Pulse Online recently shared its first ever podcast – a discussion with Technology Enabled Care’s (TEC) programme leader, Morag Hearty.
This conversation provided an insight into how TEC is used to enable direct patient to health and social care staff video links, remote monitoring of health matters such as blood pressure and diabetes – and much more.
One prominent theme was how technology can be used to provide mental health support. Our resident podcaster, Ewan Summers, was eager to explore this further – and find out what it all meant in practical terms.
That brought him to Dr Adam Daly, a consultant psychiatrist who’s been using the video platform Near Me to deliver digital care for patients.
Among other things, the pair discussed the benefits of video versus telephone consultations, how to assess which platform suits each patient, and how other forms of technology such as apps are used in supporting mental health.
So, relax, take a break from the screen and enjoy listening to this new instalment of the Technology Enabled Care podcast series.
Podcast Music: ‘Roll the intro’ and ‘piano sting’ by Alexander Nakarada
Licensed under Creative Commons BY Attribution 4.0 License
Feedback
What did you think of this podcast? We’d be really keen to hear your views. Email euan.duguid@lanarkshire.scot.nhs.uk
If you have any questions related to TEC, Lanarkshire’s TEC team will be delighted to support you. Email them on: TEC.Programme@lanarkshire.scot.nhs.uk
Podcast Transcript
Ewan: Hello and welcome to the second episode of the Technology Enabled Care podcast. My name is Ewan Summers and I have been fascinated by the massive growth in use of Technology Enabled Care, which is also known as TEC for short. TEC enables everything from providing a direct patient-to-healthcare-staff video link to remote monitoring using everyday text messages, and much more. In the first step of this journey of discovery, I spoke to Morag Hearty, who provided an overview, past and present, of TEC, so I was determined to find out just how it’s being used in practical terms. That brought me to Adam Daly, a consultant psychiatrist who’s been using the video platform Near Me to deliver digital care for mental health patients. Among other things, we discussed the benefits of video versus telephone consultations, how to assess which platform suits each patient, and how other forms of technology such as apps are used in supporting mental health issues. So please, sit back and enjoy our conversation. And without further ado, I give you Adam Daly.
Adam: Near Me works in some ways very similar to a normal appointment would. The patient comes along to a waiting room – but in this instance, it’s a virtual waiting room – and then the doctor involved will call the patient through and bring them into an appointment. There’s a facility in Near Me as well to use more than one person at the same time and that can be very helpful. So if somebody has a relative, for example, even if they’re in another part of the country, they can join for part of the assessment as well, either to support the patient or to give more information. One of the great things about Near Me is that you actually get to see the person that you’re talking to. And I think that is phenomenally useful in a mental health setting, because things like eye contact, whether or not somebody’s washed and dressed appropriately. All of these things are subtle things that you don’t notice whenever you’re on the phone with somebody, but which provide a huge amount of information about how they’re doing. Most of the appointments will last, if it’s a return appointment, it can be 15 minutes to half an hour. If it’s a new appointment, it would usually run between half an hour and an hour, depending on what the person’s issues are. And by the end of that, we’d usually be in a position to make a plan with the person about what we wanted to propose and what we wanted to happen next. So that could be another appointment, it could be a talking therapy, it could be medication, so a variety of things. But they would all follow in much the same way as it would in a normal outpatient clinic.
E: Have you found that technology has helped remove any perceived stigma of going into a clinic?
A: I think to an extent, yeah. So it brings pros with a few cons, which I’m sure we’ll get to later on, but an awful lot of benefits. So one thing that people would often find difficult is interrupting their life in order to come to a hospital. And, you know, we could see that happening potentially in the future with people who are at work, for example, if all you need to do is take 10 minutes to go and do a Near Me call with somebody and just sit in your car or, you know, somewhere private to do that, versus taking an hour to drive to the outpatient clinic and then wait and then drive back again, it really means that the service becomes much more accessible to a wider number of people. The other group of people that it really helps is people with physical disabilities as well, and people who are, for other reasons, unable to get to the outpatient clinic. So it really opens things up for those folk.
E: So you would say that it’s helped more with accessibility?
A: Yeah, I think so. Mental stigma is something which is sadly alive and well in our communities. Most of the people who are coming to our clinic have been affected by that at some stage, but obviously the people who are coming to our clinic are the ones who have managed to get over the stigma barriers enough to come and see us. The people who I worry about more are the people who are still staying away. So to them, I think I would say that Near Me offers a different way to engage with us that maybe doesn’t cause as much of a highlight and might reduce stigma for them. But I would say that, you know, overall and everybody in mental health would say this is that there really should be no stigma around coming forward to get help for mental illness. It affects many, many people in the community and everybody will know someone who has been affected by mental health. So it really shouldn’t be a stigmatising thing for anybody out there.
E: How long have you been using Near Me? And have you seen a rise in sessions since it became more prominent?
A: Yeah, so we’ve been using Near Me for a year now; we had just a little bit of sporadic use before the pandemic. But really, since the pandemic took off, we’ve really increased our use enormously. So we’ve gone from only having a handful, as I say, to hundreds of Near Me appointments every week now. And that’s not just with doctors, such as myself, but with our nursing staff and with our psychologists as well. And it ranges across the age spans. So from our Child Adolescent Mental Health Service all the way up to our older adult service. Lots of people can make use of this and there really aren’t that many barriers to a lot of people. It is always very important for us to consider the people who there are barriers for, however, whether that’s through physical disability, or intellectual disability, or financial issues, there will be some people out there who cannot access these things. So for them, we need to make sure that we’re offering something else, a face-to-face contact, a phone contact, and I’m really trying to make the appointments that we offer as person-centred as we can.
E: Do you believe that the rise that you have seen is because it’s more accessible or do you think it’s because of additional hardships brought on by COVID?
A: I think that it’s a multifactorial answer to that, obviously. I think part of the reason is the clinicians, to be honest. I think a lot of clinicians were very hesitant about using Near Me to start with; I think that a lot of people, particularly in mental health specialties, felt that there’s nothing quite like seeing somebody face-to-face. – and I think we can all agree that that’s true. But there is a place for Near Me and I think that once people appreciate it, that you can actually have a conversation with somebody over Near Me and still get something out of it. You can still do most of your assessments, you can still build up a bit of trust with somebody, it really helps people become more comfortable with that. And I think that’s mirrored in wider society that a lot more people are using things like video calls to connect to other people out there. So I think that that pushes the rise, people being more comfortable with the technology. I think, unfortunately, that there is there is an increasing hardship out there, and people are more isolated now than they have been. So people are seeking more contact. And certainly, we see more people coming forward for mental health support and mental illness support, so there is that end of it as well.
E: It’s interesting what you say about folk getting to grips with the technology. I wonder if it would have an impact because we’re using, for example, Teams and Zoom more, whether because that’s something that folk are becoming used to, whether they feel more comfortable with doing it than, say, going into a clinician.
A: Yeah, I think there’s certainly a part of that. Yeah, I think that’s an important part. If you go back a year, I think people were using video calling but not so much the way that we’re doing it now. And it certainly still felt a little bit stilted for a lot of people, whereas now I think folk are more used to it and can adapt to it a little bit more as just the norm.
E: How do your patients feel about using it? Have you spoken to them about it?
A: Yeah, so there’s a variety of experiences as you would expect. Some people are very happy using it. Some people actually seem more grateful whenever you do a call like this than whenever they would come up to the clinic, which I always think is quite an interesting thing.
E: Why do you think that is?
A: Well, because the visit at the clinic, I would automatically think that people would probably appreciate a face-to-face appointment more. But people seem to be much more appreciative whenever we’re doing our remote consultation, which is, yeah, I don’t have a good explanation for that, I’m afraid. But it is good, and there are some people who don’t like it, there’s no doubt about that, and as I said earlier, for those people, it is difficult at the minute because the pandemic is still ongoing. It’s really the people who are unable to do Near Me that we prioritise rather than the people who just don’t like it. In the fullness of time, I think that we’ll offer a suite of options to people of what we’re able to do for them. But at the minute, just with the infections still out there, we are limited in options. I think we can really appreciate whenever people make an effort to do the Near Me consultation, even though they don’t particularly like it because it does make the assessment better, so it makes it easier for us to be able to tell what’s wrong and try and be able to get the right treatment for somebody. So the effort that people make is really appreciated there.
E: Has the pandemic accelerated any changes that you were planning on implementing anyway.
A: Yeah, so we were planning on making these changes and making this offer to people. And we’d had a good few discussions about it before the pandemic started. So we were in a very good place, we sort of knew what we wanted to do. And we’ve had a few demonstrations of Near Me, so we kind of knew what it was about, and we had most of the computers and stuff ordered, so we were in quite a good place. And then, obviously, we were just pushed toward it whenever the pandemic came, because, all of a sudden, we weren’t allowed to see anybody face-to-face, and rather than just stop the service, which we couldn’t do, it was really about how do we try and do this the best way that we can under the circumstances? So yeah, these plans were here but it’s always a case of trying to make sure that we use the right mode for the right person, rather than just saying, you know, the whole service will go to Near Me, for example.
E: And is that something that you would aware of? Before in-person appointments were made much more difficult, were you aware of who would be suited to which one?
A: No, because I think we’re still learning about that. And I think there are certain conditions which are certainly harder to assess remotely. And I suppose for some people for whom Near Me is their preferred choice, we have to try and work out how do we work around that. So, for example, memory assessments is something that we find quite challenging to do, but there are now apps that are becoming available and digital ways that we can test people’s memory remotely, rather than me having to, you know, hold up a piece of paper and try and get them to read off a piece of paper over the video camera. So it is a matter of trying to try to adjust what you’re doing for the person on the other end of the camera. There are other people that we see who feel very persecuted and very afraid and they feel that doing the video call will actually be a detrimental thing to them overall. And for them, obviously, we would see face-to-face as well. And one of the things that we look at as well are people who are perhaps in a difficult relationship or are the victims of abuse, and maybe they can’t get a safe place to talk to us. And that’s another thing that we have to look out for as well. We always have to be mindful that whenever people come and see us in a clinic room, they’re usually by themselves for at least part of the appointment so that we get to know more about what’s troubling them in isolation, and that might not always be the case if there’s somebody sitting just out of screenshot or in another room nearby. So it’s one of these things that we are learning as we go. And I think it’s been a very informative process,
E: I’d be interested to know a wee bit more about the apps and the other remote means of testing memory.
A: Yeah, so there’s a few things. They started off with looking at paper copies – and we have tried that a little bit. So what we would do is post out various diagrams that people have to copy and pictures that they have to read. But one of the new features of Near Me now is screen sharing so that’s been very helpful. Because, for example, in one of the naming tests, which tests language, where initially we were holding up a piece of paper in front of us and then we were posting it out, we can put it up on somebody’s screen and it can make it a much easier experience for people. There are also those starting that we haven’t explored too much yet, but we will, is apps that can actually be set up to test people’s cognition. Because that’s obviously quite a sensible and interesting way. If somebody is, you know, used to using a phone or a tablet, they could potentially use a lot of these apps very easily. So yeah, it’s one of these interesting areas that we haven’t explored pre-pandemic. And we’re kind of, now because we’ve been pushed into it, it’s opening up an awful lot more, and we’re able to explore an awful lot more.
E: I didn’t think of other means of technology to help with mental health nursing but the apps are really interesting.
A: Yeah, so one of the things that my psychology colleagues have been very keen to promote are apps for treatment. So what we’ve just talked about our apps for assessment, but my colleague, Dr. Gary Tanner, has put together with his team a great website, which I’m sure we could share the address of later on, and it has an awful lot of self-help direction, including CBT-based helps – Cognitive Behavioural Therapy apps – that people can make use of without even having to go to a healthcare professional. So all sorts of very interesting things that we were circling around, and certainly we’ve had some sort of computerised CBT for quite a while. And we know the evidence says that it’s very effective. But to have a process now where we can do an awful lot of things, from assessment through to treatment through online and apps and things, it’s very freeing. It’s very good.
E: What was the website?
A: lanarkshiremindmatters.scot.nhs.uk. One of the problems that we have always, as doctors, is not having enough time to do all the things that we want. And there’s always more patients that we want to see, and there’s always more assessments that we want to do. And one of the things with that is, ideally, if we had all the time in the world, I would go and visit every patient at home, I think it adds a lot. But it’s much more efficient and we can see more people if they come up to an outpatient clinic at the hospital. By doing Near Me, I get to see people at home, and I get to see what their living environments are like. And it can be very, very revealing and can tell you an awful lot about how that person’s life is going. So yeah, it’s a huge advantage to us in that way too.
E: Adam, thanks a lot for joining me. You’ve been really insightful about how technology is used in psychiatry, and I hope our listeners are just as satisfied as I am. So thanks a lot.
A: Great, thank you for asking me to come along.
E: No problem, it’s been great. Thank you.
