Blended care: eHealth and mental health provision

NHS Providers found that 80% of bosses of NHS trusts fear they cannot provide timely, high-quality care to the growing numbers of people seeking mental health support. Resulting in the NHS increasingly looking to eHealth as an alternative solution. The NHS has been presenting webcam and instant messaging, (IM), appointments to patients to ease pressure and waiting times, as a combination of rising demand and cuts to the workforce provides a real challenge for NHS mental health services.

The limitations of eHealth

However, since clinicians often have a minimal or no role in stand-alone eHealth initiatives, they stay in doubt about their usability and clinical effectiveness. Currently, the number of evidence-based eHealth interventions is limited. As such, care providers remain sceptical that eHealth can significantly reduce waiting time pressures and improve the quality of life for their patients and their relatives. In addition, most eHealth interventions are highly standardised and can’t be easily adapted to meet the personal needs of each service user.

The success factors of blended care

These shortcomings can be met with a blended care format that embraces eHealth while keeping clinicians firmly in control. For this to be an effective and acceptable treatment method, it needs to meet three key requirements.

Firstly, face-to-face and digital solutions should complement each other qualitatively in a way standalone webcam or IM-based initiatives are unlikely to achieve. Clinicians are able to maximise face-to-face sessions as necessary for high-quality therapy, and consider digital alternatives for vital but lower-level treatment.

Secondly, blended care should reflect the specific needs of the service user and the flexible input of clinical expertise. For example, one therapist realised that internet based therapy enabled some patients to make a positive connection with her because they were physically in different locations. It fostered a sense of security that was needed before they were able to participate in deeper face-to-face sessions.

Thirdly, blended care should be time and cost-saving. Considering that there are shortages of specialist nurses and psychiatrists, clinicians simply lack the time to carry out all therapy sessions face-to-face. Blended care allows them to carry out some part of the treatment programme at a time and location that is convenient to both parties, saving travelling time and money.

The benefits to clinicians and patients

Waiting times can be reduced by starting treatment before the first face-to-face session. Patients can complete preparation work online, for example a diary for tracking behaviours, emotions or cognitions. It can give the service user a sense of control from the outset and accelerate the diagnosis and treatment planning process. Equally, clinicians can make other digital support tools available once face-to-face sessions have ended, allowing service users to continue building on their progress.

Traditional therapy focuses almost solely on the individual, though a mental health patient rarely exists in isolation: there will be close friends and family who wish to support but lack the knowledge and tools, or the facilities to join the patient in face-to-face sessions. A blended care approach gives the person’s support network more opportunities to provide effective help.

Adding eHealth components that target secondary health-related problems can optimise treatment services. Mental health conditions can cause financially reckless behaviour, whereas financial problems can in turn exacerbate mental health problems. eHealth modules can include advice on how to address and solve money problems. More importantly from a clinical perspective, eHealth modules can also be applied to help the patient understand the psychodynamics behind their pattern of dysfunctional behaviours, teach them how to recognise emotions that can trigger these behaviours and how to prevent them in future.

 

Blended care is a highly dynamic and flexible care format. It is not just about adding eHealth components to support face-to-face sessions in order to ease pressure on clinicians and waiting times. When done right, blended care can accelerate and deepen face-to-face therapy improving overall health outcomes for patients and the NHS.

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