According to the World Health Organisation, in the UK, there are 14.63 psychiatrists per 100,000 people (WHO, 2015). In contrast, 45% of the global population live in a country where there is less than one psychiatrist per 100,000 people (WHO, 2019).
Health services globally, and especially low-income countries face enormous challenges in order to respond to the need for mental health services (Jacob et al, 2007). Digital technology presents a global opportunity to ensure that more people have access to high quality mental health support and treatment.
Nowadays, there is also a shift in the relationship between service users and service providers, with users being more in control than ever of their own health. This is accompanied by a change in perspectives with a tendency to embrace more recovery-focused, personalised and co-produced services. By using digital technology, people have the option to be more informed about their own mental health than they have ever been before (NHS, 2019).
What Rebecca Cotton tried to do is in accordance with Public Health England, especially as they move into their new strategic plan and into using more digital technology. As the author of this study, she used a Winston Churchill Memorial Trust grant to explore what the UK health service could learn from colleagues in Australia and the USA in order to ensure the spread of best practice and innovation. These countries where chosen because:
- Cultural similarity with the UK
- Internationally recognised reputation of digital innovation
- A common vision that technology could benefit mental health service provision
- Shared challenges associated with mental health.
The research questions which drove this project were:
- How is digital technology being used in order to design and deliver better mental health services across Australia and the USA?
- What are the barriers and facilitators to implementing digital technology?
- What could the UK learn from these countries?
- How can the government support this new venture?
In order to answer these questions, Rebecca Cotton travelled to Boston, New York, Washington DC, San Francisco, Melbourne, Sydney and Canberra and met more than 50 people working in more than 25 organisations. The people she met were psychiatrists, psychologists, policymakers, academics and campaigners with a common vision; to improve the lives of people with mental health conditions using digital technology.
Seeing face to face support and digital adaptations in isolation can create unnecessary chasms. According to the author, in order to imagine and create functional and sufficient mental health services, the use of a combination of current models of care augmented by digital technology is imminent. This is not because one model of care is better than the other but because this is a realistic way to reach groups who tend not to seek care; or people who seek out help from a service that is already overstretched.
A tool that would prove useful at harnessing the power of digital tools is digital phenotyping. In simple terms, digital phenotyping uses data generated passively or actively by personal electronic devices to refine diagnostic processes, to improve relapse rates and develop better informed intervention models (Barnett et al, 2018).
Such tools could enable a large number of people to not only receive more personalised support but also participate in research worldwide. A great example is the ‘All of Us’ program which aims to extend the frontiers of medicine by building a national research cohort of more than a million participants (NIH, 2018). Any US participant aged 18 and above can participate by providing physical measurements or donating blood. The director of the program noted that they aim to expand the program in the realm of mental health.
In another very interesting case study, the author presents the potential of using data related to mobility patterns and social behaviours collected through personal phones of people with schizophrenia in the days prior to relapse. Monitoring those behavioural changes in real time could provide an opportunity to avoid a potential crisis by notifying the care providers on time. This could also potentially reduce the overall expenditure of care (Harvard TH Chan School of Public Health).
However, genuine digital innovation would not get off the ground without the support of local and national bodies. Thus, the million-dollar questions that arise are the following:
- How can providers best support innovation?
- How can staff be supported so that they turn their idea into reality?
- How can implementation be sped up?
- How can the medical sector learn from the private sector?
Through the case studies, a number of suggestions were made which are relevant for mental health services:
- Monthly speaker series on digital technology
- Launch of internal hackathons
- Support of early stage ideas
- The creation of multi-disciplinary teams of data scientists, academics, trained peer workers, technology experts and clinicians.
Suggestions were also made for national bodies focusing on:
- Supporting individual and organisational initiatives
- Creating clear strategic plans
- Promoting public and private partnerships.
Building successful innovations is not an easy task. It not only requires cultivating the right infrastructure and the appropriate culture where creativity can blossom, but it also necessitates supportive government agencies. Luckily, the author of the paper made some recommendations to NHS England that have been summarised below.
Implications for practice
- NHS England should expand its Digital Exemplars Program. NHS Trusts that have adopted digital innovations should share their learning in order to enable other trusts to follow in their footsteps.
- Time is pressing and the need for accessible mental health tools is imminent. NHS England should consider formulating a clear vision for implementing digital technology in mental health.
- The NHS Digital Academy should ensure that new digital technologies not only have been adopted by Trusts but also that impact is measured and recognised.
- NHS England could consider commissioning certain e-mental health services nationally.
- It’s in the hands of providers of mental health services to consider how digital technology can improve their job while reducing costs and to set up clear procedures in order to improve service users’ experience. As part of exploring how digital services can support service users’ recovery, they could start by considering how innovative products are incubated and tested currently and whether this needs to be done in-house. Finally, no one can promote something if they don’t fully understand it. And this is why clinicians should be fully supported in order to convey the usefulness of digital tools to their patients.
Strengths and limitations
In this review, the author compiled evidence from multiple sources in a usable format in an attempt to provide complementary views that address the issue from multiple perspectives. By providing a good balance of summaries and case studies, it constitutes a great beginning in order to start considering how national and local bodies can promote digital technology further.
However, without stating the inclusion and exclusion criteria through which the interventions were selected, the selection method can be skewed. A quality assessment followed by a synthesis of the evidence would reduce potential biases.
Conflict of interest
Cotton, R. Using digital technology to design and deliver better mental health services: Perspectives from Australia and the USA (2019). Winston Churchill Memorial Trust and NHS Confederation Mental Health Network.
World Health Organization (2015) Global Health Observatory data repository – Human resources data by country. Retrieved from https://www.who.int/gho/en/
World Health Organization (2019) Psychiatrists and nurses (per 100,000 population). Global Health Observatory (GHO) data. Retrieved from https://www.who.int/gho/mental_health/human_resources/psychiatrists_nurses/en/
Jacob KS, Sharan P, Mirza I, Garrido-Cumbrera M, Seedat S, Mari JJ, et al (2007). Mental health systems in countries: where are we now? Lancet, 370:1061–77, doi: 10.1016/S0140-6736(07)61241-0
NHS (2019) Mental Health Implementation Plan 2019/20 – 2023/24, July 2019.
Barnett I, Torous J, Staples P, Sandova L, Keshavan M, and JP Onnela (2018), ‘Relapse prediction in schizophrenia through digital phenotyping: a pilot study’, Neuropsychopharmacology. 43:1660 – 1666, doi: 10.1038/s41386-018-0030-z
National Institutes for Health (2018) All of Us research program.
Harvard TH Chan School of Public Health. Onella Lab – Beiwe research platform.