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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.

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.

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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.