What is population mental health and why is it important?
What we can learn from large scale IT programmes.
September 2nd, 2019 - Lloyd Humphreys, Head of Europe at SilverCloud Health and NHS and Innovation Accelerator alumnus. In my previous blog, I explored the learning that mental health has to share with large scale, mainstream digital health programmes. As we approach the NHS Health and Care Expo (‘Expo’) next week, I’d like to flip that paradigm and see what mental health needs to take away from some of the current big programmes of change.
This was inspired by seeing that there are lots of discussions around population approaches to healthcare, from the Long-Term Plan, use of big data/AI, Primary Care Networks, Integrated Care Systems, personalised care and so forth, but nothing about tackling mental health at such a scale.
So why haven’t we taken a population-level, large-scale and integrated approach to mental health?
Firstly, let’s say what it isn’t…it is not population health, as this is a very specific term that refers to analyzing data and outcomes to then apply learning to meeting the local needs in a proactive approach. Predictive analytics and technologies to look for patterns in healthcare presentation and service utilization is very much the remit, with solutions such as Orion’s Amadeus and Cerner’s HealtheIntent being solutions of choice. Indeed, there is a good example of this in the Wirral.
Population mental health: A continuum of experience and service
Population mental health is about recognizing that everyone is on a continuum of mental health, from positive wellbeing all the way to chronic and serious mental illness. We are all on this continuum and we all move up and down this dependent on life stressors, events and our predisposition to mental health problems.
But the way we configure our mental health services does not recognise this continuum, often being highly reactive and risk driven. This isn’t a criticism, just an acknowledgement that mental health is dynamic and ever changing but healthcare provision has been divided into clusters, with distinct entry and exit points, and pathways through the service that are usually operating independently of one another. Services find it difficult to manage co-morbid issues or treat the person in a coordinated way and end up focussing on the symptoms or condition.
With current services operating relatively independently, there has to be clear separation with obvious inclusion and exclusion criteria (where one begins and the other ends), but it is often the case that people fall in-between services or do not meet the severity or risk required to utilize our over-stretched NHS services. A recent experience of a friend highlights the issue. Their daughter experienced a significant traumatic event and needed some support to address the impact of this. The GP referred her to psychiatry, who promptly assessed her (without being seen) as not being at risk and unsuitable, thus discharging her back to the GP. Nine-months later and there has been no contact from the GP, no transition to a psychology service, back to square one, simply for being referred to the wrong service.
Population mental health explores the notion that we should have an integrated approach, so that a person’s journey through the healthcare systems mirrors their journey to positive wellbeing. There should be no waiting, no exclusion criteria and a matching of needs to the service they receive. That anyone, at any time can receive help and support whether they are feeling stressed due to work or coping with hallucinations and delusions.
This integrated approach is seen in large and ambitious healthcare reform in the Long-Term Plan, whether that be Primary Care Networks, Integrated Care Systems, Local Health and Care Record Exemplars, Personal Health Records, Healthy New Towns, NHS Login and the NHS App. The theme across these is a single unified approach overlaying a set of services underneath. The connector in this instance can be service design, commissioning, interoperability, data or other technology that is the commonality and link across service delivery modalities.
So how can we use digital to help drive population mental health and wellbeing?
With the rise of digital therapeutics and a clear evidence-based for its effectiveness across the continuum of care, should we not be leveraging technology to bridge services and provide solutions across mental health? Rather than a disparate set of apps and services, should we not be driving a seamless and unified approach, allowing a person to pick up their phone, tablet or device to access help immediately, stepping up or down care as required?
SilverCloud has the potential to do exactly this, with 30+ digital therapy programmes and modules, self-sign-up, assessment, e-triage, the ability to be delivered in a flexible and scalable way, it shows that 70% of people achieve recovery and can deliver 91% cost reductions compared to traditional services. It has been shown to be effective for people with mild to moderate issues, as well as being effective as an adjunct to traditional therapy for people with serious mental illness. It is used by universities, insurers and companies to manage wellbeing - including NHS staff as part of the GP Health service - covering millions of lives across Europe and North America. With integrations in place with mental health systems and the potential around NHS App and NHS Login, this is the beginning of a seamless approach to empowering all citizens.
This has the power to truly connect services, free up the capacity of our therapist workforce, and deliver preventative care to an entire nation.
This journey has already begun with some pioneering STPs and visionary mental health leaders, but with mental health problems accounting for 40% of all GP appointments and 23% of the burden of disease in the UK, can we afford not to take a population approach everywhere?
Why not pop by and talk to us at NHS Health and Care Expo or contact us at firstname.lastname@example.org.