Comment Blog 8 July, 2019

Back to basics: Realising the ‘digital revolution’ in mental health

‘Cinderella service’ is the phrase often used to describe mental health provision in the NHS. Recent years have seen renewed commitments to right this wrong, and attentions have rightly turned to the role of data-driven technologies to help deliver on this objective. Poor data infrastructure is slowing progress, however. To take advantage of the ‘digital revolution’ in mental healthcare, the NHS must walk before it runs.

As argued in Reform’s latest report, data-driven technologies in mental health have transformative potential. While much of the hype in recent years has focused on mobile apps, the landscape is in fact far broader. In the short-term, much of this potential lies in streamlining repetitive tasks, such as tools which help trusts identify high or low risk wards to better allocate staff across a hospital. In the long-term, research is underway to understand how new types of data collection could lead to more proactive care by, for example, using passive smartphone data to detect and diagnose Alzheimer’s disease quicker.

But data-driven technologies are only as good as the data they rely on. Familiar challenges around digitisation and interoperability have left mental health staff manually duplicating information across a confusing combination of electronic and paper systems. This can be particularly onerous for mental health staff given detailed, symptom-based assessments are often necessary in mental health to accurately monitor a condition.

It is important that emerging data-driven tools do not exacerbate the current burden on frontline staff. Integrating new patient-facing tools, such as smartphones and wearables, with existing NHS systems is key is achieving this. Berkshire NHS Foundation Trust, for example, has developed a patient-facing app which is able to communicate with electronic patient records (EPRs). In practice, this means patients can track their mood through the app and this is automatically fed into the EPR for clinicians to view at each consultation.

This rise of patient-facing tools also raises questions around data portability. It is vital that patients are able to move mood tracking data held within a smartphone app between different service providers, especially given different NHS Trusts are working with different healthtech developers. NHSX is well placed to make this a reality, and should require all healthtech providers to ensure interoperability and data portability by design.

Beyond direct patient care, the potential for data-driven technology to improve our understanding of mental health through research is significant. Machine learning techniques and advanced modelling tools are enabling researchers to consolidate data from a wide variety of sources and analyse them on an unprecedented scale. Because mental illness can be socially, as well as biologically determined, being able to link data from within and outside the NHS is particularly promising.

As it stands, however, data linkage poses potential risks to data privacy. This is because with more information about a given individual, it becomes more likely that a unique characteristic of theirs will be revealed – even when pseudonymised data is used. This challenge is particularly pertinent given the large datasets in NHS mental healthcare, which includes inpatient and outpatient data with event dates and diagnoses.

NHS Digital’s work to create a new national data architecture, which aims to create a modular system where small groups of data can flow between organisations providing care, rather than being held in large datasets, could help overcome this challenge.

To harness the potential of data-driven technology in mental health, the NHS needs to go back to basics.