Over the past 20 years, digital technology has truly revolutionised the way we conduct our everyday lives. It’s also meant big changes to how we look after our own health. NHS Choices, for example, has grown to become the most popular health website in the UK, with more than 19 million visits each month.
At the same time, the mental health sector is facing significant challenges – both in terms of the resources available to us, and the culture of our services.
Rates of common mental health problems are increasing. There are long-standing issues about access – a recent report from the London School of Economics and Political Science estimated that only a quarter of those with depression or anxiety-related mental health problems are receiving treatment.
The economic horizon remains uncertain and in the meantime – at best – the funding settlement for the NHS means increasing pressure to do more with the current or lower levels of resource. Business as usual, providing mental health services in the same way we are now, will not meet rising demand or changing patterns of consumer expectation.
Modern mental health services need to be designed and delivered in partnership with individuals as they recover, enabling people to live meaningful lives, with or without ongoing symptoms of their condition. This requires a significant cultural transformation.
Given these challenges, how can we – as a sector – make the most of the opportunities presented by technology to assist with that cultural change? Our discussion paper, published today, sets out some examples of where mental health services are already using technology in interesting ways. Some developments are focussed on delivering existing models of services more efficiently, including providing talking therapies online, using smartphone applications to monitor mood and offer medication reminders. Other innovations are truly transformative, placing the service user in a greater position of control. These include health coaching programmes to help people manage their own condition more effectively, and purpose built platforms for integrated online care pathways, such as Big White Wall.
Given the range of emergent technologies, how can our sector make sense of a rapidly evolving marketplace to inform decisions about which programmes and applications to use in our services? How can we learn from each other what’s working, good quality, and well-governed, and what isn’t? Will popular trends, policy directions, economic imperatives and technology come together to transform the nature of mental healthcare, or will they simply be used to improve efficiencies and leave existing service models untouched? Will there be a tug of war between the protectionists of medical models of health and the protagonists of social models? Or could a new balance be struck that incorporates the strengths of both?
In our view, the future will emerge from the movement that grows around, and from, this debate, supported by the development of a national framework for e-mental health. This will be helped by a two-stage process.
As a first stage, we need to create an accurate picture of how people are currently using technology ,from service users, carers, the wider public, professionals (including clinicians, managers and informatics specialists) to providers and commissioners. And we need to look for examples of international good practice. We are pleased that the mental health leads of the strategic health authorities have agreed to provide funding for this work, and more details will be made available shortly through the Mental Health Network. As a second stage of work, we need a broad process of engagement to design a vision for the future – a comprehensive framework for e-mental health.
To initiate this work, we invite your views on the questions and proposals set out in the discussion paper. Hopefully this will include many further examples of how technology is being used to transform service design and delivery.
As a sector, we have an opportunity to re-think mental healthcare in a digital age, to look beyond the daily challenges of provision and to construct a new vision for mental health and wellbeing.
Rebecca Cotton, Acting Deputy Director, Mental Health Network – NHS Confederation
Jen Hyatt, Chief Executive, Big White Wall
Dr Matthew Patrick, Chief Executive, Tavistock and Portman NHS Foundation Trust