On 14th of April 2016, Mark Brown (@markoneinfour) ran a mental health minihack at Marmalade, the fringe of the Skoll World Forum in Oxford. In preparation he prepared three provocations to put to attendees for areas where it would be possible to innovate in mental health as actors coming from outside of the established publically funded system of mental health treatment and support.
Attendees were told to apply their knowledge and experience to addressing these presenting issues.
Below is the second of these provocations ( (The first ‘Payment by Results – outcome measures – getting data – arranging payment’ can be found here and the third ‘ Provocation for innovation 3: Frugal innovation – making good stuff happen with eff-all cash’ can be found here)
Provocation 2: Communication is flakey
The NHS is the prime provider of mental health services in the UK. The target of a paperless NHS has remained an ever-postponed target. The latest target for this is 2018. Even if the NHS does go paperless internally; it still has a preference for letters and faxes.
From a user perspective, the hierarchy of communication is often
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Letter
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Phonecall
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Follow up phonecall
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Maybe another letter
Large mental health providers are still at the stage of central switchboards and extension numbers. People in offices take messages for colleagues who are not there. A patient must, for example, know exactly what service any professional they are trying to communicate with falls under and the their exact name.
The NHS mental health workflow has not been updated to include instant or asynchronous electronic messaging. Internally, the ‘ring round’ is often the way in which tasks are achieved ‘in real time’ (the traditional ring round to find a bed); with email functioning more as an analogue of letters and memos rather than as a form of instant communication. There is still a lot of ringing to check to get things done.
Electronic communication is considered differently by different trusts and organisations. Some consider it risky; especially if it involves text messaging via mobile service. Others are concerned by the privacy aspect communication that is non-paper or isn’t face to face.
Patients, clients and service users are still at the mercy of letters, photocopied letters and telephone calls which present obvious challenges for those without secure housing; those with communication difficulties and those for whom their mental health gets in the way of doing things like opening letters or taking unexpected phone calls.
Internally, patient records and patient notes are still in many ways analogue. They are often physical files with accompanying digital notes. Record keeping can be unwieldy; subject to differing levels of diligence by staff and often creates something that is not translatable fully into data.
While patient accessible electronic records are always ‘on the horizon’; in practice it often isn’t clear what the use case for these will be. There are a number of projects working upon the idea of patients being able to amend or add to existing records.
At present much of the communications traffic from service provider to service user is one way. The organisation tells or informs; the patient or service user acts.
In situations where support is provided by telephone such as Crisis Home Treatment teams, only 14% of people feel they receive the support they need according to 2016’s Mental Health Taskforce Report.
A number of organisations have developed apps and similar to help colleagues communicate with each other. One NHS Trust has developed an app that allows any member of staff to locate another member of staff while they are on the hospital estate; and a similar app so that clinicians can locate patients when they have been moved around the estate, for example when they are being prepped for surgery. In many hospitals there is one telephone per ward.
Presenting problems
How might mental health service providers better communicate with those they serve?
How might service users or patients collaborate on a meaningful health record, if a health record is what the collaboration should be?
How might different mediums of communication be used within mental health services to increase efficiency and patient or user satisfaction?
How could information and communication be used to match resources with need better?