Digital Pioneer Fellow, Rebecca Minton, is the Clinical Lead for Digital Products at ieso and a former Cognitive Behavioural Therapist and IAPT Deputy Operational Lead at Camden and Islington NHS Foundation Trust. In this blog Rebecca shares her experiences of offering video as a method of delivering psychological therapy sessions.
Mental health problems are on the rise, demand for mental health services is growing, capacity is limited, and waiting times for mental health treatment are increasing. Patients want and need an easy way to access and engage with appointments and interventions to improve their mental health. Covid-19 led to greater demand for mental health treatment and the way care is delivered has needed to change for the safety of both patients and staff.
Realising the benefits of video
Camden and Islington (C&I) has one of the highest prevalence of mental health problems in the country. At the start of the pandemic, C&I Improving Access to Psychological Therapies (IAPT) services moved quickly to remote working with the majority of appointments being carried out over the phone. The infrastructure and technology were not in place to offer video appointments straight away. There was already lots of change and uncertainty so naturally many clinicians preferred to stick to familiar ways of working and use the phone. Video however can provide a richer picture of someone’s mental health such as being able to see non-verbal cues. There is a paucity of research examining the therapeutic alliance over video but emerging research suggests experienced therapists can achieve good outcomes comparable to face-to-face. Appointments over video can reduce the stigma of having to sit in a waiting room and mean patients do not have to leave the house or office to attend. In the pandemic, they were also safer than meeting with someone face-to-face.
Moving towards digital
My fellowship project focused on increasing the offer of video as a method of delivering psychological therapy sessions and to collect reliable data on usage, patient feedback and outcomes to support implementation, effectiveness and sustainability. To enable this, it was crucial to work with clinicians and patients to bring them on board and support a digital culture shift. Having always been a big fan of digital technology and it’s potential, I had naively assumed most therapists in our services would quickly engage with and offer this innovative way of delivering therapy, but I soon realised there were many barriers and challenges to this!
A survey was carried out to better understand the challenges and needs of clinicians in moving to use of video appointments, and direct the work needed to support them with this. See the below research article for detailed results of these findings but in summary most clinicians (89%) believed video sessions were acceptable and could see the benefits of these, however problems with the video platforms and internet connections were barriers to use.
Supporting clinicians in the digital transition
Once all clinicians were issued with the appropriate devices, to support them in delivering therapy over video I led a range of initiatives including: setting up a team of video champions to offer peer support, delivering a number of training sessions, and developing a suite of helpful guides and resources. To support patients to use video appointments a webpage was created with lots of useful information and tips with support from a patient representative. Work is ongoing to gather data on clinical outcomes compared with a matched sample, and to provide a device loan scheme and private spaces for patients to use if they choose.
One year on, 40% of the C&I IAPT psychological therapy appointments were being delivered over video. Clinicians felt more confident in this way of working and patients rated their experience as 4.8 out of 5 stars. Ideas and learning were being regularly shared with the wider trust digital working group to help increase video appointments in all mental health services.
Through this work I have learnt that technology is only part of the solution in any digital transformation, and its adoption, use and effectiveness is dependent on the clinicians and patients being part of the journey from the start and being given the time and resources. Clinicians and patients need to trust and feel reassured about the safety and security of video platforms and be provided with the right information to support their decisions about its use. Of course, video is not suitable or appropriate for all patients and we need to ensure that it does not reinforce inequalities and face-to-face and phone appointments are still an option.
I now find myself in a new role at ieso as the clinical lead for digital products and innovation. eso delivers online evidence-based psychological treatments to patients in the NHS and is a leading provider of digital mental health care. It is an exciting opportunity to grow my experience and passion for digital innovation in a different environment but still focused on improving mental health care. I have been sharing the learning from my Fellowship project to support ieso’s work, in particular engaging ieso’s therapists in the mission to use digital technology to revolutionise the way care is delivered for mental health. Find out more about ieso’s work here.
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