Digital technologies appear to hold great promise for mental health care - whether it be virtual reality (VR) for exposure therapy or AI chatbots delivering coaching on demand - there are plenty of emerging innovations which tackle everything from prevention to self-monitoring and peer support. But how much of this promise is hyperbole and what are the chances of emerging technologies becoming the everyday currency of mental health care in the UK?
The lexicon of Silicon Valley startups - where disruption is good and failure must be fast - is a world away from stretched mental health services with long waits and many people left with no support at all. Too often the heady promise of tech innovation fails to resonate with a mental health nurse armed only with a battered Nokia and access to a shared computer. A Child and Adolescent Mental Health (CAMHS) practitioner recently told me how she has to explain to her young patients that her text messages will be brief by necessity, as it takes an eternity to punch each individual letter into the primitive keypad. A technology-enabled future is not yet evenly distributed. So how can we bridge the chasm between the potential of digital and the reality for mental health practitioners?
We know there are many basic barriers to digital innovation in mental health. Better infrastructure is clearly part of the solution. Equally important is digital access and inclusion for people with mental health problems. The evidence is often weak or hard to generate. Too often the complexity of workflows and care pathways are underestimated. As Bob Watcher asserts - digital in the NHS is first and foremost an adaptive problem rather than a technology problem.
But there is another missing piece of the digital puzzle - and that is the pivotal role of mental health practitioners themselves. If they are unenthusiastic or worried about digital technologies, then the likelihood that they will recommend or use them is remote. A recent mixed methods study of mental health practitioner attitudes towards digital technology found that whilst most were enthusiastic, many had concerns, and hardly any were using them in practice.
So how can we bridge the chasm between the potential of digital and the reality for mental health practitioners?
At mHabitat we started wondering what a digitally confident and savvy workforce might look like. We wondered if practitioners who have the capabilities which fit them to live, learn, work, participate and thrive in a digital society might be well equipped to support people with mental health problems to do the same. We hypothesised that a digitally confident workforce might create demand for digital innovation, as well as their own intrapreneurial push for change. So we set about finding out through a three month discovery project funded by Integrated Care Pioneers and Better Care Fund in Leeds. The Digital Practitioner report summarises what we found out about the needs, concerns and hopes of practitioners. Spoiler alert - the report may include a photo of a practitioner with a battered Nokia.
Through our interviews, workshops and surveys, we were struck by the indispensable role digital technologies play in the lives of many people living with mental health problems. We were similarly struck by frustration at the non-digitisation of services. As one of our interviewees Tricia explained:
I have OCD and wish more things, even accessing care, was available online or through an app as I find phone calls very difficult and sometimes cannot leave the house. Without internet I would be dead.
In contrast, practitioners confessed that they found digital technologies a minefield - they had been burned by technology that promised to make things easier but actually got in the way; they were concerned about increasing exclusion for people who have less access to digital technologies; they were worried about safety and confused about information governance. When core IT systems don’t speak to each other, then emerging technologies can seem like a pipe dream. It became clear that being digitally confident in one context does not automatically translate into another.
Practitioners told us they would like the opportunity to reflect on how digital technologies can help them in their role and improve lives for people they support. They want the infrastructure to be right and for managers to let them try out new things and take productive risks. They are interested in the potential of emerging technologies but also want to get to grips with basics such as text messaging and video conferencing. We found that in the hurly burly of everyday practice, digital innovation almost always fits into the important but not urgent box. It became clear that we need to create space for practitioners to innovate whilst removing infrastructure barriers.
Through our Digital Practitioner programme we have created structured opportunities for health and care teams to reflect, share learning and develop digital confidence. We help them work out how digital innovation can play a role in achieving their team purpose and objectives. We dispel myths and make topics such as information governance easier to understand. Whilst we are taking small steps, we are having an impact - one practitioner shared a story about how he helped an elderly man who was no longer able to leave the house get online so he could re-instigate his weekly tradition of buying flowers for his wife with dementia. A small thing perhaps, but something that brought him great happiness and was rewarding for the practitioner involved. There is something wonderful about helping people leverage everyday technologies to enhance their lives and improve their wellbeing.
The future for developing digitally confident practitioners looks promising. Health Education England have taken up the challenge of supporting health and care practitioners through the Building a Digital Ready Workforce programme. They are working with national bodies, such as the Royal College of Nursing (RCN) who have developed the Every nurse an e-nurse programme. NHS Digital recently launched a Digital Academy to support those with dedicated digitally-focused roles in their professional development. The NHS Innovation Accelerator Fellows are receiving support to develop their innovations and many have a digital component.
In and amongst these nationally-led programmes, we must ensure that practitioners working in mental health services (and in wider health and care) have the opportunity to make sense of digital technologies in their roles - leveraging the everyday; reimagining mental health care that blends the best of in-person help with the affordances of digital; and developing their own intrapreneurial capabilities. Digitally confident practitioners, with a deep understanding of context, are well placed to take advantage of low tech ubiquitous technologies whilst providing a receptive audience for the cutting edge of innovation.
At the end of the day, practitioners want to contribute to improving the lives of people they are there to help and support. Digital can be an enabler in achieving this goal, but patients and practitioners must be at the heart of making it happen.