By Krissie Ferris, Research Analyst, Centre for Health Solutions

Last Saturday, the 10^th of October, was the WHO’s annual World Mental Health Day (WMHD) whose aim is to raise awareness of mental health issues around the world and mobilise efforts in support of mental health.¹ This year’s theme is ‘good mental health for all’, which seems fitting since all of us need to be aware of our own mental health and wellbeing, especially this year with all of us being affected in some way by the COVID-19 pandemic. However, for those experiencing challenges to their mental health, awareness is unlikely to be enough, and tackling poor mental health will generally require some form of mental health intervention. Throughout the pandemic, however, primary care mental health services (like many other healthcare services) have had to adopt new ways of working to provide access to care in the face of lockdowns and social distancing measures. This has driven a wider adoption of technology–enabled ways of working, and changed fundamentally the face of primary care mental health support. This blog reflects on what has changed, and the opportunities for digital mental health care moving forwards.

The increase in demand for digital mental health services

Typically, around one in six people will experience a common mental health problem such as anxiety or depression in any given year.² In England, people with common mental health problems are offered two main types of primary care interventions: medication from their GP, and/or talking therapies. Talking therapies are delivered through the Improving Access to Psychological Therapies (IAPT) services.

Over the past eight months, a growing body of evidence indicates that the pandemic has worsened the mental health of many people.³ Specifically, analysis by the Institute of Fiscal Studies, using longitudinal data from the Understanding Society study, found that mental health worsened substantially (by 8.1 per cent on average) during the first two months of lockdown and social distancing. Moreover, that young adults and women, the groups with worse mental health pre-pandemic, were the hardest hit.⁴ In addition, in June 2020, the ONS reported that almost one in five adults (19.2 per cent) were experiencing some form of depression, almost double the percentage experiencing depression before the pandemic (9.7 per cent - July 2019 to March 2020).⁵ Consequently continuity of access to evidence-based mental health support has never been more important.

To ensure care continuity, many IAPT services have adopted new ways of working, swapping traditional face-to-face appointments for telephone or video appointments. Our recent report, Digital transformation: Shaping the future of European healthcare, identifies the wider challenges facing healthcare systems in meeting demand, including mental health, during the pandemic and features a number of case studies providing some solutions to the challenges, including SilverCloud Health an on-line platform providing digital interventions for mental health conditions.^6,7

Recently, Dr Lloyd Humphreys, Head of Europe for SilverCloud Health, joined us for our latest episode of our Life Sciences Connect podcast where we explored the findings from the report. Dr Humphreys explained that SilverCloud has seen a 400 per cent increase in the UK in the use of its services since the start of the pandemic. Specifically that “IAPT services went from about seven per cent utilisation of SilverCloud’s digital technologies for appointments to almost 30 per cent”.⁸

The role of digital mental health services in the NHS recovery

While digital mental health consultations have increased across the sector, during the peak of the pandemic there was a 30-40 per cent reduction in total mental health referrals.⁹ Once the lockdown restrictions were eased over summer, referrals have risen above pre-COVID-19 levels. Some providers are predicting a 20 per cent increase in demand across all of their mental health services, while also facing a 10-30 per cent reduction in how many patients they can care for at any one time because of the required infection control and social distancing measures.¹⁰ Digital technologies are likely to continue to be essential in helping mental health services cope with the anticipated surge in demand.¹¹

Some areas where digital deployment can help include:

• Improved adherence: in 2019, 1.69 million people were referred to talking therapies, 1.17 million started treatment, and just 606,192 completed a course of therapy (two or more sessions).¹² Digital therapies are more flexible and can improve ease of access by removing barriers due to travel and the need to take time off work with many patients choosing to be treated on evenings or weekends.¹³
• Enhanced recovery: in 2019-20, just 51 per cent of the 606,192 patients who completed IAPT therapy recovered.¹⁴ Digital therapies report higher recover rates (58-62 per cent) than traditional face-to-face services.¹⁵
• Reduced waiting times: Of the patients that entered treatment in 2019, 87.4 per cent had their initial assessment within 6 weeks of referral, and then waited 45 days for their next appointment. Digital therapy can reduce waiting times to days instead of weeks.¹⁶

Personal Reflections

I started my career in the NHS as a Psychological Wellbeing Practitioner and am trained to assess and support people with common mental health problems. Throughout the pandemic, I have been delivering therapy to NHS patients through ‘Ieso’, a digital health platform where patients can receive one-to-one cognitive behavioural therapy (CBT) via WhatsApp-like chat sessions.¹⁷ This has provided me with first-hand experience of the role that digital technologies can play in shaping the future of healthcare and improving both the clinician and the patient experiences.

As we note in our Shaping the future of European healthcare report, digital transformation is not just about technology, but requires a change in mind-set and a change management approach to support clinicians to work differently. This requires the right IT infrastructure to be in place, committed leadership and technologies that have ‘SMART’ characteristics (simple, measurable, agile, reliant on collaboration, tailored to end user’s needs).¹⁸ Only then will mental health services be able to realise the true potential of digital technologies in addressing their current and historic challenges, as well as enabling patients to choose a treatment appropriate to their needs.

No one is immune to mental health challenges. As Mind, our charity partner, puts it: “mental health problems can affect anyone, any day of the year, but WMHD is a reminder to show your support for better mental health and start looking after your own wellbeing”.¹⁹ You can find tips for staying well, as well as more information on how to get involved in world mental health day here, and if you are in need of support, you can find your local IAPT service here.

Krissie Ferris - Research Analyst, Centre for Health Solutions

Krissie is a Research Analyst at The Deloitte Centre for Health Solutions where she combines her diverse work background with her research skills to help find solutions for the challenges impacting the healthcare and life sciences sectors. Prior to Deloitte, Krissie worked initially in the NHS’s mental health sector before joining a health tech start-up. She has a MSc in Neuroscience from King's College London and a BSc in Psychology.

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¹ The World Health Organisation, “World Mental Health Day”, accessed 13 October, 2020.
² Mental Health Foundation, “Mental health statistics: the most common mental health problems”, accessed October 13, 2020.
³ The Health Foundation, “Emerging evidence on COVID-19’s impact on mental health and health inequalities”, June 18, 2020.
⁴ Userstanding Society “Longitudinal changes in mental health and the COVID-19 pandemic: evidence from the UK Household Longitudinal Study”, June 3, 2020.
⁵ Office for National Statistics, Coronavirus and depression in adults, Great Britain: June 2020, June, 2020.
⁶ Deloitte Centre for Health Solutions, Digital transformation: Shaping the future of European healthcare, September, 2020.
⁷ SilverCloud Health, see also: “https://www.silvercloudhealth.com/uk”, accessed October 13, 2020.
⁸ Deloitte LLP, Life Sciences Connect, “Episode #5: Digital transformation in healthcare”, October, 2020.
⁹ NHS Confederation, “Mental health services and COVID-19, Preparing for the rising tide”, August, 2020.
¹⁰ Ibid.
¹¹ Ibid.
¹² NHS Digital, “Psychological Therapies, Annual report on the use of IAPT services 2019-20”, July 30, 2020.
¹³ Ieso Digital Health, “Waiting times”, accessed October 13, 2020
¹⁴ NHS Digital, “Psychological Therapies, Annual report on the use of IAPT services 2019-20”, July 30, 2020.
¹⁵ Ieso Digital Health, “2020 will be the year of real world evidence”, accessed October 13, 2020.
¹⁶ NHS Digital, “Psychological Therapies, Annual report on the use of IAPT services 2019-20”, July 30, 2020.
¹⁷ Ieso Digital Health, see also: “https://www.iesohealth.com/en-gb”, accessed October 13, 2020.
¹⁸ Deloitte Centre for Health Solutions, Digital transformation: Shaping the future of European healthcare, September, 2020.
¹⁹ Mind, World Mental Health Day 2020, accessed October 13, 2020.