Dr Lloyd Humphreys, clinical psychologist, NHS Innovation Accelerator alumnus and Head of Europe at SilverCloud Health, explores the aspects of delivering mental health services after COVID-19 and the important future role of digital mental health therapy
Five months into the pandemic and with predictions of a forthcoming “tsunami” of mental health issues as a result, is current UK mental health provision structured to cope and directed towards the correct strategy?
Mental health has had a very different experience during COVID-19 than the acute services coping with managing the infection, where capacity was significantly increased. Instead, mental health services have been closed, staff re-deployed or had to work from home and referrals have fallen, in some cases by up to 90%.
There has been a succession of reports in the last few months demonstrating the high levels of anxiety amongst the population due to the uncertainties and direct impact of the pandemic. Most recently, the Office for National Statistics reported that almost one in five people was reporting symptoms of depression in the crisis, a rise from almost one in ten from the previous period.
Digital health solutions
With the inability for face-to-face consultations and reduced capacity for mental health service delivery, digital health and technology solutions have been much more to the forefront. Rather than being considered a ‘nice to have’, as they often have, they became a key part of enabling services to stay open.
But without the unprecedented drivers of the pandemic, what should be the legitimate view of digital mental health therapy and does it currently have its rightful profile and status?
As we enter the third phase of the NHS’s response to COVID-19, this emerges as an essential question. This is not just because of the central drive to fully restore mainstream Improving Access to Psychological Therapies (IAPT) for supporting anxiety and depression, for which internet cognitive behaviour therapy (iCBT) is a supporting strand in cases.
It is also because we are at a juncture now where if we are to experience at least a 20% spike in demand for mental health services, we need to re-evaluate and even recalibrate what and how services are delivered most effectively.
As the NHS Confederation outlined in its recent NHS Reset paper “Mental Health Services and COVID-19”, there are fundamental questions about the future of mental health services that have arisen during and as a result of the pandemic.
These include the need for more overall funding than the £2.3 billion for mental health earmarked in the 2019 NHS Long Term Plan, to cover additional costs from PPE and infection control; the challenges of social distancing and its impact on reduced capacity; staff burnout and, equally importantly, adaptation of the mental health services themselves.
On this latter point, one characteristic of the initial phase of the pandemic was the emergence of digital technology suppliers with apparent mental health solutions, but without objective evidence to substantiate their impact.
If there is a reworking of mental health delivery, there should be moves to clearly differentiate quality, evidence-based mental health solutions and unproven “vapourware”, perhaps through acknowledging mental health delivery in a central purchasing framework.
In the face of occasional public naysayers, there is also an opportunity to professionally emphasise the significant benefits in treating anxiety and depression through digital mental health therapy.
Anxiety and depression
In June, for instance, npj Digital Medicine published peer-reviewed research amongst NHS service users by SilverCloud Health that showed that treating anxiety and depression with such therapy delivered strong clinical improvements and recovery that over a 12 month period were 91% likely to be cost-effective.
It was the largest study of its kind worldwide, undertaken with Berkshire Healthcare NHS Foundation Trust. It found that more than half of those with a diagnosis of anxiety and/or depression recovered after three months.
The findings underline the benefits of long-term outcomes and cost-effectiveness of digital mental health interventions through, for instance, SilverCloud, being part of clinical care, including stepped care models such as IAPT.
The evidence suggests that digital mental health care should be viewed as a standard part of psychological support. Currently though, and perhaps surprisingly, iCBT accounts for just 7% of treatments completed within an IAPT programme.
Evidence of the future potential of digital support for coping with serious mental conditions, in this case, Bipolar Disorder, came in May with published research indicating significant improvement in patients’ sense of personal recovery.
It is widely and readily acknowledged that digital solutions and therapy are not appropriate for each individual, that some conditions will require more intensive face-to-face consultation than others or a blended approach.
We are at a key turning point when appropriate supporting and tested digital solutions need to be identified so that a technology-enabled mental health service can be developed, addressing current inequalities, and with built-in flexibility to withstand future health challenges.
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