Developing Technologically Enabled Remote Access to Recovery Colleges: A Co-Production Workshop.

On Thursday 16th of March at the Digital Exchange in Little Germany, Bradford, the  Digital Health Exterprise Zone (@DHEZ) hosted a workshop that brought together clinicians, recovery college students, users of services and technology innovators to consider the challenges of making recovery college sessions available for ‘remote participation’.

Professor Allan Kellehear, Academic Director @DHEZ, welcomes the delegates and introduces them to the challenge in hand.

Recovery colleges are meant to be health education communities where people can learn together, from each other and with educators developing personalised ways of improving their mental health, well-being and ability to work with distress. They should also offer opportunities to reforge identity, gain purpose and hope, hone life-skills and as desired work-skills without the latter being the necessary main focus of attention.

Steve Williams (@mhnurselecturer) and the lead for the @UoBRecoveryColl introduces what Recovery Colleges are and what the simulated college workshop will entail.

So why ‘remote participation’? The idea here is to consider developing technologies that enable people attending recovery education or psychological health sessions to join in from home if on that day they simply can’t get into college because they haven’t got enough money for travel, or they feel too distressed mentally or physically or for whatever reason that comes along with what health services typically refer to as ‘drop-out’ or reasons for non-attendance. Lots of advantages and lots of problems come along with this idea of remote participation. We feel it’s worth addressing these to help tackle, amongst other things, the ‘drop-out’ issue.

Drop-out is a massive problem in all forms of psychological health care, whether that’s situated in health or education. For example the most recent IAPT (Improving Access to Psychological Therapies) figures for 2015-2016 (from April 2015 to March 2016)  indicate that 33.9% of referrals end before entering treatment and of those referrals 92.1% did not attend any type of appointment. IAPT is the service aimed at providing psychological therapies for people with anxiety and depression. There were in total 1,399,088 referrals which equates to 1, 179, 328 people because there are sometimes multiple referrals, people being referred from one IAPT service to another and also people being stepped up from a lower intensity to a higher intensity service. 58.7% of referrals did not complete the course of treatment and ended participation for a variety of reasons and what ‘ending the referral’ means in IAPT terms  includes- declining to start, being deemed not suitable for IAPT or starting but not continuing. Given that IAPT aims to reach as an initial goal only 15% of those with anxiety and depression who need ‘evidence-based treatment’ and has a target of 50% reaching ‘recovery’ multiple approaches to addressing the reasons why treatment ends or is patchy are clearly urgently required. Using technology is one possible approach that we are exploring at Bradford.

Our delegates view, in another room, what is going on in the College Simulation and grasp the difficulties of current technology in providing ‘remote participation’ first hand.

Having run the workshop on the day our delegates left having worked together to form the skeleton framework of potential solutions. Problems were identified and discussed and ways to overcome them from an operational and technical perspective were raised. We now have potential partners who encompass user-experience, clinical and educator experience and technology expertise. We are looking forward to them joining with us on the next step to exploring how feasible, safe, and effective remote participation can be as a strand of delivering mental health care and to those struggling to find it and attend in our current education and care provision.

And here’s an interesting 360 degree image from one of our technology colleagues (David Renton) who participated on the day:

Interesting workshop in Bradford on Innovative tech to support Mental Health #MVPBuzz #MIEExpert #theta360 – Spherical Image – RICOH THETA

The Five Year Forward View Mental Health Taskforce

The FYFV for MH: The Independant MH Taskforce Report.

Following the NHS Five Year Forward View (5YFV) published in October 2014 work has been under-way to implement this. We are told from the foreword of the original document that this Forward View represents the:

“…shared view of the NHS’ national leadership, and reflects an emerging consensus amongst patient groups, clinicians, local communities and frontline NHS leaders. It sets out a vision of a better NHS, the steps we should now take to get us there, and the actions we need from others.” (p.2).

Bold words. In some places putting my critical hat on highly improbable words I’d say. However putting all that aside I stepped forward to be part of the recent consultation for how the 5YFV might look for Mental Health in particular following the Mental Health Taskforce public engagement findings. This was held in Cambridge last week but for one reason or another I couldn’t make it on the day. So I added my tuppence via email having scrutinised the Taskforce documents and commentary from the other consultants. This is what I said. It speaks more to what was missing then what was present in the current plan for mental health. (I’ve lightly edited this for grammatical clarity. Some would say I should edit this more heavily in this regard!).

I have been able to review the slides and the strategy workshop documents. I largely agree with much of my colleagues comments I have to say – I would like to add the following points:

Models of research – the need for more ethnographic and autoethnographic approaches as a research methodology is clear as a means of both challenging and complementing the more biological models of research. A strand of funding then and a significant one at that is needed, e.g. from within a respected research funder such as the NIHR that is dedicated to funding qualitative research would serve to (a) legitimise these chronically disregarded and marginalised forms of research (b) foster parity between the disciplines rather than division.

This would also speak to the liberal sprinkling of comments around social determinants. Social determinants are well established – now we need interventions based on our understanding of social determinants – e.g. Haslam et al.’s work as well as continuing to explore the specific social determinants and factors in place for people with mental health difficulties that are geographically and contextually relevant (see: http://www.sciencedirect.com/science/article/pii/S0165032714000573,) . Hence the ethnographic/autoethnographic approaches mentioned above.

Topics

There has been some research into the impact of the current welfare system on the mental health and lives of people with disabilities and mental health problems. The direction of travel of the current research is clear.

More research is needed on:

  • income inequality and mental health
  • workfare/psychocompulsion
  • in work and out of work benefits,  sanctions and the process of assessment and mental health
  • housing and mental health
  • the efficacy, effectiveness and safety of recovery colleges

Policies and processes of benefit assessments should be subject to evidence-based scrutiny/direction. They are not. It seems that evidence is rarely the meaningful guide to policy direction and development in spite of the money spent on the civil service, evidence reviews, consultations and strategies. There is rising media, lived experience and scientific evidence of the distress and deaths (people killing themselves) due to the assessment and sanctioning processes. (see e.g. White 2016 https://kar.kent.ac.uk/59731/1/insights-32.pdf.,  Perkins et al. 2017 http://www.emeraldinsight.com/doi/pdfplus/10.1108/MHSI-12-2016-0039).

I would strongly suggest that a specific theme of social determinants and social interventions is merited to give due regard and credence to all of the above.

As part of the upcoming Critical Mental Health Nursing volume I am developing the argument that compliments my approach to mental health nursing education, namely that MHN’s  must shift towards political-psycho-social activism. This represents in some small way a bit of that on my part. The bullet points with the exception of the final point on Recovery Colleges were raised by MH activist colleagues Recovery in the Bin.

Courtesy of and with kind permission granted from: http://www.yearoftheduck.com/trojan-duck/