Digital Therapy: addressing the challenges of cost and complexity

Cost and ComplexityThe East London Health & Care Partnership (ELHCP) had the greatest IAPT access rate increase within London as a result of changes in the prevalence rate. Five of their CCGs were ranked in the top six most affected in London. They are set to grow at a rate 60% over the next four years. The use of online therapies with SilverCloud is a key part of their strategy to address the challenges of: 

  • How to achieve cost effective growth. Given the demands on resources. 
  • How to address greater complexity. IAPT is generating an increase in referrals to secondary care psychotherapy services that already have long waiting lists. 

Greater complexity means that people tend to need longer treatments, pushing up costs and also stretching the boundary of what is possible within IAPT. 

Online therapy accounts for about 10% of the IAPT work across ELHCP with leading areas such as City and Hackney achieving 15%. However, one of the most significant areas of innovation is taking place outside of IAPT in East London Foundation Trust (ELFT). 

This is an exciting pilot which has demonstrated the applicability of programmes previously only applied to people with mild to moderate mental health problems, to people with more severe and complex mental health issues.  

It is also an important part of our overall approach for this patient group, which focuses on empowering people to manage their own wellbeing supported by online resources, which connect to professional oversight.” 

Dan Burningham Mental Health Programme Director, NHS City And Hackney Clinical Commissioning Group 

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Leading the way to Innovation 

ELFT is a provider of both mental health and community health services across East London, Bedfordshire and Luton. East London and Luton are among the most culturally diverse areas of the country but also among the most deprived. Bedfordshire has some of the most affluent communities living alongside some of the lowest income and deprived groups. This poses challenges for the provision of mental health services in terms of complexity and scale. 

To help meet these challenges ELFT worked with the SilverCloud team to review the use of online therapies in secondary care. They are now leading the way, with online integrated into care for patients with more severe mental illnesses including trauma, personality disorders and psychosis. 

Digital: supporting secondary care delivery  

The Psychotherapy Department is the biggest user of online therapies. The service uses SilverCloud’s co-morbid depression and anxiety programme because it has the widest range of content making it the most flexible to use. Supporters vary and include clinical psychologists, psychotherapists and assistant psychologists. 

"...Our preliminary findings have been that some of our service users with more complex difficulties within our pathway for individuals who may meet a diagnosis of Personality Disorder have really found the materials on SilverCloud helpful in managing through the pandemic. We now want to trial SilverCloud for people on our waiting lists who may not have had such an established relationship with us before accessing the materials.” 

Rory Bolton, Psychological Therapies Lead – City & Hackney, East London NHS Foundation Trust 

Within Early Intervention in Psychosis, SilverCloud online therapy is used with people at risk of developing psychosis or those experiencing a first episode. The online programmes help with the identification and self-management of symptoms. While teams such as the home treatment team and recovery team are finding the online programmes are an effective way for patients to actively self-manage their mental health and monitor their own risk. 

ELFT also plans to use SilverCloud as part of their Greenhouse Project to provide mental health support for homeless people with drug and alcohol issues alongside more complex mental health issues such as bipolar disorder. 

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