The IAPT & ehealth summit #discoverprism

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On Friday, November 27th Mayden held the first annual IAPT & ehealth summit at Tech UK in central London to talk about the future of digital interventions in IAPT.

The day aimed to address the challenges of adopting ehealth in IAPT services and rounded out a full year of learning for Mayden.

Key stakeholders from across the mental health community came together for the event, including services, commissioners, policy makers, researchers and ehealth providers.

Professor Lars Sundstrom from the West of England Academic Health Science Network kicked off the event with some inspiring words to encourage us to take risks in healthcare innovation.

What is the potential for ehealth in supporting IAPT?

Next to speak was Dr Jen Martin from MindTech Healthcare – an NHS cooperative and a catalyst for the development of new technologies focusing on areas of unmet clinical need in mental health.

https://twitter.com/MinddistrictUK/status/670180600884629504

Dr Martin began her presentation by exploring the ways that technology is being used to compliment face-to-face therapy at present.

Mental health, she explained, is particularly suited to digital delivery. This can be seen in the way that individuals are already using social media.

https://twitter.com/MinddistrictUK/status/670185199314067456

Dr Martin described a future for mental healthcare that includes real patient choice from a variety of evidence-based tools and services.

She talked about the potential for a blend of digital and traditional therapies, accompanied by the rapid learning and evolution that a robust digital data set would provide.

Chris Eldridge from Mayden joined us next to speak on the potential for online therapies to address IAPT’s financial and capacity challenges.

In July 2015, he stated, 24% of IAPT patients waited more than 90 days for an assessment. How can technology help?

https://twitter.com/MinddistrictUK/status/670186833582661632

In a recent survey of iaptus users, 75% of therapists and 89% of service leads believed that yes, patients would benefit from an online option.

So why isn’t CBT used more often? Chris began by discussing 3 of the main barriers.

First of all, he explained, services have traditionally delivered face-to-face treatments, so these are most familiar to them.

This means that when they receive new funding, they tend to respond in the way that they are most comfortable with and most used to: by adding more therapists.

Secondly, until recently there has been limited choice for proven, cost effective online therapy.

And finally, until very recently, there has been no way to integrate online therapy with the patient management system and complete the MDS…

You can review Chris’ presentation slides in full here:

The next section of the agenda focused on examples of ehealth. ehealth is a broad term covering many different types of online intervention.

Fennie Wiepkema UK Director from ehealth provider, Minddistrict, started off the session by demonstrating their ehealth platform.

The Minddistrict solution includes a variety of support types, from pre-care through to screening, assessment, treatment and post-care options.

Their work is centered around empowering individuals to maintain responsibility for their own mental wellbeing.

Fennie considered what flexible, seamless care means for the patient, sharing with us the story of Luke, a father and account manager in his early thirties who had begun to experience the symptoms of stress and depression.

She then showed us the options that Minddistrict offers people in such a situation, empowering them to take their treatment into their own hands.

Based on Minddistrict’s experience abroad, Fennie then discussed how ehealth can be used seamlessly in conjunction with traditional care pathways in IAPT.

Collette Bird was next to speak. Collette joined us from SilverCloud Health, an ehealth platform comprising a library of supportive programmes for mental and behavioural health issues.

Collette described several challenges in providing outcomes based cCBT to services. In SilverCloud’s experience, PWPs were sometimes reticent to try new ways of working, and integrating cCBT into existing processes and procedures was often a stumbling block.

They had found that full buy-in from management, complete understanding of the product and thorough training for all involved had been critical to successful adoption.

Collette went on to explain the three main benefits of cCBT to patients:

  • Flexibility and direct access: helping users to overcome both physical and psychological barriers of accessing therapy.

  • Personalisation: the flexibility of CBT programmes and platforms means that they can be customised to meet the needs of individual patients.
  • Ongoing support: unlike traditional therapy, cCBT can be accessed beyond the therapy itself, for up to a year, to help maintain patient recovery.

In the last session of the morning, Sarah Bateup from Ieso Digital Health discussed engaging technology to enhance quality of care.

Ieso offers one-to-one therapy appointments in real time, via typed conversation. In this way a therapy appointment can take place whenever and wherever the patient prefers.

Typed therapy sessions allow patients to maintain complete privacy. Patients don’t need to worry about bumping into an acquaintance outside the therapy space, and they don’t have to sit in front of their therapist in a one-to-one environment.

https://twitter.com/MinddistrictUK/status/670213899384410112

Typed online therapy also has the advantage of generating transcripts which can be used to track progress as well as providing a log to be referred back to by the patient throughout their recovery.

After breaking for lunch, we returned for a second presentation from Mayden’s Chris Eldridge. Chris introduced Prism, the new online referral hub designed to eliminate the administrative barriers to IAPT’s uptake of online therapy.

The hub enables IAPT clinicians to refer patients for online therapy seamlessly through the iaptus patient management system, and then to receive notes and data securely back into the patient’s digital record.

The self referral feature within iaptus enables services to place a form on their website that allows prospective patients to refer themselves directly for online treatment.

Check out Chris’s presentation in full here:

The afternoon session looked at the barriers to the adoption of ehealth. The case for digital tools to support care is growing. But how do services go about evaluating the potential options and commissioning an ehealth partner? And what are the critical factors to ensure the project is a success?

First up was Chris Buckingham from Aston University. He joined us to discuss the importance of managing clinical risk within a mental health service, and to introduce GRiST, an online risk assessment tool that supports clinical risk evaluations especially for IAPT.

GRiST is a web-based risk and safety tool which takes a whole health and social care system approach risk assessment. It was created to make risk expertise accessible to anyone from service users to front line services.

https://twitter.com/MinddistrictUK/status/670250220278702080

Chris explained that within the GRiST database is the combined expertise of 3000 practitioners, 60,000 service users and over 250,000 completed assessments- growing at a rate of over 1000 a week.
Using this ‘wisdom of the crowd’, he explained, it is possible to accurately predict risks for a service user.

In the final presentation of the day, Alison Sturgess-Durden from Mayden presented research from her white paper on commissioner perspectives on the future of ehealth in IAPT.

Alison explained that commissioners were keen to see an expanded evidence base for online therapies, and recognised the importance of the ongoing assessment of the efficacy of online therapy apps and platforms.

https://twitter.com/MinddistrictUK/status/670259020884766720

Some commissioners suggested that they would like to see platforms approved by the NHS, and that innovative and flexible commissioning arrangements should be developed for existing and emerging digital healthcare, accompanied by new and creative incentives to help leverage uptake at scale and speed.

https://twitter.com/MinddistrictUK/status/670255328911613952

You can download the full white paper from our Publications page.

We closed the day with a panel discussion on practical steps for moving forward with the adoption of ehealth tools into IAPT.

The first question was around the best ways to encourage staff within the service that cCBT is a valuable addition to the services offered.

There was general agreement that there is a need for greater education in regards to what cCBT is and what it can offer.

Technology has moved on significantly in the last five years, and there is a huge range of digital tools available on the market today.

This includes therapies where treatment is provided with a real therapist in a virtual environment via video or messaging, or through the self administration of computerised treatments via a mobile app.

It was agreed that sharing the evidence of the efficacy of individual online therapies would alleviate some of the worries about this type of technology.

The second question was directed to the ehealth providers present. They were asked how they felt about pooling and analysing their data to look at efficacy of different therapies for different patients in different scenarios.

There was overwhelming support for this from the providers. Prism itself brings huge potential for data analysis and digging into how online tools are helping different groups of patients.

The third question referred back to a presentation from the morning session. A speaker had mentioned that some patients were screened out of using cCBT, and the audience wanted to know more about the types of patients often excluded from this option of treatment.

The criteria for a patient being unsuitable for cCBT were fairly uniform across the ehealth providers we had with us on the day.

These included patients with a lack of basic technical skills, those that did not own a pc or tablet, and those that were not suitable for IAPT itself.

One point that was stressed by all ehealth providers was that it was crucial that if a patient chooses to have treatment via cCBT but it does not work for them, that they can be easily stepped up or referred for face to face therapy.

A huge thank you to everyone that took part on the day; from speakers, to delegates and all those that joined us online. You can access all the presentations from the day on our presentations page.