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.

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.

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.

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.