Maintaining Activities for Older Adults during Covid-19

Maintaining activities for Older Adults during Covid-19

Click here to watch the YouTube video to understand the needs of people living with dementia during the Covid-19 pandemic. The Activities Guide below will signpost you to excellent activities suitable for such population.

This guide to online resources for those providing care for people with dementia, is a resource that Health Innovation Network has compiled in collaboration with CHAIN members.

Activities for Older Adults During Covid-19 – aims to support the provision of free to use dementia friendly activities for older adult’s in mental health inpatient settings, Care Homes, supported housing and to those living in their own homes during the national response to Covid-19. You can download using the link below. Please share this guide with your colleagues and other relevant organisations.

 

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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.

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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Self-management could help ease the high demand on GPs

Self-management could help ease the high demand on GPs

To help ease the high demand on GPs across south London, self-management is a priority in the NHS 10-Year Plan and focuses on key areas like diabetes prevention and management, cardiovascular, asthma and respiratory conditions, maternity and parenting support and online therapies for common mental health conditions.

Individuals need support to build the skills and confidence necessary for effective self-management of longstanding conditions, and health professionals need to be aware of and trained on the available supportive tools, taking account of any inequalities and accessibility barriers their patients may face.

Research presented by Self Management UK[1] shows that, on average, people living with a heath condition spend just three hours per year with their healthcare team—the rest of their time is spent self-managing these conditions. NHS organisations need to work closely with local authorities and other partners to provide the support and guidance to help south Londoners self-manage properly.

There are many interventions available to help support the self-management of common conditions, some of which are:

  • education for specific health conditions;
  • peer-led courses;
  • online self-management tools;
  • telephone support and telehealth; and
  • self-monitoring of medication and symptoms using digital technology.

How can innovation help? 

You can help respond to our local needs by addressing the following challenge statements:

  1. How might we maximise digital solutions to support self-management of health risks and chronic conditions?
  2. How can digital solutions emphasise patient responsibility and, acting in conjunction with the provider community, move beyond education, enabling individuals to actively identify challenges and solve problems associated with their illness?
  3. What are the barriers to public awareness and successful patient uptake of these self-management solutions?

We’d love to collaborate with you on these challenges. Please get in touch with Karla Richards karla.richards@nhs.net if you have a digital solution for health and care self-management, including for long-term conditions, mental health, heart disease, COPD etc.

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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.

Virtual reality relaxation and coping skills for reducing stress and challenging behaviour on acute psychiatric wards

Virtual reality relaxation and coping skills for reducing stress and challenging behaviour on acute psychiatric wards

Virtual reality on the wards at-a-glance

Virtual reality headsets with relaxing scenarios introduced to six wards to reduce stress and anxiety in service users with complex and serious mental health needs
Research has shown that virtual reality has enormous potential to aid relaxation and improve outcomes. The team was inspired by pioneering work in the Netherlands using virtual reality with outpatients and wants to pilot this approach with inpatients in south London.
• Reduced anxiety and stress, helping people to manage their mental health conditions.
• Reduced levels of stress and challenging behaviour on wards.
• Better environment for both service users and staff.
• Fewer incidents of challenging behaviour and a positive effect on reducing staff stress and burn-out.
• Reduction in the need for seclusion.
• Parity of esteem, ensuring that mental health service users benefit from the latest technology.


Virtual reality on acute wards to help people with complex mental health conditions

Service users on psychiatric wards often report high levels of stress and difficulties regulating emotions, which can lead to violence and aggression toward staff and others. A team at South London and Maudsley (SLaM) NHS Foundation Trust plans to address this through pioneering use of virtual reality.

Funded by the HIN Innovation Grants, this project aims to evaluate the implementation of a new virtual reality (VR) technology, VRelax, to reduce stress and arousal in service users with complex mental health conditions. The VR headsets allow people to experience calming and relaxing environments. Previously, the NHS typically asked people to think of positive mental imagery, which requires more concentration and imagination and can be challenging to sustain. Virtual reality will give people the chance to feel immersed in a more calming environment.

The team will introduce 12 new VRelax headsets and assess their effectiveness in reducing service user stress and associated risks (violence, aggression and seclusion) on six acute psychiatric wards within SLaM. VRelax consists of 360 degree videos of calm, natural environments. This includes a scuba diving experience with wild dolphins, a sunny meadow in the Alps, a coral reef, a drone flight, a sunny mountain meadow with animals, a guided mindfulness meditation on the beach or a wide range of other options, all shown in a VR headset. The team will train the nursing staff on the software and nurses will then be able to decide how and when to offer this to their patients, as an additional option that complements existing relaxation techniques.

Heightened stress reactivity is not good for individuals: it’s related to recurrence of mood, anxiety as well as psychotic disorders and it’s not good for staff or ward environments: difficulties regulating emotions can increase risk of violence and aggression, which put both service users and staff at risk. This can result in seclusion being necessary, with isolation potentially increasing service user stress and costs. A previous randomised cross-over trial of VRelax with 50 psychiatric outpatients showed strong immediate effects on stress level, and on negative and positive mood states. The team at SLaM wants to bring these promising findings to service users on acute wards in the UK.

In addition to improving care for service users, VR has the potential to have a real impact on the overall ward environment. By reducing stress and anxiety, the project hopes to reduce violence and aggression. This will create a better environment for both staff and service users.
The project has collaboration at its heart. The team will link three main institutions – SLaM, University Hospital Lewisham, King’s College London and University Medical Center Groningen, in the Netherlands.

Find out more about our work in mental health


Innovator Spotlight

Dr Simon Riches, Highly Specialist Clinical Psychologist, South London and Maudsley NHS Foundation Trust said:

“At a relatively low cost, this technology could have a major impact on the ward environment and the people in our care. Service users will have the chance to feel immersed in a more calming environment, meaning that both staff and service users can benefit from reduced levels of stress and challenging behaviour.

“We’ve brought a lot of people together for the project who are very passionate about digital health, including international colleagues. It’s still very new and the opportunity to collaborate on this emerging area of research is exciting.”

Dr Freya Rumball, Clinical Psychologist, South London and Maudsley NHS Foundation Trust, said:

“There is strong evidence that relaxation and grounding techniques can have a positive impact on stress and anxiety, and we will be among the first teams to test this exciting new technology on acute wards in SLaM. Our pilot will advance the evidence base and we are keen to disseminate our findings as widely as possible.

“Innovating in the NHS can be challenging, as it can be hard to find the time to think about things from a fresh perspective. However, we’re really passionate about bringing new technology to the forefront of our clinical work and are actively supported in this by our management and leadership.”

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Simulation Lab for Health Technology Development and Adoption: Discovery project

Simulation lab for health technology development and adoption

Tech simulation labs at-a-glance

Mobile simulation labs for digital technology
The need for smart technology procurement decisions and faster confidence in new digital tools.
NASA doesn’t send its astronauts into space without testing its technology in its simulation environments. Similarly, NHS teams should not have to use technology in high pressure environments before it’s been simulated in a hi fidelity environment.
• Higher staff confidence in new technology.
Faster uptake of digital technologies.
• Better understanding about how technologies will operate in real, high pressure clinical contexts at a granular level.
• Smarter procurement decisions taken after real-world testing.
• Faster optimisation and benefits from new digital technology.

Mobile simulation labs for health technology

A new type of simulation lab aimed for the NHS to test and develop digital health technology is being designed by NHS teams. The HIN Innovation Grants have funded a new discovery project aiming to bring the benefits of hi fidelity simulation to health technology procurement and implementation in the NHS.

The NHS has used hi fidelity patient simulation for high pressure clinical scenarios for many years, where either actors or sophisticated dummies act as patients and scenarios are played out and recorded. This gives NHS staff a learning environment that is safe and controlled so that the participants are able to make mistakes, correct those mistakes in real time and learn from them, without fear of compromising patient safety. It also allows for changes in process and workflows to be identified and tested, to improve ways of working.

Simulation labs are well evidenced and used in contexts such as medical training (for example crash calls or trauma) but their application in a digital health context has not previously been systematically researched and tested in the UK. Given the abundance of new technology that NHS teams are now using, ranging from apps to new handheld devices to multi-million pound electronic record systems and equipment, this project aims to test the benefits of simulation for digital health.

At its most basic, simulation requires a screen and camera set-up, typically with cameras in the room that can show the action in real time. The simulation can use a mix of clinicians, staff and actors. Recording the action is crucial so that reflection and learning can take place effectively.

This project aims to show that simulation can be done in a cost effective, mobile way. For example, it will explore whether Trusts could create their own simulations by putting their own screens up and using in-house cameras and laptops at relatively low cost. If this is achieved it could help the NHS make better technology procurement decisions, help staff feel confident in stressful scenarios that involve multiple combinations of technologies and identify design improvements more quickly.

Technology simulation is the norm in many industries. NASA simulates its technology in the closest possible conditions to space using a neutral buoyancy lab. In healthcare, many American hospitals simulate technology on a regular basis. By contrast, while the NHS uses simulation for many traditional clinical scenarios it rarely tests new technologies in a genuinely live environment before they are procured.

The NHS invests millions in new technology every year. Roll outs of technology are complex and it can take many years for the full benefits of new technology to be realised. User testing of digital technologies at the development stage often take place separate to the clinical setting because tech companies struggle to access real-world practice settings as a result of governance, safety and capacity in teams. As a result it is not possible to identify, mitigate and manage problems faced by real users in the context of clinical care.

The team will be focusing on mental health contexts and will start with digital apps, aiming to create a simulation environment that is mobile so it can be easily repeated by other trusts without the need for an expensive standalone simulation lab. The pilot simulation model will be developed drawing on simulation theory and research, user-centred design, agile and implementation methodologies and technology engineering. The final result from this pilot project will be a powerful resource that supports adoption of digital technologies in practice and promotes a technology simulation culture within the NHS.

Find out more about our work in mental health


Innovator Spotlight

Dr James Woollard, Chief Clinical Information Officer, Consultant Child and Adolescent Psychiatrist, Oxleas NHS Foundation Trust

“The amount of technology we procure is only set to increase and often as clinicians, we find ourselves needing to use multiple new pieces of technology simultaneously to care for patients. The NHS has used clinical simulation for years and it’s time we applied this same theory to digital technology. At the moment, we’re asking our staff to use equipment that has very rarely been tested live in the kind of high pressure scenarios they face.

“Our focus is on developing cost-effective mobile simulation labs that will help us all learn, build confidence and make roll outs much faster. If technology companies can rapidly find and address real world problems associated with using their technology before they are rolled out to staff, we’ll see better product design, ease of use and faster adoption.”

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Lewisham Primary Care Recovery College Pilot Project

Lewisham primary care recovery college pilot project

Recovery College Pilot at-a-glance

A new way to support people with mental health needs in primary care, through 10 week courses delivered by clinical experts alongside people with lived experience of mental health conditions.
The team wanted to find a way to help people whose mental health needs more support than a GP can offer in a short appointment, but don’t need acute services. They were also inspired by the power of these courses to connect people through shared experience.
• Improved and open access for people who need support.
• In South East London, 40 per cent of GP consultations relate to mental health. This could help reduce pressure on primary care at the same time as improving access.
• This is a new way to improve patients’ understanding of conditions, confidence in managing their health independently and personal resilience: and for this to have a measurable impact on their subsequent patterns of contact with a clinician.
• Increases opportunities for patients/service users and carers within primary care to work within a co-production framework, learn together and reduce of mental health stigma within the primary care environment.
• Strong example of care delivered in different settings and opportunities for primary care to offer new services in collaboration with other parts of the system.
• An opportunity to gather evidence and make the case for a sustainable roll-out.
• Recovery colleges quite new so evidence base is still emerging but studies to date show a high return on social investment – up to £10.81 for every £1.


Recovery College: innovating to improve mental health support in primary care 

A new project to take mental health recovery, self-management and wellbeing workshops into GP practices will be funded by the HIN Innovation Grants.

From the team that leads SLaM’s successful Recovery College, this project will take its model to GP practices. Recovery Colleges focus on hope, opportunity and choice/control- co production. They enable the students to become experts in their own self-care, and develop skills they need for living and working.

Students are usually individuals who do not currently need acute mental health services but do need more support than they’re able to get from busy GPs at present. It could be for a very wide range of conditions, for example long term stress or low-level depression and anxiety that affects people’s daily lives but not to the point where it needs acute intervention.

The project will provide free, co-produced self-management, recovery and wellbeing workshops and courses for patients, carers and staff in primary care, using shared perspectives, skills and knowledge to help people recover and live as well as possible. By extending into GP practices for the first care, it aims to reach more people with support and improve access.

The pilot college will be based within a health centre in Lewisham and aimed at service users/patients registered with five GP surgeries at in and around New Cross. A key part of the approach is that the trainers are paired together so that there is one ‘peer recovery trainer’ – someone who has lived experience of mental ill-health or distress as a service user – and a ‘professional trainer’ – someone who has professional experience. This means students get the clinical perspective and a personal narrative so that they can discuss and learn from someone who knows what it can be like, and feel more comfortable to share personal experiences.

Recovery College also helps people to network and meet people who are in a similar circumstance, increasing peer support. Often people are isolated and benefit from social networks. Learning about staying well in addition to having opportunities to stay connected can be very helpful for recovery. The team plans to offer a range of courses over a ten week pilot period. The courses will be co-designed, based on current SLaM Recovery College content, including topics around depression, anxiety, mindfulness, staying well and making plans and wellbeing.

The pilot will accept both referrals from GPs as well as self-referrals, with a maximum of 20 – 25 per workshop. Increasing access and routes to this kind of support will not only support people with their mental health, it aims to reduce the need for these individuals to use GP appointments for support that can be offered through the college.

The use of peer trainers has been very successful at SLaM Recovery College to date. Taking the peer trainer model into primary care is likely to be an extra and impactful support for the current NHS workforce when designing services and an additional forward step to tackle stigma and culture around mental health services.

Find out more about our work in mental health


Innovator Spotlight

Kirsty Giles, Manager (OT), SLaM Recovery College, South London and Maudsley NHS Foundation Trust, said:

“Our hope is that this pilot shows that recovery colleges can become an essential part of the primary care landscape, improving access to support for people with mental health needs while reducing the pressure on traditional GP appointments. Our trainers and our students are really brave, by putting themselves out there and sharing their story to help someone else. The approach is welcoming and effective.

“The college works with a really diverse group of people. As clinicians, we’re always learning from our students’ lived experience and are inspired by how they look after their wellbeing. This is a two-way knowledge exchange.”

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The first cohort of LGBTQ+ Project Dare graduate!

The first cohort of LGBTQ+ Project Dare graduate!

Last week, Project Dare celebrated the graduation of their first LGBTQ+ cohort with a showcase event that saw students performing excerpts of the work they have created on the subject of positive body image.

LGBTQ+ Project Dare, funded by the Health Innovation Network, is a 12-week practical, creative and educational course that encourages individuals to participate in dares as a way of approaching wellbeing, encouraging confidence. It gets students to step out of their comfort zones in a safe space amongst their peers whilst also providing support for those within the LGBTQ+ community, for whom resources are often limited.

Ursula Joy, Lead Facilitator said: “LGBTQIA+ Dare Sessions allow participants a judgement free safe space in which to express themselves creatively, and address head on the issues that affect LGBTQIA+ bodies.”

“Within the gay community, there can be immense pressure to look certain ways. The need to conform in a society dominated by social media and marketing where binary bodies are under the spotlight and non-conformity is monetised.”

“LGBTQIA+ Dares not only gives participants a voice but challenges them to step out of their comfort zones, make positive and accepting connections to who they are, forge meaningful relationships and make changes in their lives.”

“Drama is the perfect vehicle for personal growth and the final showcase provides a sense of ownership, empowerment, and achievement.”

Josh Brewster, Project Manager, Health Innovation Network said:“The Innovation Grants are crucial for projects like “Project Dare” that would be unlikely to receive support from the usual commissioning sources. The grants are a fantastic opportunity to fund projects that can make a huge different to people and do so in ways that are very unique. They act as a great springboard for success allowing the projects to prove their value and hopefully get adopted elsewhere.”

Project Dare ran this course in collaboration with the Recovery College and all of the participants were recruited from the College’s database of service users. The Recovery College offers recovery and wellbeing courses with co-production at the heart of everything they do.

Time to Talk – mental health and the role of digital

It’s time to talk about mental health

Mental health problems affect one in four of us, yet people are still afraid to talk about it. Time to Talk day encourages everyone to talk about mental health and at the HIN we’re bringing digital innovators and clinicians together to identify solutions, says Amy Semple.

Time to Talk day is about encouraging everyone to talk about mental health. Last week, the Health Innovation Network started the conversation early with the sometimes contentious topic of digital. In our experience working with both NHS stakeholders and digital companies, there remains some scepticism and reticence amongst both groups on how they can work together to benefit the 1 in 4 of the population who are currently experiencing mental health issues. So what better way to open up the channels of communication than to invite 100 key decision makers and innovators to spend the day discussing the opportunities and challenges of maximising digital opportunities in mental health, together.

The NHS Long Term Plan

The stars (at least on paper) have recently aligned in terms of national strategy, with the NHS Long Term Plan having digital at its core and a strong focus on mental health. I believe that success in both areas will be mutually dependent. To date, most digital companies, in my experience, have targeted primary care and the acute sector as this has often been the easiest way to prove their concept. Digital interventions available in the NHS are associated with benefits such as improved access to services, online self-help and therapies, prevention and organisational efficiencies.
When speaking to some companies prior to the event I felt that mental health was perhaps outside their comfort zone, seemed too large and unwieldly to take on, or wasn’t acknowledged as a viable space for their product. This is understandable. Stigma surrounding mental health means that many people believe that people with a mental health condition are unable to self-manage and will struggle to maintain the consistency needed to use some technologies. These viewpoints only sustain the inequalities we continue to see in terms of people with mental health conditions gaining equal access to services and support with physical health conditions. Mental health services can be equally cautious of digital solutions, often concerned about the ethical implications of removing the human face to face element in mental health care without putting people at risk.

Maximising digital opportunities

With our Maximising Digital in Mental Health event we created a space to encourage a healthy debate to air these concerns. To get the people who could really effect change talking to each other. We invited national and local leaders to set out their digital strategies, we presented real life examples where digital companies are already working successfully within mental health and we showcased digital companies not yet working in mental health whose products have relevance to the sector in terms of patient care or organisational efficiencies. The result; a two-way conversation where both sides could speak openly and honestly about their fears as well as their excitement at the potential to radicalise mental health care with digital technology. Honest dialogue, open conversations and exploration of the solutions were met with a real appetite for adoption and lateral thinking.

Reducing the inequality in mental health

Yes, there were challenges highlighted, barriers questioned and a little bit of scepticism still; but overwhelmingly there was positivity and real desire to work together. We know that people with serious mental illness are likely to die on average 15-20 years earlier than other people and two thirds of these deaths are from avoidable physical illnesses. It’s time to talk; to find a safe and cost-effective way for users of mental health services to benefit from digital solutions and reduce this inequality. As Liz Ashall-Payne from ORCHA eloquently phrased it, “the conversation [in the room] has moved from not if, but when.”

Time to keep talking

From the dialogue on the day, I believe there are three key next steps to the conversation:

1. Get the decision makers on board. Talking to the right people who are influential in ensuring digital is part of mental health strategy and decision making process, such as Innovation Teams, CCGs, Strategy Teams, Board Members, Systems and Information Teams will ensure digital stays on the agenda.
2. Engage with front line staff. Unless you engage the people who will be using digital technologies, they simply won’t get used. Asking them what solutions they need, what their preferences are working in true partnership with staff and users will secure the buy-in needed to test ideas.
3. Consider the system implications. Interoperability is a huge challenge and needs to be overcome with commitment and responsibility from both organisations and digital companies to make this happen. Put simply, we need to ensure that the systems being able to talk to each other is also part of the conversation.

Enjoy this blog? Then we think you’d also like:
Maximising Digital Opportunities in Mental Health: programme and slide pack
Digital is helping us tackle healthcare inequalities, but the real issues are deeper and run system-wide
Digital is a valuable tool for prevention – and so rightly it’s at the heart of the long term plan

For more information on the Health Innovation Network’s Mental Health theme, click here.

Health Innovation Network sign up to join the #EquallyWellUK charter

Health Innovation Network sign up to join the #EquallyWellUK charter

In December 2018, Health Innovation Network became the first AHSN to commit to the #EquallyWellUK charter. With more than 100 organisations already signed up, including NHS England and Public Health England, the charter is one of three initiatives that seeks to promote and support collaborative action to improve physical health among people with a mental illness by signing individual organisational pledges.

Pictured above L-R: acting CEO, Zoe Lelliott; Head of Mental Health, Aileen Jackson; and Clinical Director for Mental Health, Dr Muj Husain.

For Health Innovation Network, signing this charter means that all our clinical themes have committed to ensuring that their work improves outcomes for all, including those with mental illness. A great example of a project that already does this is our work in improving the detection of Atrial Fibrillation in people with serious mental illness that you can read about here. We are also committed to introducing providers and commissioners to promising digital solutions, and evaluating their impact.

Read more about our Mental Health theme here and about the pledge here.

Speeding up the best in mental health together

Speeding up the best in mental health together

Speeding up the best in mental health together with the four SIM London pathfinder NHS Trusts, South West London and St. George’s Mental Health trust, South London and Maudsley, Oxleas, Camden and Islington NHS Foundation Trust alongside the Metropolitan Police is a pioneering mental health project for the Health Innovation Network.

SIM London is a new way of working with mental health service users who experience a high number of mental health crisis events. SIM brings mental health professionals and police officers together into joint mentoring teams. The police officer and the mental health professional work together to provide intensive support service users to reduce high frequency and high-risk crisis behaviours.

Central to SIM is the Care and Response Plan completed by the service user, SIM Police officer and the SIM Mental Health professional.

‘SIM London is the start of a revolution for the co-production of 1st person singular care plans.’
Dr Geraldine Strathdee, Clinical Director, Health Innovation Network Implementation team

SIM developed by Paul Jennings (recipient of multiple awards) on the Isle of Wight, has gone from strength to strength in terms of the lives improved, fewer 999 calls, fewer Emergency Department attendances and fewer hospital admissions.

SIM is going national, the benefits of the involvement of the HIN in leading the London pathfinder implementation, the new sites will we be able to measure. We will share resources, highlight obstacles and solutions and capture and spread the dedication, commitment and enthusiasm we are encountering to implement the programme.

SIM London pathfinder sites are due to go live April 2018

Learn more about SIM and the High Intensity Network here.

To speak to someone about the project, please contact Aileen Jackson, Mental Health lead on aileen.jackson@nhs.net or Josh Brewster, Project Manager on josh.brewster@nhs.net

Older Adults recover well from common mental health conditions

Older Adults recover well from common mental health conditions

We all need to do more to recognise older adults who may have depression and anxiety; older adults engage well with IAPT (including digital IAPT interventions) and most importantly they recover well, evidence shows that the recovery rate of older adults is better than working age adults. These were the key messages given to a capacity audience at the recent Health Innovation Network’s Improving Older Adults Access to Psychological Therapies (IAPT) event which took place on 19 September. All these points seem relatively simple, so why can’t we quickly fix this problem?

It seems everyone has a part to play, we should not be treating older adults as a homogeneous group 65 – 100 years old is a large age span and perceptions and needs will be different.

The third sector, housing and social care organisations have significant role in facilitating referrals to IAPT and ensuring older adults are aware that depression and anxiety can be resolved through talking therapies. We should encourage older adults to share their experience of IAPT and we need all to listen. IAPT services need to train their staff to work with this large older adults age range and liaise more closely with their secondary mental health colleagues particularly the memory service who are diagnosing people with dementia.

Finally, our very busy GPs who are often the gateway to supporting referrals to IAPT services. Think always that chronic health conditions go hand in hand with mental health issues, don’t just refer the physical issues, address both mind and body to make sure the older adult is enabled to maximise independence and live a happier life.

Aileen Jackson, Senior Project Manager Healthy Ageing and Mental Health lead, Health Innovation Network