Helping young people get rapid and specialist support for their eating disorder

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To mark Eating Disorders Awareness Week FREED Champion Dr Kirsty Manning, South West London & St George’s Adults Eating Disorders Service, shares her experiences about how FREED is helping young people get the rapid and specialised support they need for their eating disorders.

Did you know?

Since the start of the AHSN National EIED Programme:

  • 33 Eating Disorders Services across England have adopted FREED
  • We have recruited 45 FREED Champions across England
  • 960 young people have accessed evidence-based treatment, on average 10-12 weeks faster than treatment as usual

What is First Episode Early Intervention for Eating Disorders (FREED)?

Eating disorders are severe, often life-threatening mental health conditions that frequently begin in adolescence or early adulthood. The first three years of illness onset offer a window for effective early intervention in order to achieve full, enduring, recovery. However, difficulties recognising and acknowledging problems early, and poor access to services are key barriers to early interventions in eating disorders.

FREED aims to address these difficulties by reducing treatment waiting times and therefore the duration of untreated eating disorders in young people who are experiencing the illness for the first time.

Designed for 16-25 year olds, FREED is driven by the key principles of health care for young people: holistic, proactive and optimistic. It encourages flexibility and creativity in how professionals and services approach, and work with, young people. For example, treatment incorporates the impact of social media and major life transitions (e.g. in education, work, living circumstances, relationships) on individuals and their eating difficulties.

Is FREED making a difference?

All the data to date is really positive and supports the effectiveness of FREED across diverse treatment settings. Patients wait significantly less time between referral and assessment, and between assessment and treatment. What’s even more encouraging is that FREED patients tend to require less intensive treatment and are more likely to maintain their progress after treatment than non-FREED patients.

Direct feedback from patients also shows that in general they feel supported and understood by the service, and families also feel involved. For example, I worked with a young girl who was referred to us after presenting to her GP with her mother with a very low weight and really bad body image. The same day I tried to give her a call but couldn’t get an answer. I then sent a text and got an immediate response. The girl expressed difficulty talking on the phone, so we chatted through text to help her get comfortable and we arranged an assessment for the following week. She later told me that had we not had that initial contact she probably would never have attended.

At assessment, it appeared that her anorexia nervosa had developed and spiralled very quickly within a year. I encouraged her to bring her parents to the assessment who were really relieved to be included as they felt lost and helpless. This young girl was offered treatment two weeks later and we started to see changes almost immediately. Her parents attended our service’s workshops to help them develop understanding and skills to best support their daughter.

This young person’s journey is not over yet, and it has proven to be really challenging for her. But intervening early has meant that she stopped losing weight, has already got insight into her difficulties and is motivated to recover so she can go to university next year. Had there not been the FREED pathway, she would still be on the waiting list right now, without any support to make positive changes and therefore most likely deteriorating or stagnating.

What is it like to be a FREED Champion?

Being a FREED champion is a really exciting and novel role where you get to be involved in so many aspects of the service. For example, you might get involved in business meetings about funding and investment which really give you insight into how Trusts and services work, and how all these details impact our clinical work and staffing.

You also receive really good support and supervision from the FREED network and get to meet peers across the country who you can share ideas on how to implement FREED and improve your service with. For example, recently many FREED champions expressed interest in MANTRA groups for individuals with anorexia nervosa so a webinar was organised to help us think about how we could implement this model in our services.

One of the best things about FREED is that it is optimistic and aims to instil hope in others. It pays special attention to the challenges young people face during the critical years of their life as they transition to adulthood, making it much more effective than traditional service models at reversing the changes to brain, body and behaviour caused by eating disorders. As a result, young people are less likely to miss out on study, relationships and other opportunities because of their illness.

Finally, it’s also exciting to be part of something so innovative. For me, a real highlight is having a genuine and meaningful impact on service provision for young people, making sure that they have access to evidence-based treatment when they need it. All the data and feedback collected shows significant improvements and less need for intensive treatments, highlighting just how important this pathway is.

Further information about the FREED National Programme

The AHSN Network in partnership with South London & Maudsley NHS Foundation Trust (SLaM) and Kings College London (KCL) are leading on the national scaling of FREED (First Episode Rapid Early Intervention for Eating Disorders).

FREED is an innovative service for 16 to 25-year-olds who have had an eating disorder for three years or less, enabling rapid access to specialised treatment which gives special attention to challenges we know young people face during these years of their life, and in the early stages of an eating disorder.

We are working with 33 eating disorder services who have adopted FREED and supporting implementation at a further 12 Trusts who anticipate to launch their FREED service by Summer 2022.

As leaders in spread and adoption, the AHSN Network in collaboration with SLaM/KCL provides early and ongoing support to services interested in adopting FREED, working with the wider system to ensure all young people across England have rapid access to treatment by 2023.

Further information

Find out more about FREED and their work.

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

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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. 

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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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Innovating in mental health in an unequal world

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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

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

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.

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

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.

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Save every life

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

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.