March 31, 2012 1 Comment
This post discusses the recent Mind Tech Unconference, a transcript of the back channel discussing the day can be found in my previous post http://claireot.wordpress.com/2012/03/31/mindtech-the-unconference-grabchat/
There are several issues that I immediately wished to comment on, namely, commissioning criteria in the new health economy, how this is impacted on by the ides of #mentalhealthpound, the scope of using Apps to support mental health, social prescribing, and the place of the social enterprise in poulation based mental health promotion activity.
This point in time is fairly unique, in terms of the transitions happening in healthcare commissioning I was reliably informed at the #AHPNorth Conference this week by very senior members of the Department of Health just how the new commissioning environment is likely to work. Currently, the system of tariffs for work done has contributed to the “Cinderella” nature of mental health services, as well as thorny issues in attempts to implement Payment by Results etc. One of the salient points is that rather than rely on these historic tariffs as a system for commissioning care, we are more likely to see population based commissioning coming to the fore. Now, one of the advantages of this is that (in theory) it then becomes possible for a successful mental health promotion service to be commissioned, if they can show an effect at population level for reducing the incidence of mental illness, and a reduction on other areas of the service such as inpatient admissions. This has huge implications for the work of organisations working to promote good mental health such as Moodscope and Mindapples, who both presented information at the Mind Tech event. I’m not clear about the outlined ideas of the #mentalhealthpound presented at the event, but look forward to exploring these and looking at how this in combination with the commissioning environment means we can address funding issues relating to many fantastic projects that many people like myself wish to engage with.
We all know that the recent MapsandApps project run by the Department of Health was a huge success, and that it really shifted some thinking about how to use crowdsourcing and technology to help to address health inequalities, and to promote good health. In my opinion, this benefit has hardly been touched on in health services, and particularly in mental health services. There are concerns with the Informatics agenda related to this. Who owns the information uploaded by the patient? What are the ethics of allowing the app development company to be selling this (anonymised) information on as another income stream? If these issues are worked out, how do they impact on how our statutory services are funded-will they be expected to pursue similar revenue streams using their valuable data?
It is also worth noting that apps and devices that can take advantage of gaming theory could have an impact on adherence to treatment regimens, perhaps even medications compliance. We know that there is a cost impact to this- as people adhering to treatment regimes and medications schedules are cheaper to engage in health services. If we see the wholesale adoption of gamification in tech applications in health and mental health, how will this affect the bottom line of organisations delivering care?
We know the future is co-morbidity. In the same way that we are now comfortable with APIs that mash up data from several social networks, could we see implications in Telecare and Telemedicine as APIs are developed that mash up data gathered by different specialists, different healthcare providers, that bring personalised, granulated information down to the point of care delivery by doctors and healthcare providers? What does it mean for the de-professionalisation of medical and therapeutic services when these APIs become available to the general public? Will they result in greater self-care, or will they result in people choosing to treat themselves rather than engage in formal healthcare provision?
Social Prescribing- or Occupational Therapy?
I was interested to read one of the first blogs produced upon reflection of the Mind Tech event, by Puffles (working, as ever, with his Bestest Buddy). To read the blog, please see here http://adragonsbestfriend.wordpress.com/2012/03/30/mind-tech-unconference-30-march-2012/
Bestest Buddy has frankly documented his own difficulties with managing his menetal health, and gives us a great insight into tunderstanding of the nature of mental illness. He describes:
one of the big challenges I faced was getting away from the idea that a short course of medication was going to solve things. It didn’t and it hasn’t. If anything, it’s made me realise that medication in my case has only suppressed the worst of the symptoms and that a longer term recovery is only going to be achieved through a tailored/personalised combination of other things.
Bestest Buddy relates his idea
Conditions such as moderate to mild depression and anxiety by their nature affect and are affected by the lifestyles that we lead. Every time I’ve been through an acute period of anxiety, depression or generally being ‘a mess’ I’ve tried to pick myself up by trying new actions and activities to deal with it.
When I read this sentence, I was struck by the notion that if I had been asked to define what mental health occupational therapy does, my definition would have been very close to that of Bestest Buddy’s idea of social prescribing.
giving patients and GPs the option of looking at what activities might be beneficial for patients I think would be brilliant. Rather than a course of medication and a few sessions of counselling alone, what about things that can complement such treatments? And how about making them on the NHS? This could include things like exercise classes, cooking classes covering things such as foods that help and hinder conditions such as anxiety. It’s one thing saying ‘avoid X,Y & Z’ but quite another to build it into a lifestyle.
It is clear that despite the wish of the public for activity based intervention to mediate mental health difficulty, this is not associated with Occupational Therapy treatment We have to ask ourselves as a profession, why is this? Despite our rich and growing evidence base within the profession and the related dicipline of occupational science, why is the message not getting through to the general public about what we do? How can it be that people who are engaged in mental health treatment, and who are in attendance at events with other members of clinical staff are not being informed that what they are talking about is occupational therapy?
This is a topic we may cover on the #OTalk #occhat hashtags on Tuesday nights as part of our regular weekly peer-supervision Tweetchats. I think its an issue that deserves some of our attention. The analysis, prescription, and grading of activity to facilitate health really is the bread and butter of what we as OTs can offer. In the new health ecology, we need as a profession to start to stand up and define ourselves in terms that the public can understand- perhaps social prescribing should be added to our list of core competencies? I certainly believe that this is in line with advice I have taken on board from Karen Middleton, the Chief Health Professions Officer at DH after listening to her rousing speech at the AHP North conference.
Social Enterprises in Population Based Commissioning
Taking on board the Section above looking at commissioning, it becomes clear that this is a real opportunity for ex-NHS staff, service uers, mental health activists, and social entrepreneurs who want to make a shift into promoting mental health rather than waiting for mental illness to develop. It’s my belief that this commissioning environment will start to have an impact on the number of Social Enterprises, and the reach that they will have- moving out from community development activities into health promotion, and hopefully into peer-support networks commissioned to mediate mental illness.
I’m working on an interesting Social Enterprise idea which uses peer-support, in combination with appropriate APIs and my Occuaptional Therapy background to both promote good mental health and to catch the early warning signs of mental illness developing. Although it is a worrying time for people who care about healthcare in our Country, I am beginning to think that if we do get this sea-change in the nature of commissioning decisions, then we can see the stage opening up for players like myself and many others, who find their innovative ideas are very difficult to develop within traditional statutory services, and within the big voluntary sector organisations. We are nimble and agile in our peer-to-peer solutions to these issues, perhaps our time has come?