The app signposts people to local support help lines and ensures new parents are confident and equipped to make decisions about their child and themselves during pregnancy and early parenthood.

BfB Labs’ mission is to develop and deliver highly engaging, clinically evidenced and cost-effective digital interventions that provide timely and effective support to young people so they can improve and sustain their mental health. BfB Labs evidence-based digital treatment interventions can be delivered at all points in the care pathway: before, during and after clinician-led support. Evidence

Calm Harm is a multiple award-winning app to help young people manage their urge to self-harm using ideas from evidence-based Dialectic Behaviour Therapy (DBT). The app has been downloaded 1.13 million times worldwide with a reported 93 per cent rate in the reduction of self-harm behaviour after each use.

ChatHealth is a multi-award-winning, risk-managed messaging helpline platform, providing a way for service users to easily and anonymously get in touch with a healthcare professional. Backed by NHS England’s Innovation Accelerator, evaluated by NICE and NHS Digital, ChatHealth is used by half of public health school nursing teams in England.

The free-to-download distrACT app by Expert Self Care allows NHS and other providers to give people easy, quick and discreet access to information around self-harm and suicidal thoughts. Created by a team of experts in self-harm and suicide prevention, doctors, NHS organisations and charities, the app can be customised for local areas that want to signpost local services and support all in one place.

Dr Julian is an innovative mental healthcare platform that increases accessibility of mental healthcare. It connects patients almost immediately to mental healthcare therapists by secure video/audio/text appointments using a calendar appointment booking system, which matches a patient to the correct therapist using filters such as language, issue and therapy type.

QbTest is a continuous performance test (CPT) that simultaneously measures the core indicators of ADHD: attention, impulsivity and motor activity. Evaluation of the QbTest showed pathway efficiencies, quicker diagnosis, release of clinical workforce time and improved patient experience.

Recognising that one in four young people who use a smartphone have experienced depression, anxiety, perceived stress and poor sleep, Humankind designed the pocket digital trainer, Goozby, which improves sleep, concentration and sedentary behaviour, using behaviour science and health analytics.

Kooth, from XenZone, is a transformational digital mental health support service. It gives children and young people easy access to an online community of peers and a team of experienced counsellors. Access is free of the typical barriers to support: no waiting lists, no thresholds and complete anonymity. Evidence here and here

MeeTwo is a multi-award winning fully moderated, anonymous peer support app for young people aged 11-23. MeeTwo integrates the latest psychological research to promote the development of protective factors such as emotional resilience, empathy, social skills, stress management and coping techniques. Evidence

Mind Moose builds digital tools to support early intervention in children’s mental health. They are currently piloting virtual reality (VR) and online emotional support to help children with their mental and emotional wellbeing.

Mum & Baby app is a personalised digital toolkit to support women and their families through pregnancy, birth and beyond with access to local, national and international guidance and resources.

Mush brings women together to prevent social isolation and reduce anxiety in pregnant women and new mums. It empowers women to build local friendships, share advice and find support from an understanding community.

My Possible Self is the mental health app clinically proven to reduce stress, anxiety and low mood, developed by our team of in-house psychologists. The app empowers people to become their best possible self by using proven psychological methods and clinically-proven research from world-leading experts in e-mental health research.

Shout is the UK’s first 24/7 text service, free on all major mobile networks, for anyone in crisis anytime, anywhere. Shout exists in the US as ‘Crisis Text Line’, but this is the first time the tried and tested technology has come to the UK. The anonymised data collated by Shout gives unique insights into mental health trends to help improve people’s lives.

Learn about more about our work in mental health

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Save every life

Published and last updated by Rahel Gerezgiher

Save every life

Aileen Jackson, our Head of Mental Health, reflects on her involvement in a new national digital suicide prevention resource funded by the Department of Health and Social Care

Having spent the last few decades working extensively in the health and social care sector, I have seen first-hand the effect that use of certain language can have in particularly sensitive situations. The language used to describe suicide is often regarded as wholly negative and this was brought to light again at our recent stakeholder engagement workshop, where I was challenged on the term ‘zero suicide’.

The man who posed the challenge, like some people with enduring mental illness, lives with suicide ideation. He felt that the ambition of ‘zero suicide’ furthers the stigmatization he already experiences. The harmful thoughts he explained are very much part of his mental illness and, as such, won’t just go away.

National engagement and research on suicide prevention

The workshop in question was part of a national engagement and research project I was involved in as part of my role at the Health Innovation Network. The project, commissioned by the Zero Suicide Alliance (ZSA), was designed to find out what professionals need to know about preventing suicide and what information is already available online to assist them. The purpose of both tasks was to inform a new digital suicide prevention resource funded by the Department of Health and Social Care.

Worldwide close to 800,000 people took their own lives in 2018, and suicide is the second leading cause of death among 15 to 29-year-olds and still the biggest killer for men under 50. Every week, 12 Londoners lose their life to suicide. It does not take much imagination to work out how many others are affected by each life lost. Zero Suicide is an ambition being adopted around the UK and the world, and the Major of London announced his support for Zero Suicide in September on World Suicide Prevention Day.

The stakeholder engagement took several forms, workshops, telephone interviews and a digital survey, which gathered nearly 1,000 responses in just six short weeks.

What we are learning

The project has taught us several things. Firstly, it showed us how passionate people working in this field are about knowing more about suicide prevention. People want to be trained, to know how digital apps and research are contributing to this area of mental health, and what best practice is out there and ready to share. Perhaps most simply of all, people want to be able to know what to say if someone they encounter is suicidal.

Our research also demonstrated there are plenty of good quality national and international examples out there to support and equip professionals to build their suicide prevention toolbox. The responses demonstrated there is a need for a national suicide prevention ‘go to’ digital resource to inform and support the full range of professionals; NHS, police, fire, social care, unions, private and third sector that work so tirelessly to prevent suicide.

On a personal level, I learnt that many of us have first-hand experience of suicide, which we seldom speak about. All the learning from our project has been provided to ZSA and is informing the content and design of a new digital resource, which will be made invariably stronger by the open, honest and brave contributions that everyone involved throughout the process has made.

To learn more about this project please email hin.southlondon@nhs.net.

A thank you

Thank you to all of you who contributed so openly, you inspired us to complete this work on your behalf. Thank you to the man who had the courage to challenge us at that first workshop. You opened my mind to the life that you and your peers live, you stayed and joined in despite your anger and upset. I believe by the end you were uplifted, like me, by the sheer number of professionals in the room from all different services that wanted to understand more about how they can be better equipped to prevent suicide. By engaging with the topic, sharing your experience and your viewpoint, you helped us to ensure the experience of others like you is captured and considered.

And thank you to those colleagues who bravely shared their personal experiences of suicide. I hope you have been helped through hearing some of the other sad stories of loss, which were presented so eloquently and courageously at our workshops around the country.

Suicide touches the lives of so many of us in some way, either through relatives or friends, or through living with suicidal ideation as part of a mental illness. What we’re not always able to do is talk about it. I believe if the Zero Suicide ambition helps even more people affected to find the words and forums to talk about it, is an ambition worth pursuing.

Help us to achieve our Zero Suicide ambition

The Health Innovation Network has joined with the ZSA in its support of the Major of London’s Zero Suicide campaign. You can learn more about preventing suicide through free Save a Life training.

The aim of Save a Life is to #See #Say #Signpost

  • Identify when someone is presenting with suicidal thoughts/behaviour
  • Be able to speak out in a supportive manner
  • Empower them to signpost the individual to the correct services or support.

Take 20 mins now to Save a Life, access the training here.

Acknowledgements and further information

Thank you to King’s Health Partners for supporting our suicide prevention engagement work and to the Zero Suicide Alliance for the opportunity to contribute to the design and content of the new national digital suicide prevention resource.

This piece was originally published on 10 October 2019 on kingshealthpartners.org

World Mental Health Day: A story of a burning platform for change

Published and last updated by Claire Portsmouth

A burning platform for change

By Breid O’Brien, HIN Director of Digital Transformation

Today is World Mental Health Day; a day observed by over 150 countries globally to raise awareness and reduce stigma around mental health. In the 17 years since the day was first conceived, society has come a long way in its understanding of mental health. However, even today, people with serious mental illness are still likely to die approximately 15-20 years earlier than other people.

So this World Mental Health Day we would like to highlight some of the incredible progress being made by mental health teams around the world, to bring about parity of esteem in this area by reflecting on a recent roundtable event we held to share learning internationally, where Martin Davis, a Clinical Nurse from New South Wales’ Mental Health Emergency Care division (MHEC), presented on the successful implementation of a virtual consultation system in a rural and remote mental health setting in Australia.

This is a story of a small team that led the way. MHEC was kick started by a government cash injection at a time when the team needed to deliver a better, more cost-effective system of care to its rural and remote population in rural Australia. Before the MHEC service was introduced remote and rural ambulances (and often other emergency services) were transporting patients hundreds of miles just for an acute mental health assessment; taking them from the comfort of their home, family and friends when they were in a vulnerable state, and often leaving their hometown without any emergency provision. Imagine living somewhere where if there was a fire, there would be no one to put it out, simply because they are effectively acting as a patient taxi? Their situation provided a clear rationale for change – a burning platform, if you will. By using virtual consultations, they could save time, save money and deliver faster patient care.

Starting with an 1-800 number 12 years ago and progressing to an online video system just under a decade ago, MHEC now prides itself on answering calls within three rings, and being able to assess patients on a video call within an hour during daytime hours. The stats continue. Every year since its inception, they have saved the combined services over $1,000,000 AUD a year; and 80% of the patients they see are discharged back into their community within a day, a direct reversal of the 20% of patients who were able to go home under the previous system.

“All just geography”

Despite the obvious differences between MHEC’s setting (their ‘patch’ is the size of Germany but has only 320,000 residents), and our urban south London area where almost three million people reside in an area a fraction of the size, when Martin shared his story the similarities were immediately apparent. In London we have a diverse population who speak an estimated 250 languages, requiring a need for numerous cultural sensitivities; the MHEC team have a large aboriginal population – almost 40% of their mental health in-patients identify as aboriginal.

Patients in New South Wales were having to travel miles away from their families to receive acute mental health care; we too have examples of this happening in acute mental health care in the UK, and while the distances in Australia may be greater, the impact on the patient and their family will be the same. The Australian health system also faces an increasing demand for acute mental services against a backdrop of challenges with staff recruitment; turns out, Julia Roberts had it right in Pretty Woman; it is “all just geography”.

The question our roundtable guests discussed cut to the heart of the complexities of digital transformation: if we have so much in common, why, over a decade later, are we still not embracing virtual consultations in the same way that they are? Distance and cost were MHEC’s burning platform, pushing them to make changes ten years ago that other services are only just catching up with. We seemingly are yet to find our burning platform, despite the pressures on our services and the progress being made in many areas.

As our roundtable participants moved the discussion on to the inevitable complexities of implementation, many of the usual barriers made an appearance; procurement, interoperability, money, time. But a few more situation-specific ones also livened the debate; what are the implications for information governance? How do you prevent reprisals of misdiagnosis? How do you train people to deliver virtual care? How do you ensure that changing a pathway won’t affect patient safety? How do you empower your teams to step outside their role? How do you get buy-in from all the organisations needed to deliver the change?

The need for systems to talk

For Martin – and MHEC – all the barriers to change raised were not only a stark reminder of how far they have come, but also how much work is still to be done. We delved into the extensive stakeholder engagement the MHEC team undertook (they visited all the GP practises in person because face-to-face meetings achieved better buy in from clinicians – an irony that wasn’t wasted on them), and listened to how the accountability process was redefined, before unveiling a key area of distinction between our two situations; how joined up their IT systems had become. A steely silence answered Martin’s assumption that we’d managed to fix the interoperability of medical records in the 20 years since he’d served at Homerton, Enfield and the Royal Free. Sadly, Martin, we have not but it is high on the agenda of NHSX and others so perhaps this time we will.

And therein lies part of the problem. The collaborative nature required to implement the MHEC system between mental health, emergency departments, General Practitioners, community mental health teams and even the police (they have supplied local police with digital tablets to ensure they can get the virtual consultations to people in their own homes, not just the local emergency department) is a testament to the power of joined-up care systems, but working together was undoubtedly made simpler by the support of a joined up technology system, something the various LHRCEs are still working hard to crack.

From the discussion, it became clear however that no one issue of technology, procurement, change management, organisational boundaries or geography on its own poses enough of a barrier, but the cumulative effect of them all risks putting off too many commissioners, clinicians and managers from implementing digital transformation. The risk made all the more terrifying by the fear that it might go wrong and that safety could be compromised.

Martin was incredibly open and forthcoming about the fact that MHEC is not yet perfect. When they started the technology didn’t work; not everyone was bought in to the system; it was not – and still isn’t – an overnight success, but none of that mattered. They were trying something new that, at its heart, was trying to improve patient care and support emergency services to deliver better support to people in a mental health crisis, whilst also saving the overall system money. It is clear that really innovative organisations are willing to tolerate failure and see it as an opportunity for learning and doing things even better. Whilst we can’t tolerate failure in terms of compromising patient safety, it does feel that perhaps sometimes this fear also stops us from implementing proven innovations. So why does the fact that something won’t work perfectly first-time round make us in the NHS feel so uncomfortable? Perhaps this is our inherent fear of failure?

We heard from some present about the fabulous work they are doing to implement similar technology and different ways of working, however, to really impact care we need to do this at scale. And to achieve anything at scale, risks will have to be taken. Perhaps our burning platform is just not hot enough. Yet.

About the author
Breid O’Brien leads HIN’s digital consultancy function. She has extensive improvement and digital transformation experience supported by a clinical and operational management background in acute care within the UK and Australia. She has supported major system level change and has a strong track record of delivering complex programmes of work whilst supporting collaboration across varied teams and organisations. With a Masters in Nursing, an MSc in Healthcare Informatics and as an IHI improvement Advisor, Breid is especially interested in the people, process and technology interface.