IE SO INSIGHTS ISSUE 1 JUNE 2020
Covid-19 mental health special New data reveals suicidal thoughts down 30%
Breaking barriers to digital mental health treatment Sarah Bateup shares some unlikely silver linings of lockdown in mental health care.
Welcome to Ieso Insights magazine For as long as I can remember the Ieso team have been collaborating with customers, partners, staff, therapists and data scientists to collect and share intelligence relating to the science of therapy, the state of treatment, latest techniques, developments in commissioning and all things NHS psychological treatment related. This magazine is our way of sharing this information more broadly to hopefully help more people. I hope you are interested in what we are learning. We really want to hear from you too and share this knowledge with all our colleagues across the NHS. If you haven’t heard of Ieso, please allow me to explain a little about what we do. We aim to improve mental health using clinically-proven digital healthcare solutions that put patients and practitioners first and remove barriers to treatment and recovery. Our therapy platform provides a confidential and discreet online CBT service with a network of qualified therapists and PWPs. Our technology enables CBT to be delivered anytime, anywhere through secure, real-time instant messaging. To date we have conducted over 300,000 therapy hours and treated over 50,000 patients in the NHS IAPT programme.
James de Bathe, Director of Partnerships
Welcome to the first edition of Ieso Insights. I hope you will share it with your colleagues and sign up for future editions. James de Bathe, Director of Partnerships
Subscribe here to receive the next issue
Ieso Digital Health
|
02
Ieso Insights
Contents 04
A letter from our CEO, Nigel Pitchford
06
New data reveals 30% drop in
suicidal thoughts
10
The silver lining of rapid adoption of digital therapy
12
Why digital appointments hold the
answer to wait lists and stigma
16
Advances in clinical supervision
18
IAPT mental healthcare service status summary
22
Sarah Bateup shares advice on how to
24
What patients say
08
Impending surge in mental health patients
14
West Kent’s Zena Watson shares her Ieso experience
20
Day in the life of a therapist
during lockdown
25
Careers and subscription
deliver remote therapy effectively
Ieso Digital Health
|
03
iesohealth.com
A message from our CEO We’re here to help as demand for mental healthcare surges
O
ver the past few months, the world as we know it has altered dramatically. It has been a time of change and challenges for
everyone and, after many weeks of confinement
at home, the extraordinary times we now live in will be taking their toll on many people’s mental health. It is a time when people will need mental healthcare more than ever before, so continuity and quality of service has never been more critical, and is a key priority for us and the NHS. Over recent weeks, we have scaled up our service to meet increased demand in digital delivery. We are working with our NHS partners closely to help anyone who has mental illness get access to the treatment they need. We understand many of us are dealing with
uncharted
territories
and
uncertain
times, and if you feel worried about your Nigel Pitchford, CEO, Ieso Digital Health
mental health, we encourage you to come forward and talk. Please don’t feel that your symptoms are not important or normalised due to more of your family and friends talking about their own feelings and distress. If you are worried about putting more pressure on NHS staff, or that your GP is not available to refer you – they are working virtually and are there to help, so don’t be afraid to ask. We are working closely with IAPT and our NHS partners to ensure services are up, running
Ieso Digital Health
|
04
Ieso Insights
and accessible, and we are here, on hand and
We are now treating more patients through
ready to help. To find out more about support
IAPT than ever before. In April, we hit record
available, please visit the NHS psychological
numbers in therapy delivery, providing online CBT
services page.
to 2163 patients compared to 1002 in April 2019.
If you need support, you can refer yourself online or by contacting your GP or local mental health service directly. Alternatively, you can visit the NHS website and find a list of psychological services nearest to you. By scaling up our online
We aim to support everyone in our community by offering treatment to as many people as possible including our own employees, therapists and NHS staff that may be needing support at this time.
CBT service, we can treat many more patients,
As we transition through the next phase of this
sooner.
journey, the work we have done means we are
Our
wellbeing
therapists
practitioners
and (PWPs)
psychological are
ready
prepared and can scale to meet any surges in demand.
to help you. Ieso has always delivered psychological therapy online, so it is business as usual for our team, who are all working from home and are ready
Navigating through the unknown is
difficult for all of us, but we care and will be by the side of the NHS, our IAPT partners, therapists, PWPS, and patients as circumstances continue to change. If you are worried about your mental
to support you. We are committed to sharing
health, seek help now and get the care you need;
our knowledge and using our technology
we’re ready to treat you.
to continually improve the quality of our care, by monitoring what is working in treatment, and by making high-quality, free training and resources available to therapists so they can learn and share knowledge during this
Nigel Pitchford, CEO, Ieso Digital Health Find our latest COVID-19 updates: www.iesohealth.com/covid19
challenging time.
Ieso Digital Health
|
05
iesohealth.com
NEWS
30% drop in suicidal thoughts since lockdown Anxiety on the increase but depression decreasing: the coronavirus effect is unique in our time
•
•
Reduction in depressive symptoms while
seen when individuals feel a part of collective
experiencing higher anxiety is a newly
community, supporting each other to stop the
observed UK Covid-19 therapy trend
spread of the virus and fundraising for the NHS.
Decrease in depression seen as patients
Dr. Ana Catarino, principal scientist at Ieso
benefit from ‘collective camaraderie’
Digital Health said:
effect as fundraising, clapping for carers and community kindness brings people together •
Calm before the storm as surge in depression and anxiety is forewarned
Suicidal thoughts have seen a sustained reduction of up to 30% in patient assessment scores on referral to adult psychological therapies. The
“Depression and anxiety symptoms often go hand in hand. The contrast we’re seeing at the moment is a first for recorded UK therapy trends. Despite the global crisis and the obvious restrictions and issues we are facing as a society, patients are feeling more positive, even though they’re nervous about the future.”
trend coincides with the start of lockdown. Ieso has been tracking patient psychological trends in relation to the coronavirus since the beginning of the year. The decrease in suicidal
In the past, studies have shown that camaraderie can positively affect your mental health. Largescale sporting events such as the Olympics or a World Cup come with a sense of belonging and
thoughts accompanies a 10% drop in other
broad social integrations rarely experienced
symptoms of depression such as tiredness, lack
by individuals.
of energy and low self-esteem. This is despite symptoms of anxiety increasing.
However, experts at the company say current levels of referrals are alarmingly low for a crisis
We have seen a sustained drop in depression in
of this scale and an unprecedented surge of new
new patients since the UK Government closed
cases is imminent. Before the pandemic, the UK
schools and requested the UK public work from
mental health system was already struggling
home if possible. One explanation for this trend is
to reach its target of treating 25% of the one
that the reduction in certain depressive symptoms
in four adults who usually suffer from mental
is being caused by a “camaraderie effect”, often
health issues.
Ieso Digital Health
|
06
Ieso Insights
Dr Catarino added: “The 30% drop in suicidal thoughts is significant but likely only temporary as we are expecting to see a dramatic reversal when the situation normalises. We’ve seen in history that recessions correspond with an increase suicide rates. In the last few weeks we have seen a pattern emerging around difficulties with sleep, either sleeping too little or too much, both of which can be early signs of depression. This may be related to lockdown restrictions easing, yet life failing to go back to normal, which may be key to recovery.
Locals and restaurants pull together to feed front line NHS workers in Hertfordshire. (c) RMC Photography.
Dr Catarino concluded: “In contrast to many traumatic experiences, the coronavirus pandemic is not a discrete point in time, but something that is prolonged over several months with no end in sight. This is likely to cause trauma exposure at a global scale at various levels.” These findings are a result of a preliminary analysis of the impact of the Covid-19 crisis on therapy data collected by Ieso Digital Health anonymised from over 8,000 patients this year. We will continue to monitor and explore this data in more detail during the next stages of this crisis, including investigating the impact of Covid-19 on other variables, such as changes in average required treatment duration and changes in clinical outcomes including recovery rates.
Ieso Digital Health
|
07
iesohealth.com
NEWS
Surge of Covid-19 mental health issues set to come
Lock down continues to prevent a sense of normality returning to our high streets (c) RMC Photography.
•
•
Delays in help seeking behaviour; unprecedented wave
Due to the scale of the pandemic, this delayed onset of
of new patients is imminent
issues will result in an unprecedented surge of new cases
Easing of restrictions will result in an unprecedented demand for mental health treatment
•
30% of new patient referrals cite Covid-19 as a reason they are seeking support
New data points to an imminent surge in Covid-19 related mental health issues. Data scientists at Ieso believe that current levels of referrals are alarmingly low for a collective
descending on the UK mental health system, which before the current crisis was already struggling to reach its target of treating 25% of the one in four people who usually suffers from mental health issues. Ieso has identified that 30% of all new referrals for therapy cite Covid-19 in their reasons for seeking support. Just 5% discussed money worries in the sessions suggesting these issues, for the moment, pale in comparison.
crisis such as the coronavirus pandemic. Low levels of
Dr. Ana Catarino, Principal Scientist at Ieso Digital Health,
referrals indicate that patients may be bottling up mental
warns that the UK’s mental health system will be under huge
health issues and postponing help-seeking. This phenomenon
pressure. She says: “The scale of the mental health emergency
has been associated with previous incidents involving wide-
is going to put services under incredible pressure; there simply
scale trauma such as terrorist incidents and natural disasters.
aren’t enough therapists. Many services are switching to
Ieso Digital Health
|
08
Ieso Insights
remote therapy delivery but haven’t had sufficient time to train
These findings are a result of a preliminary analysis of the
in this mode of treatment. We need to innovate and look
impact of the Covid-19 crisis on data collected by Ieso Digital
at other ways to help patients if we are to have any
Health. We will continue to monitor and explore this data in
chance of resolving this issue.”
more detail during the next stages of this crisis, including investigating the impact of Covid-19 on other variables, such
Across the board, NHS admissions are at a record low, with
as the types and severity of disorders; changes in average
members of the public choosing not to risk going to hospitals,
treatment duration; and changes in clinical outcomes
or burdening the NHS. Referrals to mental health services
including how long treatment lasts and recovery rates.
across the country have seen a drop of 30-60% in April, despite digital services being put in place. The lack of support-
Ross O’Brien, Digital Innovation Director at Central and North
seeking indicates people are experiencing too many pressures;
West London NHS Foundation Trust, added:
and do not have the time or ability to address any issues they’re experiencing. There are vast sets of triggers for mental health issues in the context of a pandemic. Dr. Catarino explains: “You have people who spend time in hospital without support from loved ones. You have their family members at home alone, unable to be there for their dying relatives or those unable to attend funerals. Those at high-risk who have to live for weeks in a state of hyper-vigilance, constantly thinking they are going to get ill and die. You have hospital staff and undertakers seeing thousands of bodies awaiting disposal with no hope of giving
“There is potential for the mental health impact of COVID-19 to be more severe than the physical effects of the virus. Patient referral rates have been alarmingly low over the past few months across IAPT services in England, in London alone we have seen up to a 50% reduction in referrals. This is a concern because we know that people are struggling with their mental health and not reaching out for support from the NHS. There is a wealth of digital technology that is enabling therapy to continue without people needing to leave their homes. We need people to seek the help that is there and not feel that they are going to burden the NHS.”
them and their families the usual levels of respect and time. The list goes on.”
A white paper sharing Ieso’s findings is available
As restrictions begin to lift across England, Dr. Catarino warns
to download here.
that this will not necessarily mean anxieties will be alleviated. She said:
“The Covid-19 situation is unique in comparison to other disasters. It is not a discrete point in time, but something prolonged over several weeks and months, causing trauma exposure at a global scale at various levels.” “Compounding this is the lack of ability for people suffering from anxiety and depression to return to anything that remotely resembles “normal life”, which is usually the primary path to recovery - a psychological first aid. In the immediate aftermath of disasters, people need continuity of normal life, and to spend time with others, get back into the swing of their routine. With social distancing measures looking likely to continue for some time, this isn’t possible.”
Ieso Digital Health
|
09
iesohealth.com
COMMENT
Covid-19 tragedies will take time to heal, thankfully it has broken barriers to adoption of digital mental health treatment As published in The Independent
While our social freedoms were curtailed, there were some silver linings for mental health patients, says Sarah Bateup, Chief Clinical Officer for Ieso Digital Health.
The trauma caused by Covid-19, to so many, on so many
While we have been experiencing this collective trauma, we
different levels, will take time to heal. Covid-19 has affected
have also collectively cared for each other.
so many of us. You may have spent time in hospital without support from loved ones, been a family member unable to
I work alongside 700 NHS therapists, and we’ve observed
be there for dying relatives, unable to attend funerals or are
what’s known as the ‘camaraderie effect’ happening across the
a high-risk individual living for weeks in a state of hyper-
UK. It’s a mental health phenomenon witnessed during both
vigilance. You may work at a hospital as a doctor, cleaner,
world wars, where communities and countries pull together
porter or nurse and seen thousands of people but have been
against one cause, and as a result, it has a positive effect on
unable to give your usual levels of respect and time. The list
the nation’s mental health. It presented itself as a big decrease
goes on.
in suicide rates adults across the globe during wartime, and
Ieso Digital Health
|
10
Ieso Insights
similarly since lockdown, suicidal thoughts have
transport find they can tap into a more flexible
dropped by 30% in our new patient assessments.
work life. Patients no longer have to travel
We have analysed over 14,000 new patient referrals and seen this trend, alongside a 10%
across cities or remote countryside to attend appointments in working hours.
drop in other symptoms of depression such as
Improving
the
quality
and
availability
of
tiredness, lack of energy and low self-esteem. All
psychological therapies has been a challenge
since being asked to work from home and stay at
for many years, but the pandemic has removed
home.
those barriers for the benefit of everyone. This
The camaraderie effect has been seen all around
thankfully, therapists, patients and mental health
us, giving us a nationwide sense of purpose
services want this one silver lining to stay.
is a revolution in mental health treatment, and
and belonging. NHS clapping and fundraising, shopping runs for neighbours and local support networks are everywhere. And while we were in lockdown, we’ve seen the NHS embracing online mental health treatment, bringing down barriers to patient access and moving towards a future of more convenient psychological therapy. The Internet is part of everyday life and yet, prior to lockdown, very few patients had access to psychological therapy online. The barriers to adopting digital methods of delivering psychological therapy have now been broken as psychologists, psychiatrists, counsellors and
Sarah Bateup, Chief Clinical Officer
therapists have turned to video, phone and text based methods of delivering treatment. Patients across the country are at last able to access treatment from home at a time that suits them and their therapists. Extended hours don’t always mean working
Sarah Bateup is Chief Clinical Officer at Ieso Digital Health and chair of the IT special interest group for the British Association for Behavioural and Cognitive Psychotherapies.
weekends. Few people want to deal with their mental health at weekends and mental health services have learned, to their surprise, that therapists are very willing to work evenings and enjoy working around their lives and the lives of their patients. One of the benefits of working using online methods is that therapists who might otherwise be unable to work because of a health related problem, caring responsibilities or access to
Ieso Digital Health
|
11
iesohealth.com
COMMENT
Why digital appointments hold the answer to wait lists and stigma issues As published in Health Europa
Digital GP appointments could make it “difficult”
care might not be the best thing for patients
for doctors to diagnose and manage patients’
or the health system.
mental health problems during the coronavirus pandemic, the chair of the Royal College of
Rapid access to targeted care is crucial
General Practitioners has warned. However,
in mental health treatment. Our research
based on many years’ experience providing
shows correlation between positive response
digital mental health therapy to NHS patients we
to treatment and shorter waiting times . NHS
know that for many patients, digital is an enabler,
data in 2018/2019 reports mean waiting times
not a barrier.
of ~70 days from referral to second treatment
We have evidence indicating that enabling patients to access mental health treatment through digital self-referral actually increases patient access and dramatically reduces waiting times. In some CCGs we have seen patient access increase by a factor of ten over a nine-month period once patients learned they were able to self-refer to the service removing the need to refer via their GP. This brings the dual benefit of speeding up time to treatment and freeing up GP time for the more complex patients most in need of their attention.
appointment in conventional services. This compares to 36 days for Ieso in the same time period. So far in 2020 this number is 26 days. At present, even in the midst of the COVID-19 crisis, we are able to allocate the majority of patients to a therapist on the same day they present to the service. In part, this is because digital delivery enables us to load-balance supply and demand across a much broader geography and avoid localised ‘bottlenecks’. Stigma remains a real issue and many patients don’t necessarily want or need to go to a GP with
The NHS mental health leadership are embracing
their mental health problems. In our experience,
digital care delivery. Digital services play a vital
many patients actually find it easier to open up
role in enabling people to access high quality
about their problems when their care is not face-
care, avoiding excessive wait lists and stigma
to-face. Our clinical team tell us patients open-up
issues. Going back to the ‘old way’ of accessing
earlier and patients often need fewer sessions.
Ieso Digital Health
|
12
Ieso Insights
Time and time again we find that when we start working with
services also use carefully designed data-sharing and
a new CCG, GPs are reticent about digital care delivery. They
risk escalation protocols with local GP and other mental
are concerned that not being physically in the same room will
health services.
have a negative impact on outcomes. Yet our patient outcomes data consistently exceed national targets and ultimately, they are convinced.
What is undoubtedly needed is more investment in training clinicians in effective online care delivery. Whilst digital is an integral part of the NHS 5-year plan, digital delivery is
Whilst there will always be the need for face-to-face GP
not yet on the curriculum of most training programmes for
support for some patients, particularly those with complex
health care professionals. It cannot be underestimated that
needs, for patients who have time and travel constraints, live
clinicians need support and adequate training to assess and
in remote areas, or have social anxiety , digital access can be
treat patients using any digital method, including telephone
a life saver. Not to mention that online access may be the only
and video calls.
option for some people in the current climate, such as those in isolation or at high risk of infection.
Throughout history it is need that drives innovation, ultimately to the benefit of society. The NHS is currently embracing digital
As services are currently less able to offer face-to-face
access. I hope everyone involved in patient care will closely
appointments there is a danger that waiting lists will just get
consider the benefits that it can give to both primary care and
longer, unless we embrace new models of care delivery. To
patients. With an open mind and careful implementation, the
reject digital options would simply be storing up problems
COVID-19 pandemic will leave us with better access to high
for GPs and patients alike. The important thing with online
quality mental health treatment for the long term.
treatment is that it must be done well and follow approved protocols. This means using accurate patient outcome
By Andy Blackwell, Chief Scientific Officer at Ieso
measures, therapists with the right training and privacy
Digital Health
standards being maintained.
Ieso Digital Health
|
13
Of course, all good digital
iesohealth.com
West Kent CCG shares their experience of working with Ieso
W
est Kent Clinical Commissioning
“Our priority is about giving patients choice to select a treatment they feel will
Group (CCG), who merged with
work for them, while also ensuring mental healthcare is easily accessible
Kent and Medway CCG on April 1
and available to all that need it. While we understand some people will
2020, aims to deliver the right mental health
always prefer to visit their GP to discuss symptoms and treatment for anxiety
services at the right time, to meet the needs
and depression, we also encourage people to take action themselves if they
of the local population and give patients
feel their mental health is suffering.”
more choice with treatments. Mental Health Project Manager at West Kent CCG, Zena Watson, shares her experience.
“We work with our service providers to ensure that people can easily register and self-refer to one of our IAPT services. There is information and options available so patients can make informed decisions about their pathway to recovery. They can select a treatment based on their own symptoms, situation and requirements. This can be through a GP or alternatively, patients can self-refer directly.” Ieso supports West Kent through a self-referral model, making online CBT available to local residents in the area. From 2017, Ieso was contracted through Thinkaction in West Kent to provide 15% of the IAPT services, which worked well from a digital therapy standpoint. However, while Thinkaction (now We Are With You) still work alongside Ieso to provide digital therapy to West Kent residents, from May 2019 the CCG contracted directly with Ieso. This gives West Kent direct ownership over the relationship, meaning they have more control over service management, delivery and reporting back to IAPT and the NHS. “We have worked with Ieso for a number of years – first through Thinkaction but now directly, which means that we can offer high-quality digital mental health therapy services while increasing accessibility and mobilising more people into treatment. As part of contracting with Ieso, we have increased service delivery from 15% to 25% of the total contracted IAPT services, so we have capacity to scale up as needed and better manage incoming referrals across West Kent.”
Ieso Digital Health
|
14
Ieso Insights
“We have always worked well with the Ieso team; they are very positive and professional.
Takeaway tips 1.
and quickly, while also reducing waiting times to move
We have found service management to be
patients into treatment quickly.
excellent and the team also helps to support our data analysis.” concluded Zena. Being an online digital service, patients in West Kent can get access to and connect with Ieso therapists remotely from
Consider online therapy to help reach patients remotely
2.
Think about taking more capacity to scale as demand increases.
3.
Online therapy is generally in parity with face to face therapy but is more discrete for those wanting more
the comfort of their own homes within weeks, which moves
privacy or not wanting to meet someone face to face.
people from referral to treatment quickly, and ideal for those unable to travel to appointments or confined to homes. Ieso’s service offers true flexibility and choice in terms of the time and location a patient receives therapy – so outside normal working hours if they prefer. The text- based nature of Ieso’s online CBT also provides more discretion in therapist / patient communication, as conversations can happen in messaging form away from others who could be listening, and is ideal for
Clinical outcomes NHS year April 2019- March 2020 1959 patient entered treatment. 1643 patients completed treatment
anyone nervous about meeting a therapist face to face.
•
Recovery Rate: 56%
In the 2019 / 2020 period, 9663 people entered treatment
•
Improvement Rate: 60%
across all IAPT mental health services from across the West Kent area, with Ieso treating 1959 of these patients. Ieso has also over achieved against IAPT targets, supporting West Kent’s waiting list reduction programme and improving recovery rates.
Waiting Times: •
60% treated with 4 weeks
•
83% treated with 6 weeks
•
96% within 18 weeks
Key learnings 1.
A self-referral model means GPs can educate on the best
There are a range of IAPT service providers across Kent and Medway CCG and you can find your local service here: https://www.nhs.uk/service-search/find-a-psychological-therapies-service/
IAPT treatment available but patients make their own selection based on their own symptoms, situation and requirements. Patients can also self-refer with the need to visit their GP. Both options gives control back to patient. 2.
Digital delivery of therapy provides flexibility to patients in terms of availability, can be accessed remotely anytime, and is more accessible for more patients across
To find out how Ieso can support your IAPT services please email info@iesohealth.com
demographics. 3.
With their own therapists and ability to scale up as needed, Ieso’s service deployment and management is easy and pain free.
Ieso Digital Health
|
15
iesohealth.com
COMMENT
Throwing the doors open on clinical supervision in CBT Shazna Khanom, UK Clinical Director, tells us how she ensures her team of 700 therapists become the best therapists that they can be.
We
have
found
that
when
therapists do present a recorded session to their supervisor they often will pick a session they think went well instead of picking a session that may have gone ‘badly’ in some way thus missing the opportunity to learn and grow from the experience. Many Services have no way of knowing why some therapists get
better
outcomes
than
others. They also have no way of Shazna Khanom, UK Clinical Director
tracking whether the supervision therapists
receive
impacts
Before Covid-19, most therapy took place face
positively on their clinical work. There is a
to face, behind closed doors. Once qualified,
belief that is does but this has not been widely
CBT therapists had very little direct feedback in
researched. Working digitally brings many
relation to their clinical work compared to the
advantages and gives us unique insights into
feedback they received during their CBT training.
what works for whom. I’d like to talk you through the supervision capability that our platform
Whilst some CBT therapists provide recordings
offers and what it means mean for long-term
of their clinical work to their supervisor most
quality of care and career progression.
avoid doing so. There are a number of reasons a therapist might shy away from recording themselves during clinical work and presenting
All clinicians have access to the Ieso on-demand supervision and case management tool which is monitored and tracked by our clinical team. It
this to a supervisor. Fear of judgement, time
offers both proactive and reactive supervision
pressure and assumption that a patient may not
from assessment to discharge. What normally
like the session to be recorded all can all play a
happens in supervision is that a therapist
part in why a therapist will avoid this activity.
approaches their supervisor with a problem or
Ieso Digital Health
|
16
Ieso Insights
attends a supervision group with a prepared supervision question relating to a case but the supervisor has no way of knowing if that advice helped with that patient’s care, or even if the therapist chose to follow the advice. By using our clinical support tools, a supervisor can see what actions a therapist has taken and if their advice had an impact on the patient’s recovery and/or engagement. It also gives us a data set to find out what supervision methods have the best impact on therapy. All of our therapy sessions are recorded and analysed against our historic data set. Our supervision tools automatically flags issues to a supervisor so that they can proactively offer advice to the therapist on how best to treat a patient. Ieso clinical supervisors have transparency into all their therapists’ cases. As well as the ability to review all patient case transcripts and notes for retrospective and live analysis, we have the ability to track which therapists perform better for different conditions over time. This allows them to specialize if they wish, and only treat patients that suit their skillset, or for us to offer tailored training on areas of weakness. This means that we can offer tailored training to therapists to ensure that they become the best that they can be. All supervision notes related to a case are kept in one place, as part of the patient’s clinical records. It also provides case management support for urgent risk, step up, suitability and session extension. The purpose of these tools is to create a close alliance between supervisors and therapists. It is as much about improving patient care as it is about creating a data set to see what actually works in supervision. It’s an exciting part of ensuring the best possible care for patients and ultimately improving outcomes.
Ieso Digital Health
|
17
iesohealth.com
State of the mental health nation IAPT mental healthcare service status summary
Ieso Digital Health
|
18
Locals and restaurants pull together to feed front line NHS workers in Hertfordshire. (c) RMC Photography.
Ieso Insights
S
haron Harrison and Nii Wallace-Davies share their
Impact on clinicians
findings from conversations with IAPT services about
When moving to online therapy methods there is a period of
how
adjustment, particularly for those clinicians who have been
they
are
handling
patient
needs
during
the pandemic.
used to delivering face to face therapy in a different set up
Mental healthcare is available and online The IAPT (Improving Access to Psychological Therapies) programme is regarded as critical by the NHS to keep mental healthcare up, running and available, particularly
and environment. However, services are reporting that their clinicians are happier and more productive working from home by delivering therapy via online tools, as they are not having to travel or run between sessions in different clinics.
during the COVID-19 crisis. Most health care providers have put contingency plans in place to support the ‘remain open’ directive, including: •
Adopting or increasing capacity to digital psychotherapy services as alternative approaches to face to face treatment delivery. For example, some NHS Trusts are deploying services like Ieso’s online CBT or extending existing digital contracts in order to move more people through treatment and reduce waiting times.
•
Transitioning face to face therapists to digital communication and collaboration tools, such as Microsoft Teams and Zoom. These tools have been embraced by GPs, NHS Trusts and patients as they continue to take appointments, triage patients and deliver treatments.
While many mental health services are still available and running as usual through digital delivery across much of the UK, in April mental health referrals to services across the country experienced a 30-60% drop off which is surprising during a collective crisis such as COVID-19. In the past few weeks, referrals have begun to pick up again, but they are still not at pre-COVID-19 levels experienced during months leading into the pandemic.
Despite ongoing security concerns around Zoom, it has become commonplace, and clinicians are reporting that whilst similar to face-to-face, they have had to change their style of working. There will always be some challenges to working in a digital environment, and particularly when more households are at home and online, including uptime of network connections, and lack of privacy. Text-only communication, such as Ieso’s online CBT, means that there is more privacy during sessions, and tech issues occur less often. Transcripts
‘Business as usual’ stance Many healthcare providers recognise that digital as a delivery
from text-based therapy can also be used by the clinician to provide more support to the patient.
method for therapy is here to stay, and therapists and patients
The industry is working hard to help clinicians work more
are becoming more comfortable using digital methods.
effectively online, particularly as referrals increase. Many
Digital delivery will be more embedded into working practice generally, and so for the most part, many NHS Trusts are taking a ‘business as usual’ stance with a focus on getting through each quarter. As no one is really sure what is going happen next, we are also seeing the decision-makers be more pragmatic and flexible in their approach, while also preparing for the expected onset of a delayed mental health services.
Ieso Digital Health
|
19
providers and associations, including Ieso, the NHS and BABCP, are offering training and support to enable clinicians to transition to digital methods. Advice is also being provided on what to be aware of during the COVID-19 pandemic in terms of how patients are presenting, what to think about in terms of consent and patient contact, what trends are being seen 8+ weeks into the lockdown, as well as more specific training on conditions we expect to see more of during this time.
iesohealth.com
A day in the life of a therapist As published in Stylist Magazine
Muge Ahmet is a 30 year old therapist, living in Crayford in south east London, and lives with her partner Tanju.
a banana and jump on my cross-trainer for 40 minutes. I’m doing this every day at the moment, to keep my fitness levels up and maintain my mental health. I feel energised this morning, more than usual. I slept far better than I have the last few weeks and I can tell. My sleep has been broken since we went into lockdown. I try not to dwell on it, but the change of routine has affected me. I shower, get dressed, do my hair and make-up, grab a coffee and start panicking that I’ll be late for my first patient, even though I won’t be. I open my laptop and start prepping.
10am I start work at 10am every day. The first thing I do is check my emails then my diary, and remind myself of the patients I’m Muge Ahmet, CBT therapist
She specialises in cognitive behavioural therapy (CBT) and eye movement desensitisation reprocessing therapy (EDMR),
seeing today. I refamiliarise myself with my cases and where we are in each treatment plan to make sure we get the most from each session.
where a therapist supports you to relive traumatic or triggering
I generally book in around six to eight patients a day; each
experiences in brief doses while directing your eye movements
session takes around 50 minutes. I take breaks in between
and distracting you, so that recounting the experience is less
everyone, to prep and refocus.
painful. CBT helps you manage your problems by changing the way you think and behave. She is currently working solely from
12pm
home, for IESO Digital Health, providing NHS patients with
I take a complete break at lunchtime. I’ve learned the hard way that not giving myself the time away from my laptop isn’t
1 to 1 therapy.
good for my own mental health. It gives me that break to refuel
7am
and re-energise for my next patient. I’m really good at getting
I’m trying to keep to a routine and structure, so that whenever
my five a day, and I have a sandwich with veg, or sometimes
‘this’ is over, it’s not too much of a shock to the system. I grab
scrambled eggs or baked beans on toast.
Ieso Digital Health
|
20
Ieso Insights
1pm.
7pm
I see three to four clients over the course of the
I prep for my last patients of the day, who I see
afternoon. Although my patients won’t notice, my own mood can be affected by the clients I see. If some are progressing well, I often feel that mirrored in my own energy. I try to schedule my
at 8 and 9. When my appointments end, I try to use closing my laptop as a mental switch that I’m done for the day, but it can be hard. I advise
patients so I don’t treat multiple individuals who
my patients to put their laptops away - especially
have severe trauma or PTSD back to back, but
right now, working excessively can be a sign of
practicalities get in the way, which can be tough.
avoidance but there are healthier ways to tackle
It’s a unique time in my career, for all therapists. We’re experiencing the same anxieties as our patients where it comes to Covid-19, when usually we’re completely objective. The concerns
what’s happening. How successful I am in tuning out depends on the cases I’ve had, and what’s happening in my own
the public have are the same concerns I have,
life. At the moment I can’t see my parents, they’re
as my colleagues have. Trying to contain those
over 70, I miss them. I also lost my best friend
feelings to provide the best care for others can
on Easter Sunday. It’s my first real experience of
be challenging. I look after myself by limiting the amount of news I watch and read, but if you’re supporting someone else through their anxiety on the subject, it’s impossible to get away from it. That can feel heavy, and it isn’t going to go away. It’s accepted in psychology circles there will be a
loss. It’s been hard. And it’s hard to keep yourself together when you’re helping others with their suffering.
10pm.
new wave of new patients seeking support very
I generally go to bed at 11pm. Before that I shower,
soon, and that the UK mental health system will
and do a 10 minute breathing exercise. I spray
not be able to cope.
lavender over my pillow, and fall asleep after an
5pm
hour or so.
I break for the day, have an early dinner with Tanju. I’m learning to cook and today it was home-made curry. During this break I watch a film to switch off - I’m watching a lot
I feel tired tonight, drained. When you finally switch off, you notice how you feel. I hope for another good night’s sleep so I feel energised
of comedy at the moment, it’s so important to have
again tomorrow, so I can give the best version of
a little laughter.
myself to my patients, and start all over again.
Ieso Digital Health
|
21
iesohealth.com
Sarah Bateup shares advice on how to deliver remote therapy effectively Ieso’s Chief Clinical Officer and chair of the BABCP IT Special Interest Group, Sarah Bateup, provides advice and guidance to
In her online vlog series, Sarah covers a number of topics including: •
methods during COVID-19
clinicians on how to adapt working practices and deliver therapy effectively during the current coronavirus outbreak.
The best preparation for seeing patients using digital therapy
•
Housekeeping and consent when moving to digital therapy methods
•
How to deal with patient contact in-between therapy delivery
•
The common phenomena when moving to non-face to face therapy delivery
• …and much more. Here is an transcript from the first episode. Part one: Preparation for seeing patients using digital therapy methods The coronavirus outbreak and the move to lockdown in the UK has brought about new challenges in therapy delivery, particularly for those that deliver treatment in a face to face environment. With many people still currently confined to homes and unable to get out for treatment, normal pathways to mental healthcare have been disrupted and, service providers, including the NHS, have moved to providing treatment digitally to keep services running. As a provider of online cognitive behavioural therapy (CBT), we believe at Ieso that digital mental healthcare delivery is equally as effective as face to face CBT. However, with anything, the delivery method is only ever as good as the person delivering it, and this is the same with clinicians. If you are a clinician that has recently moved to digital therapy, then the way to get the best out it is through training and learning the methods that work for you. Digital therapy provides more flexibility for therapists and
We also understand that there are many digital methods you can consider
patients alike
using in your clinical work. However, because of the sheer number of tools
Ieso Digital Health
|
22
Ieso Insights
Covid-19 has impacted on people from all walks of life. (c) RMC Photography.
and terms related to digital methods, it might be confusing to
usually work with their patients. Whatever digital method you
understand what is out there and the best approach. We hope
choose, you will need to think about how you use it and don’t
this post supports you in defining this during this crisis and
assume that you can just plug in and play.
can bring some clarity to the digital delivery world.
There are many therapists out there who have worked online
Digital methods can be highly effective, but it really is down to
for longer, and our advice to them is to build a community
each clinician to bring digital therapy to life and enable patients
of peers who have experience using alternative methods of
to make the most of what is on offer to them. Digital methods
delivering CBT. By creating some peer supervision groups,
of therapy sit on a continuum. At one end, there are self-
you can share learnings about the particular techniques that
help methods offered to patients and accessed online. Then
you’re using and what is working and not working for you.
somewhere in the middle, there are guided self-help methods,
Discussions on what you’re finding difficult, and what your
traditionally using online platforms with digital materials,
patients are finding difficult will help you understand if these
which the clinician will guide the patient through. We know
are unique to you others experience it too.
from the research work of Henry Maudsley and David Clarke that guided self-help is very effective in treating patients with conditions such as social anxiety disorder. At the other end of the continuum, there is therapist delivered digital interventions, which use communication methods like video, telephone and email, or text-based messaging to deliver treatment. The latter is how we provide online CBT at Ieso. All offer varied benefits for delivering interventions. However, with our experience working with therapists for many years, we find that those that adopt digital methods, come up against at least one of three things as they learn the process. About 10% of therapists can adapt to digital delivery really well using whatever communication method that works for them. The majority, however, need some support and training, and we’ve been lobbying hard to get digital method delivery on
For those clinicians more used to working in face to face IAPT services and clinics, it is easy to take for granted the informal support and consultancy from our colleagues that we might meet in a coffee room or the office. We use these engagements to seek some informal guidance regarding a patient – something that is harder online. Perhaps if we’ve seen a patient that is a little more complex, or someone that worries us or has maybe made us feel a little distressed, we can seek some reassurance regarding risk or safeguarding. These informal conversations are really important to our work and should continue in a digital environment. We encourage you to build a community where you have informal support, which is the fastest way to disseminate learning and share experiences about how to deliver CBT online.
the training curriculum for IAPT therapists, and those in the NHS. On the whole, the healthcare industry needs to support therapists to work smarter online because it does take some
Subscribe to Ieso’s YouTube channel here to be notified of episodes as they go live.
time to adapt, especially if it is different from the way they
Ieso Digital Health
|
23
iesohealth.com
What patients say about digital therapy
Parents have had the additional responsibilities of home schooling and child care while often working from home
“Being online took away added anxiety about
“This was a life saver for me. My anxiety and
meeting someone face to face which can be a
PTSD was too bad to leave house and speak
challenge in itself.”
face to face with a stranger. It was focused on moving forward and coping skills not the
“I personally think it’s much easier sometimes to write what you’re thinking than say it, and felt I was probably more honest because of this. I liked the fact I didn’t have the stress of meeting someone face to face to deal with.”
traumatic experience. Previous face to face counselling was mostly me crying for 50 mins and then having to been seen in public and drive home after in a state of anxiety and panic attacks. This was much less stressful.”
“The great thing about being online is that I have opened up more than I probably would have face to face or over the phone sessions.”
Ieso Digital Health
|
24
Ieso Insights
At Ieso we are committed to delivering world-class mental healthcare We have one overriding mission here at Ieso that rings true with all of our people. We are truly passionate about making people better; driving improvements and breakthroughs in mental healthcare for everyone. Our patients are at the centre of everything we do.
Our cutting-edge technology Imagine for a moment capturing the collective knowledge of the world’s leading and most effective therapists. Then imagine taking that collective knowledge, and by using deep learning techniques, natural language processing engines and sophisticated artificial intelligence practices, being able to make every therapist better. Imagine those learnings translated into clinical practice guidance tools that provide patient-personalised guidance to therapists, to improve the therapy being delivered and as a result, get patients better, faster.
How you can be a part of it Visit our website to see our list of current vacancies https://www.iesohealth.com/en-gb/careers
In the next issue •
Latest news and comments from Ieso
•
What’s happening in IAPT services around the UK
•
The latest trends in therapy presentations
•
Day in the life of...
Click here to download our digital resouce pack for clinicians
Subscribe here to receive the next issue
This magazine was produced by Huuha Ltd. If you have any feedback, or would like to contribute, please email hello@huuha.co.uk
Ieso Digital Health
|
25
iesohealth.com
Contact us today envelope info@iesohealth.com phone-alt 0800 074 5560 map-marker-alt
Ieso Digital Health The Jeffreys Building Cowley Road Cambridge Cambridgeshire CB4 0DS
