New data reveals suicidal thoughts down 30% Sarah Bateup shares some
Welcome to Ieso Insights magazine
For as long as I can remember the Ieso team have been collaborating with customers, partners, staff, therapists and data scientists to collect and share intelligence relating to the science of therapy, the state of treatment, latest techniques, developments in commissioning and all things NHS psychological treatment related. This magazine is our way of sharing this information more broadly to hopefully help more people. I hope you are interested in what we are learning. We really want to hear from you too and share this knowledge with all our colleaguesacrosstheNHS
If you haven’t heard of Ieso, please allow me to explain a little about what we do. We aim to improve mental health using clinically-proven digital healthcare solutions that put patients and practitioners first and remove barriers to treatment and recovery. Our therapy platform provides a confidential and discreet online CBT service with a network of qualified therapists and PWPs. Our technology enables CBT to be delivered anytime, anywhere through secure, real-time instant messaging. To date we have conducted over 300,000 therapy hours and treated over 50,000 patients in the NHSIAPTprogramme.
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James de Bathe, Director of Partnerships
Welcome to the first edition of Ieso Insights. I hope
James de Bathe, Director of Partnerships
04 06 08
A letter from our CEO, Nigel Pitchford
New data reveals 30% drop in suicidal thoughts
10 12
The silver lining of rapid adoption of digital therapy
16
Why digital appointments hold the answer to wait lists and stigma
18
Advances in clinical supervision IAPT mental healthcare service status summary
22 24
Sarah Bateup shares advice on how to deliver remote therapy effectively
What patients say
Impending surge in mental health patients
14
West Kent’s Zena Watson shares her Ieso experience
20
Day in the life of a therapist during lockdown
25
Careers and subscription
A message from our CEO
We’re here to help as demand for mental healthcare surges
Nigel Pitchford , CEO, Ieso Digital Health
Over the past few months, the world as we know it has altered dramatically. It has been a time of change and challenges for everyone and, after many weeks of confinement at home, the extraordinary times we now live in will be taking their toll on many people’s mental health. It is a time when people will need mental healthcare more than ever before, so continuity and quality of service has never been more critical, and is a key priority for us and the NHS.
Over recent weeks, we have scaled up our service to meet increased demand in digital delivery. We are working with our NHS partners closely to help anyone who has mental illness get access to the treatment they need.
We understand many of us are dealing with uncharted territories and uncertain times, and if you feel worried about your mental health, we encourage you to come forward and talk. Please don’t feel that your symptoms are not important or normalised due to more of your family and friends talking about their own feelings and distress.
If you are worried about putting more pressure on NHS staff, or that your GP is not available to refer you – they are working virtually and are there to help, so don’t be afraid to ask. We are working closely with IAPT and our NHS partners to ensure services are up, running
and accessible, and we are here, on hand and ready to help. To find out more about support available, please visit the NHS psychological services page.
If you need support, you can refer yourself online or by contacting your GP or local mental health service directly. Alternatively, you can visit the NHS website and find a list of psychological services nearest to you. By scaling up our online CBT service, we can treat many more patients, sooner. Our therapists and psychological wellbeing practitioners (PWPs) are ready to help you.
Ieso has always delivered psychological therapy online, so it is business as usual for our team, who are all working from home and are ready to support you. We are committed to sharing our knowledge and using our technology to continually improve the quality of our care, by monitoring what is working in treatment, and by making high-quality, free training and resources available to therapists so they can learn and share knowledge during this challenging time.
We are now treating more patients through IAPT than ever before. In April, we hit record numbers in therapy delivery, providing online CBT to 2163 patients compared to 1002 in April 2019. We aim to support everyone in our community by offering treatment to as many people as possible including our own employees, therapists and NHS staff that may be needing support at this time.
As we transition through the next phase of this journey, the work we have done means we are prepared and can scale to meet any surges in demand. Navigating through the unknown is difficult for all of us, but we care and will be by the side of the NHS, our IAPT partners, therapists, PWPS, and patients as circumstances continue to change. If you are worried about your mental health, seek help now and get the care you need; we’re ready to treat you.
Nigel Pitchford, CEO, Ieso Digital Health
Find our latest COVID-19 updates: www.iesohealth.com/covid19
30% drop in suicidal thoughts since lockdown
Anxiety on the increase but depression decreasing: the coronavirus effect is unique in our time
• Reduction in depressive symptoms while experiencing higher anxiety is a newly observed UK Covid-19 therapy trend
• Decrease in depression seen as patients benefit from ‘collective camaraderie’ effect as fundraising, clapping for carers and community kindness brings people together
• Calm before the storm as surge in depression and anxiety is forewarned
Suicidal thoughts have seen a sustained reduction of up to 30% in patient assessment scores on referral to adult psychological therapies. The trend coincides with the start of lockdown.
Ieso has been tracking patient psychological trends in relation to the coronavirus since the beginning of the year. The decrease in suicidal thoughts accompanies a 10% drop in other symptoms of depression such as tiredness, lack of energy and low self-esteem. This is despite symptoms of anxiety increasing.
We have seen a sustained drop in depression in new patients since the UK Government closed schools and requested the UK public work from home if possible. One explanation for this trend is that the reduction in certain depressive symptoms is being caused by a “camaraderie effect”, often
seen when individuals feel a part of collective community, supporting each other to stop the spread of the virus and fundraising for the NHS.
Dr. Ana Catarino, principal scientist at Ieso Digital Health said:
“Depression and anxiety symptoms often go hand in hand. The contrast we’re seeing at the moment is a first for recorded UK therapy trends. Despite the global crisis and the obvious restrictions and issues we are facing as a society, patients are feeling more positive, even though they’re nervous about the future.”
In the past, studies have shown that camaraderie can positively affect your mental health. Largescale sporting events such as the Olympics or a World Cup come with a sense of belonging and broad social integrations rarely experienced by individuals.
However, experts at the company say current levels of referrals are alarmingly low for a crisis of this scale and an unprecedented surge of new cases is imminent. Before the pandemic, the UK mental health system was already struggling to reach its target of treating 25% of the one in four adults who usually suffer from mental health issues.
Dr Catarino added: “The 30% drop in suicidal thoughts is significant but likely only temporary as we are expecting to see a dramatic reversal when the situation normalises. We’ve seen in history that recessions correspond with an increase suicide rates. In the last few weeks we have seen a pattern emerging around difficulties with sleep, either sleeping too little or too much, both of which can be early signs of depression. This may be related to lockdown restrictions easing, yet life failing to go back to normal, which may be key to recovery.
Dr Catarino concluded: “In contrast to many traumatic experiences, the coronavirus pandemic is not a discrete point in time, but something that is prolonged over several months with no end in sight. This is likely to cause trauma exposure at a global scale at various levels.”
These findings are a result of a preliminary analysis of the impact of the Covid-19 crisis on therapy data collected by Ieso Digital Health anonymised from over 8,000 patients this year. We will continue to monitor and explore this data in more detail during the next stages of this crisis, including investigating the impact of Covid-19 on other variables, such as changes in average required treatment duration and changes in clinical outcomes including recovery rates.
Locals and restaurants pull together to feed front line NHS workers in Hertfordshire. (c) RMC Photography.
Surge of Covid-19 mental health issues set to come
• Delays in help seeking behaviour; unprecedented wave of new patients is imminent
• Easing of restrictions will result in an unprecedented demand for mental health treatment
• 30% of new patient referrals cite Covid-19 as a reason they are seeking support
New data points to an imminent surge in Covid-19 related mental health issues. Data scientists at Ieso believe that current levels of referrals are alarmingly low for a collective crisis such as the coronavirus pandemic. Low levels of referrals indicate that patients may be bottling up mental health issues and postponing help-seeking. This phenomenon has been associated with previous incidents involving widescale trauma such as terrorist incidents and natural disasters.
Due to the scale of the pandemic, this delayed onset of issues will result in an unprecedented surge of new cases descending on the UK mental health system, which before the current crisis was already struggling to reach its target of treating 25% of the one in four people who usually suffers from mental health issues.
Ieso has identified that 30% of all new referrals for therapy cite Covid-19 in their reasons for seeking support. Just 5% discussed money worries in the sessions suggesting these issues, for the moment, pale in comparison.
Dr. Ana Catarino, Principal Scientist at Ieso Digital Health, warns that the UK’s mental health system will be under huge pressure. She says: “The scale of the mental health emergency is going to put services under incredible pressure; there simply aren’t enough therapists. Many services are switching to
Lock down continues to prevent a sense of normality returning to our high streets (c) RMC Photography.
remote therapy delivery but haven’t had sufficient time to train in this mode of treatment. We need to innovate and look at other ways to help patients if we are to have any chance of resolving this issue.”
Across the board, NHS admissions are at a record low, with members of the public choosing not to risk going to hospitals, or burdening the NHS. Referrals to mental health services across the country have seen a drop of 30-60% in April, despite digital services being put in place. The lack of supportseeking indicates people are experiencing too many pressures; and do not have the time or ability to address any issues they’re experiencing.
There are vast sets of triggers for mental health issues in the context of a pandemic. Dr. Catarino explains: “You have people who spend time in hospital without support from loved ones. You have their family members at home alone, unable to be there for their dying relatives or those unable to attend funerals. Those at high-risk who have to live for weeks in a state of hyper-vigilance, constantly thinking they are going to get ill and die. You have hospital staff and undertakers seeing thousands of bodies awaiting disposal with no hope of giving them and their families the usual levels of respect and time. The list goes on.”
As restrictions begin to lift across England, Dr. Catarino warns that this will not necessarily mean anxieties will be alleviated. She said:
These findings are a result of a preliminary analysis of the impact of the Covid-19 crisis on data collected by Ieso Digital Health. We will continue to monitor and explore this data in more detail during the next stages of this crisis, including investigating the impact of Covid-19 on other variables, such as the types and severity of disorders; changes in average treatment duration; and changes in clinical outcomes including how long treatment lasts and recovery rates.
Ross O’Brien, Digital Innovation Director at Central and North West London NHS Foundation Trust, added:
“There is potential for the mental health impact of COVID-19 to be more severe than the physical effects of the virus. Patient referral rates have been alarmingly low over the past few months across IAPT services in England, in London alone we have seen up to a 50% reduction in referrals. This is a concern because we know that people are struggling with their mental health and not reaching out for support from the NHS. There is a wealth of digital technology that is enabling therapy to continue without people needing to leave their homes. We need people to seek the help that is there and not feel that they are going to burden the NHS.”
“The Covid-19 situation is unique in comparison to other disasters. It is not a discrete point in time, but something prolonged over several weeks and months, causing trauma exposure at a global scale at various levels.”
“Compounding this is the lack of ability for people suffering from anxiety and depression to return to anything that remotely resembles “normal life”, which is usually the primary path to recovery - a psychological first aid. In the immediate aftermath of disasters, people need continuity of normal life, and to spend time with others, get back into the swing of their routine. With social distancing measures looking likely to continue for some time, this isn’t possible.”
A white paper sharing Ieso’s findings is available to download here
Covid-19 tragedies will take time to heal, thankfully it has broken barriers to adoption of digital mental health treatment
As published in The Independent
While our social freedoms were curtailed, there were some silver linings for mental health patients, says Sarah Bateup, Chief Clinical Officer for Ieso Digital Health.
The trauma caused by Covid-19, to so many, on so many different levels, will take time to heal. Covid-19 has affected so many of us. You may have spent time in hospital without support from loved ones, been a family member unable to be there for dying relatives, unable to attend funerals or are a high-risk individual living for weeks in a state of hypervigilance. You may work at a hospital as a doctor, cleaner, porter or nurse and seen thousands of people but have been unable to give your usual levels of respect and time. The list goes on.
While we have been experiencing this collective trauma, we have also collectively cared for each other.
I work alongside 700 NHS therapists, and we’ve observed what’s known as the ‘camaraderie effect’ happening across the UK. It’s a mental health phenomenon witnessed during both world wars, where communities and countries pull together against one cause, and as a result, it has a positive effect on the nation’s mental health. It presented itself as a big decrease in suicide rates adults across the globe during wartime, and
similarly since lockdown, suicidal thoughts have dropped by 30% in our new patient assessments.
We have analysed over 14,000 new patient referrals and seen this trend, alongside a 10% drop in other symptoms of depression such as tiredness, lack of energy and low self-esteem. All since being asked to work from home and stay at home.
The camaraderie effect has been seen all around us, giving us a nationwide sense of purpose and belonging. NHS clapping and fundraising, shopping runs for neighbours and local support networks are everywhere.
And while we were in lockdown, we’ve seen the NHS embracing online mental health treatment, bringing down barriers to patient access and moving towards a future of more convenient psychological therapy.
The Internet is part of everyday life and yet, prior to lockdown, very few patients had access to psychological therapy online. The barriers to adopting digital methods of delivering psychological therapy have now been broken as psychologists, psychiatrists, counsellors and therapists have turned to video, phone and text based methods of delivering treatment. Patients across the country are at last able to access treatment from home at a time that suits them and their therapists.
Extended hours don’t always mean working weekends. Few people want to deal with their mental health at weekends and mental health services have learned, to their surprise, that therapists are very willing to work evenings and enjoy working around their lives and the lives of their patients.
One of the benefits of working using online methods is that therapists who might otherwise be unable to work because of a health related problem, caring responsibilities or access to
transport find they can tap into a more flexible work life. Patients no longer have to travel across cities or remote countryside to attend appointments in working hours.
Improving the quality and availability of psychological therapies has been a challenge for many years, but the pandemic has removed those barriers for the benefit of everyone. This is a revolution in mental health treatment, and thankfully, therapists, patients and mental health services want this one silver lining to stay.
Sarah Bateup is Chief Clinical Officer at Ieso Digital Health and chair of the IT special interest group for the British Association for Behavioural and Cognitive Psychotherapies.
Sarah Bateup, Chief Clinical Officer
COMMENT
Why digital appointments hold the answer to wait lists and stigma issues
As published in Health Europa
Digital GP appointments could make it “difficult” for doctors to diagnose and manage patients’ mental health problems during the coronavirus pandemic, the chair of the Royal College of General Practitioners has warned. However, based on many years’ experience providing digital mental health therapy to NHS patients we know that for many patients, digital is an enabler, not a barrier.
We have evidence indicating that enabling patients to access mental health treatment through digital self-referral actually increases patient access and dramatically reduces waiting times. In some CCGs we have seen patient access increase by a factor of ten over a nine-month period once patients learned they were able to self-refer to the service removing the need to refer via their GP. This brings the dual benefit of speeding up time to treatment and freeing up GP time for the more complex patients most in need of their attention.
The NHS mental health leadership are embracing digital care delivery. Digital services play a vital role in enabling people to access high quality care, avoiding excessive wait lists and stigma issues. Going back to the ‘old way’ of accessing
care might not be the best thing for patients or the health system.
Rapid access to targeted care is crucial in mental health treatment. Our research shows correlation between positive response to treatment and shorter waiting times . NHS data in 2018/2019 reports mean waiting times of ~70 days from referral to second treatment appointment in conventional services. This compares to 36 days for Ieso in the same time period. So far in 2020 this number is 26 days. At present, even in the midst of the COVID-19 crisis, we are able to allocate the majority of patients to a therapist on the same day they present to the service. In part, this is because digital delivery enables us to load-balance supply and demand across a much broader geography and avoid localised ‘bottlenecks’.
Stigma remains a real issue and many patients don’t necessarily want or need to go to a GP with their mental health problems. In our experience, many patients actually find it easier to open up about their problems when their care is not faceto-face. Our clinical team tell us patients open-up earlier and patients often need fewer sessions.
Time and time again we find that when we start working with a new CCG, GPs are reticent about digital care delivery. They are concerned that not being physically in the same room will have a negative impact on outcomes. Yet our patient outcomes data consistently exceed national targets and ultimately, they are convinced.
Whilst there will always be the need for face-to-face GP support for some patients, particularly those with complex needs, for patients who have time and travel constraints, live in remote areas, or have social anxiety , digital access can be a life saver. Not to mention that online access may be the only option for some people in the current climate, such as those in isolation or at high risk of infection.
As services are currently less able to offer face-to-face appointments there is a danger that waiting lists will just get longer, unless we embrace new models of care delivery. To reject digital options would simply be storing up problems for GPs and patients alike. The important thing with online treatment is that it must be done well and follow approved protocols. This means using accurate patient outcome measures, therapists with the right training and privacy standards being maintained. Of course, all good digital
services also use carefully designed data-sharing and risk escalation protocols with local GP and other mental health services.
What is undoubtedly needed is more investment in training clinicians in effective online care delivery. Whilst digital is an integral part of the NHS 5-year plan, digital delivery is not yet on the curriculum of most training programmes for health care professionals. It cannot be underestimated that clinicians need support and adequate training to assess and treat patients using any digital method, including telephone and video calls.
Throughout history it is need that drives innovation, ultimately to the benefit of society. The NHS is currently embracing digital access. I hope everyone involved in patient care will closely consider the benefits that it can give to both primary care and patients. With an open mind and careful implementation, the COVID-19 pandemic will leave us with better access to high quality mental health treatment for the long term.
By Andy Blackwell, Chief Scientific Officer at Ieso Digital Health
West Kent CCG shares their experience of working with Ieso
West Kent Clinical Commissioning Group (CCG), who merged with Kent and Medway CCG on April 1 2020, aims to deliver the right mental health services at the right time, to meet the needs of the local population and give patients more choice with treatments. Mental Health Project Manager at West Kent CCG, Zena Watson, shares her experience.
“Our priority is about giving patients choice to select a treatment they feel will work for them, while also ensuring mental healthcare is easily accessible and available to all that need it. While we understand some people will always prefer to visit their GP to discuss symptoms and treatment for anxiety and depression, we also encourage people to take action themselves if they feel their mental health is suffering.”
“We work with our service providers to ensure that people can easily register and self-refer to one of our IAPT services. There is information and options available so patients can make informed decisions about their pathway to recovery. They can select a treatment based on their own symptoms, situation and requirements. This can be through a GP or alternatively, patients can self-refer directly.”
Ieso supports West Kent through a self-referral model, making online CBT available to local residents in the area. From 2017, Ieso was contracted through Thinkaction in West Kent to provide 15% of the IAPT services, which worked well from a digital therapy standpoint. However, while Thinkaction (now We Are With You) still work alongside Ieso to provide digital therapy to West Kent residents, from May 2019 the CCG contracted directly with Ieso.
This gives West Kent direct ownership over the relationship, meaning they have more control over service management, delivery and reporting back to IAPT and the NHS.
“We have worked with Ieso for a number of years – first through Thinkaction but now directly, which means that we can offer high-quality digital mental health therapy services while increasing accessibility and mobilising more people into treatment. As part of contracting with Ieso, we have increased service delivery from 15% to 25% of the total contracted IAPT services, so we have capacity to scale up as needed and better manage incoming referrals across West Kent.”
“We have always worked well with the Ieso team; they are very positive and professional. We have found service management to be excellent and the team also helps to support our data analysis.” concluded Zena.
Being an online digital service, patients in West Kent can get access to and connect with Ieso therapists remotely from the comfort of their own homes within weeks, which moves people from referral to treatment quickly, and ideal for those unable to travel to appointments or confined to homes. Ieso’s service offers true flexibility and choice in terms of the time and location a patient receives therapy – so outside normal working hours if they prefer. The text- based nature of Ieso’s online CBT also provides more discretion in therapist / patient communication, as conversations can happen in messaging form away from others who could be listening, and is ideal for anyone nervous about meeting a therapist face to face.
In the 2019 / 2020 period, 9663 people entered treatment across all IAPT mental health services from across the West Kent area, with Ieso treating 1959 of these patients. Ieso has also over achieved against IAPT targets, supporting West Kent’s waiting list reduction programme and improving recovery rates.
Takeaway tips
1. Consider online therapy to help reach patients remotely and quickly, while also reducing waiting times to move patients into treatment quickly.
2. Think about taking more capacity to scale as demand increases.
3.
Key learnings
1. A self-referral model means GPs can educate on the best IAPT treatment available but patients make their own selection based on their own symptoms, situation and requirements. Patients can also self-refer with the need to visit their GP. Both options gives control back to patient.
2.
Digital delivery of therapy provides flexibility to patients in terms of availability, can be accessed remotely anytime, and is more accessible for more patients across demographics.
3. With their own therapists and ability to scale up as needed, Ieso’s service deployment and management is easy and pain free.
Online therapy is generally in parity with face to face therapy but is more discrete for those wanting more privacy or not wanting to meet someone face to face.
Clinical outcomes
NHS year April 2019- March 2020
1959 patient entered treatment. 1643 patients completed treatment
• Recovery Rate: 56%
• Improvement Rate: 60%
Waiting Times:
• 60% treated with 4 weeks
• 83% treated with 6 weeks
• 96% within 18 weeks
TherearearangeofIAPTserviceprovidersacross KentandMedwayCCGandyoucanfindyourlocalservicehere: https://www.nhs.uk/service-search/find-a-psychological-therapies-service/
To find out how Ieso can support your IAPT services please email info@iesohealth.com
COMMENT
Throwing the doors open on clinical supervision in CBT
Shazna Khanom, UK Clinical Director, tells us how she ensures her team of 700 therapists become the best therapists that they can be.
Before Covid-19, most therapy took place face to face, behind closed doors. Once qualified, CBT therapists had very little direct feedback in relation to their clinical work compared to the feedback they received during their CBT training.
Whilst some CBT therapists provide recordings of their clinical work to their supervisor most avoid doing so. There are a number of reasons a therapist might shy away from recording themselves during clinical work and presenting this to a supervisor. Fear of judgement, time pressure and assumption that a patient may not like the session to be recorded all can all play a part in why a therapist will avoid this activity.
We have found that when therapists do present a recorded session to their supervisor they often will pick a session they think went well instead of picking a session that may have gone ‘badly’ in some way thus missing the opportunity to learn and grow from the experience.
Many Services have no way of knowing why some therapists get better outcomes than others. They also have no way of tracking whether the supervision therapists receive impacts positively on their clinical work. There is a belief that is does but this has not been widely researched. Working digitally brings many advantages and gives us unique insights into what works for whom. I’d like to talk you through the supervision capability that our platform offers and what it means mean for long-term quality of care and career progression.
All clinicians have access to the Ieso on-demand supervision and case management tool which is monitored and tracked by our clinical team. It offers both proactive and reactive supervision from assessment to discharge. What normally happens in supervision is that a therapist approaches their supervisor with a problem or
Shazna Khanom, UK Clinical Director
attends a supervision group with a prepared supervision question relating to a case but the supervisor has no way of knowing if that advice helped with that patient’s care, or even if the therapist chose to follow the advice.
By using our clinical support tools, a supervisor can see what actions a therapist has taken and if their advice had an impact on the patient’s recovery and/or engagement. It also gives us a data set to find out what supervision methods have the best impact on therapy.
All of our therapy sessions are recorded and analysed against our historic data set. Our supervision tools automatically flags issues to a supervisor so that they can proactively offer advice to the therapist on how best to treat a patient.
Ieso clinical supervisors have transparency into all their therapists’ cases. As well as the ability to review all patient case transcripts and notes for retrospective and live analysis, we have the ability to track which therapists perform better for different conditions over time. This allows them to specialize if they wish, and only treat patients that suit their skillset, or for us to offer tailored training on areas of weakness. This means that we can offer tailored training to therapists to ensure that they become the best that they can be.
All supervision notes related to a case are kept in one place, as part of the patient’s clinical records. It also provides case management support for urgent risk, step up, suitability and session extension.
The purpose of these tools is to create a close alliance between supervisors and therapists. It is as much about improving patient care as it is about creating a data set to see what actually works in supervision. It’s an exciting part of ensuring the best possible care for patients and ultimately improving outcomes.
State of the mental health nation
Sharon Harrison and Nii Wallace-Davies share their findings from conversations with IAPT services about how they are handling patient needs during the pandemic.
Mental healthcare is available and online
The IAPT (Improving Access to Psychological Therapies) programme is regarded as critical by the NHS to keep mental healthcare up, running and available, particularly during the COVID-19 crisis. Most health care providers have put contingency plans in place to support the ‘remain open’ directive, including:
• Adopting or increasing capacity to digital psychotherapy services as alternative approaches to face to face treatment delivery. For example, some NHS Trusts are deploying services like Ieso’s online CBT or extending existing digital contracts in order to move more people through treatment and reduce waiting times.
• Transitioning face to face therapists to digital communication and collaboration tools, such as Microsoft Teams and Zoom. These tools have been embraced by GPs, NHS Trusts and patients as they continue to take appointments, triage patients and deliver treatments.
While many mental health services are still available and running as usual through digital delivery across much of the UK, in April mental health referrals to services across the country experienced a 30-60% drop off which is surprising during a collective crisis such as COVID-19. In the past few weeks, referrals have begun to pick up again, but they are still not at pre-COVID-19 levels experienced during months leading into the pandemic.
‘Business as usual’ stance
Many healthcare providers recognise that digital as a delivery method for therapy is here to stay, and therapists and patients are becoming more comfortable using digital methods.
Digital delivery will be more embedded into working practice generally, and so for the most part, many NHS Trusts are taking a ‘business as usual’ stance with a focus on getting through each quarter. As no one is really sure what is going happen next, we are also seeing the decision-makers be more pragmatic and flexible in their approach, while also preparing for the expected onset of a delayed mental health services.
Impact on clinicians
When moving to online therapy methods there is a period of adjustment, particularly for those clinicians who have been used to delivering face to face therapy in a different set up and environment. However, services are reporting that their clinicians are happier and more productive working from home by delivering therapy via online tools, as they are not having to travel or run between sessions in different clinics.
Despite ongoing security concerns around Zoom, it has become commonplace, and clinicians are reporting that whilst similar to face-to-face, they have had to change their style of working. There will always be some challenges to working in a digital environment, and particularly when more households are at home and online, including uptime of network connections, and lack of privacy. Text-only communication, such as Ieso’s online CBT, means that there is more privacy during sessions, and tech issues occur less often. Transcripts from text-based therapy can also be used by the clinician to provide more support to the patient.
The industry is working hard to help clinicians work more effectively online, particularly as referrals increase. Many providers and associations, including Ieso, the NHS and BABCP, are offering training and support to enable clinicians to transition to digital methods. Advice is also being provided on what to be aware of during the COVID-19 pandemic in terms of how patients are presenting, what to think about in terms of consent and patient contact, what trends are being seen 8+ weeks into the lockdown, as well as more specific training on conditions we expect to see more of during this time.
A day in the life of a therapist
Muge Ahmet is a 30 year old therapist, living in Crayford in south east London, and lives with her partner Tanju.
She specialises in cognitive behavioural therapy (CBT) and eye movement desensitisation reprocessing therapy (EDMR), where a therapist supports you to relive traumatic or triggering experiences in brief doses while directing your eye movements and distracting you, so that recounting the experience is less painful. CBT helps you manage your problems by changing the way you think and behave. She is currently working solely from home, for IESO Digital Health, providing NHS patients with 1 to 1 therapy.
7am
I’m trying to keep to a routine and structure, so that whenever ‘this’ is over, it’s not too much of a shock to the system. I grab
a banana and jump on my cross-trainer for 40 minutes. I’m doing this every day at the moment, to keep my fitness levels up and maintain my mental health.
I feel energised this morning, more than usual. I slept far better than I have the last few weeks and I can tell. My sleep has been broken since we went into lockdown. I try not to dwell on it, but the change of routine has affected me.
I shower, get dressed, do my hair and make-up, grab a coffee and start panicking that I’ll be late for my first patient, even though I won’t be. I open my laptop and start prepping.
10am
I start work at 10am every day. The first thing I do is check my emails then my diary, and remind myself of the patients I’m seeing today. I refamiliarise myself with my cases and where we are in each treatment plan to make sure we get the most from each session.
I generally book in around six to eight patients a day; each session takes around 50 minutes. I take breaks in between everyone, to prep and refocus.
12pm
I take a complete break at lunchtime. I’ve learned the hard way that not giving myself the time away from my laptop isn’t good for my own mental health. It gives me that break to refuel and re-energise for my next patient. I’m really good at getting my five a day, and I have a sandwich with veg, or sometimes scrambled eggs or baked beans on toast.
Muge Ahmet, CBT therapist
As published in Stylist Magazine
1pm.
I see three to four clients over the course of the afternoon. Although my patients won’t notice, my own mood can be affected by the clients I see. If some are progressing well, I often feel that mirrored in my own energy. I try to schedule my patients so I don’t treat multiple individuals who have severe trauma or PTSD back to back, but practicalities get in the way, which can be tough.
It’s a unique time in my career, for all therapists. We’re experiencing the same anxieties as our patients where it comes to Covid-19, when usually we’re completely objective. The concerns the public have are the same concerns I have, as my colleagues have. Trying to contain those feelings to provide the best care for others can be challenging. I look after myself by limiting the amount of news I watch and read, but if you’re supporting someone else through their anxiety on the subject, it’s impossible to get away from it. That can feel heavy, and it isn’t going to go away. It’s accepted in psychology circles there will be a new wave of new patients seeking support very soon, and that the UK mental health system will not be able to cope.
5pm
I break for the day, have an early dinner with Tanju. I’m learning to cook and today it was home-made curry. During this break I watch a film to switch off - I’m watching a lot of comedy at the moment, it’s so important to have a little laughter.
7pm
I prep for my last patients of the day, who I see at 8 and 9. When my appointments end, I try to use closing my laptop as a mental switch that I’m done for the day, but it can be hard. I advise my patients to put their laptops away - especially right now, working excessively can be a sign of avoidance but there are healthier ways to tackle what’s happening.
How successful I am in tuning out depends on the cases I’ve had, and what’s happening in my own life. At the moment I can’t see my parents, they’re over 70, I miss them. I also lost my best friend on Easter Sunday. It’s my first real experience of loss. It’s been hard. And it’s hard to keep yourself together when you’re helping others with their suffering.
10pm.
I generally go to bed at 11pm. Before that I shower, and do a 10 minute breathing exercise. I spray lavender over my pillow, and fall asleep after an hour or so.
I feel tired tonight, drained. When you finally switch off, you notice how you feel. I hope for another good night’s sleep so I feel energised again tomorrow, so I can give the best version of myself to my patients, and start all over again.
Sarah Bateup shares advice on how to deliver remote therapy effectively
Ieso’s Chief Clinical Officer and chair of the BABCP IT Special Interest Group, Sarah Bateup, provides advice and guidance to clinicians on how to adapt working practices and deliver therapy effectively during the current coronavirus outbreak.
In her online vlog series, Sarah covers a number of topics including:
• The best preparation for seeing patients using digital therapy methods during COVID-19
• Housekeeping and consent when moving to digital therapy methods
• How to deal with patient contact in-between therapy delivery
• The common phenomena when moving to non-face to face therapy delivery
• …and much more.
Here is an transcript from the first episode.
Part one: Preparation for seeing patients using digital therapy methods
The coronavirus outbreak and the move to lockdown in the UK has brought about new challenges in therapy delivery, particularly for those that deliver treatment in a face to face environment. With many people still currently confined to homes and unable to get out for treatment, normal pathways to mental healthcare have been disrupted and, service providers, including the NHS, have moved to providing treatment digitally to keep services running.
As a provider of online cognitive behavioural therapy (CBT), we believe at Ieso that digital mental healthcare delivery is equally as effective as face to face CBT. However, with anything, the delivery method is only ever as good as the person delivering it, and this is the same with clinicians. If you are a clinician that has recently moved to digital therapy, then the way to get the best out it is through training and learning the methods that work for you.
We also understand that there are many digital methods you can consider using in your clinical work. However, because of the sheer number of tools
Digital therapy provides more flexibility for therapists and patients alike
and terms related to digital methods, it might be confusing to understand what is out there and the best approach. We hope this post supports you in defining this during this crisis and can bring some clarity to the digital delivery world.
Digital methods can be highly effective, but it really is down to each clinician to bring digital therapy to life and enable patients to make the most of what is on offer to them. Digital methods of therapy sit on a continuum. At one end, there are selfhelp methods offered to patients and accessed online. Then somewhere in the middle, there are guided self-help methods, traditionally using online platforms with digital materials, which the clinician will guide the patient through. We know from the research work of Henry Maudsley and David Clarke that guided self-help is very effective in treating patients with conditions such as social anxiety disorder.
At the other end of the continuum, there is therapist delivered digital interventions, which use communication methods like video, telephone and email, or text-based messaging to deliver treatment. The latter is how we provide online CBT at Ieso. All offer varied benefits for delivering interventions. However, with our experience working with therapists for many years, we find that those that adopt digital methods, come up against at least one of three things as they learn the process.
About 10% of therapists can adapt to digital delivery really well using whatever communication method that works for them. The majority, however, need some support and training, and we’ve been lobbying hard to get digital method delivery on the training curriculum for IAPT therapists, and those in the NHS. On the whole, the healthcare industry needs to support therapists to work smarter online because it does take some time to adapt, especially if it is different from the way they
usually work with their patients. Whatever digital method you choose, you will need to think about how you use it and don’t assume that you can just plug in and play.
There are many therapists out there who have worked online for longer, and our advice to them is to build a community of peers who have experience using alternative methods of delivering CBT. By creating some peer supervision groups, you can share learnings about the particular techniques that you’re using and what is working and not working for you. Discussions on what you’re finding difficult, and what your patients are finding difficult will help you understand if these are unique to you others experience it too.
For those clinicians more used to working in face to face IAPT services and clinics, it is easy to take for granted the informal support and consultancy from our colleagues that we might meet in a coffee room or the office. We use these engagements to seek some informal guidance regarding a patient – something that is harder online. Perhaps if we’ve seen a patient that is a little more complex, or someone that worries us or has maybe made us feel a little distressed, we can seek some reassurance regarding risk or safeguarding. These informal conversations are really important to our work and should continue in a digital environment.
We encourage you to build a community where you have informal support, which is the fastest way to disseminate learning and share experiences about how to deliver CBT online.
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Covid-19 has impacted on people from all walks of life. (c) RMC Photography.
What patients say about digital therapy
“Being online took away added anxiety about meeting someone face to face which can be a challenge in itself.”
“I personally think it’s much easier sometimes to write what you’re thinking than say it, and felt I was probably more honest because of this. I liked the fact I didn’t have the stress of meeting someone face to face to deal with.”
“The great thing about being online is that I have opened up more than I probably would have face to face or over the phone sessions.”
“This was a life saver for me. My anxiety and PTSD was too bad to leave house and speak face to face with a stranger. It was focused on moving forward and coping skills not the traumatic experience. Previous face to face counselling was mostly me crying for 50 mins and then having to been seen in public and drive home after in a state of anxiety and panic attacks. This was much less stressful.”
Parents have had the additional responsibilities of home schooling and child care while often working from home
At Ieso we are committed to delivering world-class mental healthcare
We have one overriding mission here at Ieso that rings true with all of our people. We are truly passionate about making people better; driving improvements and breakthroughs in mental healthcare for everyone. Our patients are at the centre of everything we do.
Our cutting-edge technology
Imagine for a moment capturing the collective knowledge of the world’s leading and most effective therapists. Then imagine taking that collective knowledge, and by using deep learning techniques, natural language processing engines and sophisticated artificial intelligence practices, being able to make every therapist better. Imagine those learnings translated into clinical practice guidance tools that provide patient-personalised guidance to therapists, to improve the therapy being delivered and as a result, get patients better, faster.
How you can be a part of it
Visit our website to see our list of current vacancies https://www.iesohealth.com/en-gb/careers
In the next issue
• Latest news and comments from Ieso
• What’s happening in IAPT services around the UK
• The latest trends in therapy presentations
• Day in the life of
