As research finds that three in 10 GPs are advising parents of children with mental health problems to use apps, Dr Ian Jackson suggests that technology could help through the use of secure two-way messaging and teleconsultation
In a survey of 994 GPs 31% said they recommend patients use one of the NHS-approved apps to manage poor mental health if they’re rejected by NHS child and adolescent mental health services (CAMHS), or face delayed treatment due to waiting lists.
This is a thorny issue that stems from demand significantly outstripping supply within NHS CAMHS. Evidence shows this is due to under-investment in these services. There’s a deficit of appropriately trained clinicians (nurses, doctors, psychologists). On top of this, we have the increase in incidents plus, probably, an increase in recognition of psychiatric problems in children. I think the background risk of suicide plays on parents’ minds which makes this an even more emotive area.
I suggest technology can help, but only as part of a process of increased investment and support. I think it is fair to assume that staff involved in the NHS provision of CAMHS are working flat out and have little headroom for new initiatives.
But there are technological innovations that could help ease the burden, and improve services.
This can be set up so that support is provided to known and completely new patients by a multidisciplinary team that can cross boundaries – secondary care, primary care, social care and third sector organisations. The ability to monitor messages and respond quickly is fundamental to such a service as is the ability to hand off conversations, if needed, to a more appropriate person.
Consider a teenager with a chronic mental health condition, who are known to mental health services, as they are on long-term support. The teenager has an app on their smartphone, and when they login they have access to a secure messaging system. When experiencing a problem, they know they can send a message directly to the care team. The team monitoring the service can see who the person is because they are registered. So, as well as messaging support the team can quickly access the patient’s electronic record. If necessary, they can provide telephone or video consultation/support or hand off the patient to a specialist, all in a short amount of time.
The medical professional can then download the chat and any notes to the EPR, as an episode of care.
This can be set up at any stage in the messaging stream. Then, if needed, it’s possible to have a video call with the patient and their parent or guardian. This offers the ability to escalate in the provision of support to the child.
Teleconsultation can also be used as part of the support process for known patients, especially for those who are referred from a long distance. It provides flexibility, the clinician does not need to be in the outpatient department.
The final part, I believe, is the use of Telehealth support groups. Where one clinician links into several patients remotely rather than face-to-face in a clinic room. This concept still requires testing but would offer greater flexibility, especially where there can be great distances between patients and available services.
I truly believe that new applications for existing technology will deliver better care for children in need of mental health services. But only by using technology to improve existing ways of working will we see real improvements in how mental health is managed in the future.