Kate Newhouse, COO of digital mental health care provider, Kooth discusses the need to diversify mental health treatment and support to improve the delivery and accessibility of care.
Pre-pandemic, the World Economic Forum and the Harvard School of Public Health estimated that the cost of mental health care is expected to rise to $6 trillion globally by 2030, up from $2.5tn in 2010.
Undoubtedly, this knowledge and a pandemic that has impacted mental health across the globe has been a catalyst for change in the mental health ecosystem. It has helped de-stigmatise the topic in mainstream media, opened up conversations about wellbeing in businesses of all shapes and sizes, and raised awareness of the barriers to accessing help.
Easy access to mental health treatment needed
Everyone in the UK should have access to well-designed and easily accessible mental health treatment and services regardless of who they are or where they live. But the reality is that 1.4 million UK citizens are waiting for specialised NHS mental health treatment, and there are another eight million who cannot get on the waiting list but would benefit from support. What’s more, 25% of adults experience mental problems every year and 10 million people in the UK will need help as a direct result of the pandemic.
This has not gone unnoticed. As part of its ‘Build Back Better’ and ‘Build Back Fairer’ initiatives, the UK Government has promised to improve the nation’s mental wellbeing and put it on a ‘level footing with physical health’ by 2030. It is one of many commitments made in the ‘levelling up’ white paper published in February 2022 – to create equal opportunity for economic growth and social development across the UK by eradicating the disparities in access to jobs, education, healthcare, and housing.
In April 2022, a call for evidence from the then health secretary Sajid Javid followed. Insights from both the public and those with lived experience of mental health, as well as health and care professionals and providers, will contribute to the development of a new 10-year plan. One that builds on the existing NHS Long Term plan and aims to prevent and mitigate the impact of risk factors on mental health and suicide, particularly for groups who experience disparities. This is not enough, while being part of a consultation process is great, what is needed is for the – potentially new – health secretary to work together with all those involved in the provision of mental health treatment and services.
By working together, the Government can create a policy – and a plan – that delivers effective, personalised early intervention and mental health treatment that is accessible to all. One that is based on a bottom-up analysis of what service users are asking for, and considers insights garnered from academic research. As well as using anonymous service provider data, to ensure it fits within the wider ecosystem of mental health treatment while supporting current structural changes taking place within the NHS.
It has been proven that a one-size-fits-all approach to care does not work. Despite this, it is the predominant mode of delivery for mental health treatment, services, and support. What is needed is a choice of safe and confidential options that match an individual’s needs, in a way they feel comfortable. To make a positive change in a person’s life, it is important to empower them. Early intervention and preventative routes are most effective when the mental health treatment provided gives individuals the autonomy, skills, and efficacy to improve their wellbeing. Encouraging them to be part of the decision-making process helps to determine what help may be most appropriate.
Therefore, personalised early intervention and preventative mental health support are key to improving everyone’s wellbeing.
For too long, mental health treatment has been fragmented, confusing and often hard to access. This mental health support must be effective, affordable (preferably free), and compassionate while removing any barriers to care. Waiting lists are too long and individuals are often told their condition is not severe enough, or indeed that they are too severe or complex. We need to get to a point in time where there are no thresholds or criteria to meet, and no one should have to rely on a referral from a medical professional or take their place on a long waiting list to seek mental health treatment .
We need to be better at providing mental health treatment for people when they need it – support should be available 24 hours a day, seven days a week – outside of the usual nine to five. This could be in a variety of forms, such as low-level, early help or peer support that nips an otherwise emerging issue in the bud, right through to a drop-in or longer-term support from a specialist for more complex issues. Prevention and risk management are both important for effective suicide prevention. The same individual can present at different ends of the spectrum at different times and may benefit from accessing multiple layers of mental health treatment.
This is the reason why future UK Government policies must have digital services and support baked in. They should not be an add-on or a nice-to-have.
Technology key to providing better care
Harnessing the power of technology and the expertise of digital service providers can support local authorities, governments, and organisations such as the NHS to provide citizens with efficient, effective, and accessible public services i.e., mental health treatment, and other healthcare services. After the Department of Health’s Future in Mind report referenced the importance of digital innovation in Local Transformation Plans, as a digital mental health provider, Kooth experienced significant growth in demand for our services from NHS CCGs.
Digital services can provide a wealth of support alongside the more traditional one-to-one support, all ‘under the same roof’, thus providing a sense of coherency and safety. Activities such as e-CBT and online journaling can not only be used as an adjunct to face-to-face interventions but can also be used to help manage those on waiting lists (post a brief online triage) or those who may have been recently discharged from services – both are crucial periods in terms of the risk of worsening mental health.
There is also increasing recognition of the value that digital services bring not just as a choice of services (traditional one-to-one support and self-help content and journaling) but also from a logistical choice (face-to-face versus online) perspective. Specifically, among many groups such as children and young adults for whom digital communication is second nature, marginalised groups where stigma prevents them from accessing face-to-face services, those in rural locations who may struggle to travel and busy working parents who cannot commit to attending appointments during normal hours.
By integrating services across systems, from face-to-face services to global and specialised digital services, the NHS can provide more access points for individuals. This gives individuals who are less likely to access traditional face-to-face services more options and choices in where they access care.
There is a unique opportunity through the newly created Integrated Care Boards (ICBs) to establish a proactive partnership of public, private and voluntary sector organisations.
Digital services will provide earlier access to care
By collaborating they could provide early help and better care for people accessing mental health treatment. ICBs include key partners such as local authorities, the NHS (provider trusts and commissioners) and Voluntary Community and Social Enterprise (organisations and infrastructure). Mechanisms to consult and co-produce pathways need to be developed to ensure that universities, housing associations, independent health, and social care providers, as well as private sector companies are included. Improvements needed include simplification of data sharing agreements and better care system knowledge to encourage signposting and referrals to more appropriate provisions.
This requires mapping of existing mental health networks at a place-based and ICB level, to ensure that current partnership working is enhanced, further supported and augmenting achievements through previous work such as the Prevention Mental Health Concordat.
An integral part of this is the development of a digital ‘map’ of mental health services and support organisations where early help can be accessed. This would be more useful than a traditional directory, where it is difficult to differentiate levels of support or understand what is suitable for the specific need and instead be designed for both the service user and the referrer/facilitator. Development of a ‘holding your hand’ service and/or signposting tool that works alongside the map would help to better support both the end user and the referrer/facilitator in understanding not only what support is available, but how to better match the specific need. A list of services that use similar words and descriptors on a single website is difficult to navigate and understand. Using a participatory approach to work with service users to develop this map and service means the words, terms, and way of navigation are accessible, and understandable and cater to the needs of different groups.
For the UK Government to truly ‘Build Back Better’ and ‘Build Back Fairer’ the digital transformation of services including mental health care and support must be at the core. Only then can the new health secretary make headway on the promise to improve the mental wellbeing of the nation and achieve the goal of putting it on a ‘level footing with physical health’ by 2030.
Chief Operating Officer
This article is from issue 23 of Health Europa Quarterly. Click here to get your free subscription today.