ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
Digital resources for mental health
There are thousands of resources in the digital world alone for mental health. Brian Runciman, part of BCS, The Chartered Institute for IT, examines the relationship between IT and mental health services
It’s no secret, indeed it’s the motivation for a campaign platform for BCS, that healthcare provision and its relationship with technology is struggling. In May of this year, the Institute ran an event that asked whether the NHS can truly deliver person-centred care. That question is hugely important as the UK faces the challenges of the multidisciplinary nature of health and care. Primary, secondary and tertiary care very rarely join up well - even whilst each individual part can do a great job.
The issues seem to be even more fraught in the mental health arena. Youth has the worst access of any group to mental health services. Yet, interestingly, there are literally thousands of resources in the digital world alone for mental health. Entrepreneurs are stepping up to address existing problems, so what’s the problem in the NHS itself?
As with any health service, the overall strategy for dealing with mental health issues includes parents, schools, youth workers and others, it's not just about digital. Although digital is just part of a health provision landscape, however, there are rich resources out there. But for younger members of society facing mental health issues even this digital landscape appears to be letting them down.
At the BCS Health Informatics Scotland conference in 2016, Dr Diane Pennington discussed empowerment for those with mental health issues. She presented with Dr Trevor Lakey, looking at the youth perspective, and set the context with a quote from the British Journal Psychiatry 2013, which showed, as mentioned above, that youth have the worst service access of any age group.
With well over 10,000 apps in the mental health area, quantity is not the problem. It's much more about understanding people’s lives and how they communicate and, of course, it’s about quality. One interesting motivator mentioned is that those with mental health issues often want to help their peers, as they are the first to find out friends’ problems.
Some good exemplars cited were Ayemind, which aims to create a digital platform to support young people in mental well-being and create digital resources for it; and the Docready app, which is designed to help with a person's first GP conversation on mental health. The Ayemind resource page includes a toolkit for workers, which covers all levels of experience, from basic knowledge to practitioner level information.
The ongoing issues for trusts in this area are trend watching (keeping an eye open for new things to bring in), getting organisational policies usable, curating resources, developing staff (supporting workflow to include, for example, social media) and so on.
Finding good resources
Dr Pennington looked at the issue of finding good resources, as there is a very broad range and they are not always joined up. They vary very much in approach too - from pages of plain text describing depression, to interactive tests for anxiety and online chat services like Childline.
One interesting approach mentioned was the personal stories from e-mental health charities like mindyourmind, which replaces 'like' buttons with 'fistbumps', uses videos from celebrities and interactive games (although, as Dr Pennington said, it can be difficult to engage people with these when competing against the production values of the likes of Call of Duty...).
Facebook and Twitter can be good for personal stories too. All these things open up conversations and are often instigated by people who have been through the situation. In apps there are mood trackers, meditation apps, inspirational quote apps and more. Young people's specific needs from mobile technology include safety, with the idea of confidentiality; avoiding cyberbullying and avoiding stigma. Then comes engagement, functionality, social interaction and accessibility issues. Women use these services more than men, but research shows that they are still not fully trusted.
Searching for help
When facing mental health difficulties people often start with Google, using their own terms (for example, ‘life sucks’, ‘I want to die’), which won't lead them to good resources. But even if a result returned is good, it still needs to be appropriately formatted. For example, if a result is too text heavy, people won't read it - they are much more likely to view video, interact with forums, or even use light-hearted quizzes and the like.
Another problem is that no-one looks past the first page of a search, which makes some negative resources easier to find. That could include pro-anorexia sites, and even sites that give suicide method recommendations. As Dr Pennington pointed out, ‘we can't compete with what Google returns, so need to set up and encourage the finding of positive information.’
In the BCS role of making IT good for society this raises some interesting questions about the moral role of algorithms and search engines, and those who design them. Can/should they continue to be agnostic about results in areas like this?
A recent study on how online content makes us feel asked participants to search for things to make them feel better, and it showed that these searches are actually quite difficult to articulate. Explorathon 2016 asked people to search for feelings-oriented services or content, but the end result was that people tended to search for things they already knew would make them feel better - such as an uplifting song - rather than being able to do a search in more general terms that returned helpful results. There are clearly some excellent resources out there. The sheer number of them indicate that there is a need, and that those in IT are clearly trying to fill it. But there is still work to do.
The bigger picture and getting involved
Beyond the issues of mental health, or the specifics of any one area of healthcare and its domain-specific issues are larger things that need to be resolved – largely under that banner heading of ‘person-centred care.’
In May this year, a new campaign was launched to inspire those in a position to harness technology to put people and their communities first. It aims to gather people working on health and care digital and bring them into a multi-disciplinary community. That way it can help them to share ideas, good practice, and turn that into standards that they apply to themselves.
Its objective is to unlock the potential of everyone involved in making health and care the best it can be, harnessing information and technology. It’s called Well Connected and is brought together by The Federation for Informatics Professionals in Health and Social Care (Fed-IP), organised by a coalition comprising of BCS, The Chartered Institute for IT, CILIP, IHRIM and Socitm.
The pledge asks an individual to: actively promote and demonstrate their commitment to putting communities first in health and care, and to set an expectation that others do the same; seek to learn, develop and share what delivers the best health and care; not tolerate professional or organisational rivalries that conflict with what communities need; and play an active role in their own professional community, and multi-disciplinary communities that support these aims.
The Well Connected pledge page is here: https://forms.bcs.org/fed-ip/1/
And if you’re not in healthcare directly, there is also an open pledge that anyone in the NHS or indeed members of the public can sign to show their commitment. It is here: https://forms.bcs.org/fed-ip/2/