How is telehealth working in Mid Wales?

Clare Clark & Owen Hughes from the Pain & Fatigue Management Service

Over the past few weeks I have attended a number of events where a familiar theme has emerged – the increasing importance of using digital technology to deliver and receive support for people in Powys accessing NHS services, particularly around their mental health. We have already heard the latest about the pilot computerised Cognitive Behavioural Therapy project run by Mastermind in conjunction with Powys Teaching Health Board – so this seemed like a good opportunity to share information about other telehealth initiatives in the county.

On November 10 I attended the Powys Research, Therapies and Health Sciences Conference, where I found out how staff at the Pain & Fatigue Management Centre in Bronllys near Brecon deliver condition management groups by Skype. The team at Bronllys provide help to people who want to live life more fully but are hindered in doing so by symptoms of long term health conditions – these could be conditions relating to physical or mental health or both.

This session was delivered by Owen Hughes, Head of Pain & Fatigue Management, and Clare Clark, Advanced Practitioner – Occupational Therapist – both based in the Pain & Fatigue Management Service in the Centre of Long Term Condition Management. Owen and Clare explained that there is currently a Skype group running from Bronllys, and through their presentation they explored the benefits of working in this way and what to consider when setting up a new Skype group.

Owen started the session by asking why it is important that we consider using software applications such as Skype to have video appointments and group support sessions over the internet. At this point his presentation featured a photograph of a famous actress from the silent movie era – but not a single person in the room recognised her because she had refused to switch to the “talkies” once they came along. (And I’ve forgotten exactly who she was already, though Owen did tell us her name!) The moral from that story being – we must move with the times or be left behind forever…. Owen said “technology is everywhere, and homes are getting smarter.” He asked us to imagine what people’s homes would look like in ten years’ time.

Eleanor Boardman - the forgotten silent movies star...?

How it works

Clare picked up here to detail other issues which affect both patients and the team when trying to engage over a period of time. As we know people living in Powys often have to travel huge distances to see medical professionals even within the county. They may already be anxious and even on a good day people experiencing mental distress may not be ready to take on the long journey, perhaps by public transport, to make an appointment.

Other people may find it inconvenient to take a whole day from work to attend a session every 6 weeks, but would be able to free up an hour in a private room to make the Skype call. The issue of time is a factor for the staff too, who may otherwise have to spend many hours behind the wheel of their cars when they could be talking to more patients. They simply do not have the capacity to deliver all their sessions face-to-face, and Skype has proved an additional extra tool by which they can offer support to people.

Lessons learnt

• Peer support still works when Skype is used – there is a lot of interaction between the participants on the group sessions.
• It can be hard to manage group dynamics online – there is no social filter – so if some people are being derogatory this needs to be managed. Now there is a working agreement and boundaries are set at the start.
• It is important for participants to have a trial one-to-one session at the beginning during a coaching period with a telehealth facilitator, particularly if they are not familiar with the technology. 
• The maximum number for a group session is probably 8. There were 4 in this group.
• It should not be forced on people. Generally they self-select.
• It can be effective for quite complex issues, not just mild anxiety or conditions.
• It is a transferable skill as it teaches people how to communicate online. It increases their social connectedness.

What people said

"I thought it would encourage isolation – but it made me feel less isolated. If I’m working with levels of anxiety, being at home can be a good place to start".

"I felt it improved my confidence so I was able to go out and socialise".

"I would never have been able to attend a face-to-face session today, but was able to log into the PC and join in".

Then on 22 November I went along to a public session run by the Mid Wales Healthcare Collaborative in Newtown. The MWHC covers North Powys, Ceredigion and South Gwynedd, an area served by three health boards including PTHB, and works with providers and communities “to plan and deliver safe, sustainable, high quality and accessible health and social care services for the population of Mid Wales”. One of its twelve priorities this year (2016 – 17) is to look at Telehealth, Telemedicine and Telecare:

“There should be a coordinated effort by all three Health Boards to identify the opportunities for much greater use of telehealth capacity and a determined drive to hasten its implementation”.

“A 6 month project will be undertaken to ensure that the telemedicine equipment in Mid Wales is working, sited in the best place and that staff are trained to use it”.

At the Newtown session I met Adrian Thomas, Director of Therapies and Health Sciences at Betsi Cadwaladr University Health Board and lead on telehealth for the MWHC, and Emma Pritchard - the Telehealth Project Manager. They described some recent telehealth work developed as a result of this priority which focussed on a teledermatology service in North Ceredigion. We also spoke about other options that could be developed in future, taking into account feedback from the Mastermind Beating the Blues pilot and other initiatives such as those running at the Pain & Fatigue Management Centre. It was emphasized on the table where I was contributing that the telehealth option would not work for everybody - personal choice was key - but it should be offered as an option as it may be preferable for some.

Pages 32 – 38 of the 2016 report “A review of telehealth, telecare and telemedicine in Wales” give some details of recent initiatives in Wales which have used telehealth, including a Veterans’ mental health project in South Wales and the Powys Mastermind project. There are also links to further published research evidence around computerised CBT including that relevant to autism, eating disorders, and veterans.

If you are in contact with mental health services, or have been in the past, have you tried the telehealth option? What was your experience? If not, would you like to try it, particularly if it meant you were able to receive support sooner? Let us know in the comments box below.

The latest on MasterMind - computerised CBT in Powys

Powys Teaching Health Board staff at a MasterMind seminar in Odense, Denmark in October 2015.
Front row far right: Dr Wasi Mohamad, PTHB Clinical Director & Consultant Psychiatrist who is the Clinical Lead for MasterMind; next to him: Becka Williams Project Administration Assistant. Back row second from right: Harold Proctor Dementia Lead for PTHB and the MasterMind Project Executive.

Back in August 2014 our friends at Powys Teaching Health Board wrote on Introducing MasterMind - computerised CBT in Powys. 

The MasterMind project is currently being piloted across Europe, including Powys. Some individuals with a diagnosis of low to moderate depression have been able to access the computerised Cognitive Behavioural Therapy course in their own homes. We decided now was a good time for an update and Becka Williams, who works with the team overseeing this project, gives us the latest news.

MasterMind – where are we?

We have just begun the final year of the MasterMind project with the project due close in February 2017.

We went ‘live’ with the online CBT programme in March 2015 and have had 216 referrals since. We have implemented this service into the Local Primary Mental Health Support Service teams (LPMHSS), Pain Management and Occupational Health and in recent weeks have started engaging with the GP practices in Powys to encourage GP direct referrals.

A bit about the programme…

Powys staff opted for Beating the Blues as their software of choice which was developed by our service provider Ultrasis with ownership transferring to 365 Health & Wellbeing.

What does Beating the Blues consist of?

Beating the Blues consists of eight, approximately 1-2 hour sessions recommended to be completed weekly. The programme is interactive. During sessions you can watch video clips, complete exercises and learn CBT techniques that can help with depression and anxiety. Each week tasks will be given to be completed during the time between sessions.

How will it help?

Beating the Blues will help to pinpoint and change unhelpful ways of thinking that can affect how you feel, whilst teaching you more effective ways of solving problems.

How many sessions need to be completed?

It is important to complete as many sessions as possible. When completing the first couple of sessions it may be hard to see how it is relevant to your situation, however the programme is designed to build up your knowledge and skills over the weeks, if you stop too early, you will not get the full benefit of the treatment. The advice is to complete all eight sessions.

Where can the course be completed?

The course can be completed in your home or in a community site such as a library. To do it at home you need a PC or laptop with either speakers or earphones, along with access to a printer as there will also be a need to print material most weeks. Beating the Blues does not run on iPads, Tablets or Smart Phones at present. When doing it at home it is important to set aside enough time to complete your session at roughly the same time each week and ensure you have sufficient privacy to do so. You do not have to complete all sessions from the same location, you may want to complete some from home and some form one of the community sites. 

Feedback from participants

“The sessions were brilliant.”

“The programme was good in many aspects.”

“Most techniques I knew but Beating the Blues helped me put them into action.”

The Mastermind seminar in Denmark, October 2015

Collaborative Care through Videoconferencing (cCVC)

The second part of the MasterMind project is the collaboration of care through videoconferencing (VC) which we are currently implementing. In the initial stages we will be implementing this in the Crisis Resolution Home Treatment Teams (CRHTT) and the Community Mental Healthcare Teams (CMHT). In short, a member of these teams will meet with the patient and together they will have an appointment with the Consultant Psychiatrist through the use of Videoconferencing. The VC software that has been rolled out across the Health Board is Skype for Business.

Our EU Partners

Throughout the project, there have been a number of meetings and events taking place across Europe to get together with our European MasterMind partners to discuss the project, the pros and cons and generally share thoughts and ideas. The project has been a great opportunity for networking, building working relationships and shared learning. 

Many thanks to Becka for the update. Have you had experience of Beating the Blues or other computerised CBT sessions? Let us know what you think in the comments box below.

You can find out more about the MasterMind Project on the project website, and also join the debate on Twitter.

Introducing Mastermind - computerised CBT

Tanya Summerfield (left), an ICT (Information & Communication Technology) Project Manager at Powys teaching Health Board, is working to develop an innovative digital project to help support people experiencing depression in Powys. 

She is supported by her colleague Menna Reese (below), who is also helping to promote the roll-out of Mastermind in Powys.

We spoke to Tanya and Menna recently to find out more about Mastermind.

Tell us about your role at the health board 

To facilitate the implementation of two European Union projects, one of which is Mastermind, which is the introduction of the computerised Cognitive Behavior Therapy across Powys by November 2014.

What is the Mastermind Project?

The Mastermind Project aims to make high quality treatment for depression more widely available across Europe through the use of ICT. In Powys the software of choice is ‘Beating the Blues’ developed by Ultrasis.

What is cCBT? 

Computerised Cognitive Behavioral Therapy. 

Tell us about the Powys pilot of the Mastermind project

The pilot aims to facilitate access to cCBT through purchasing licenses and training primary care mental health staff in its application along with provision of video conferencing facilities between ‘GP and Specialist Clinician’ or ‘Specialist Clinician and patient’. 

How do you think it will benefit people who may be experiencing mental distress or be depressed?

The Programme will only be available for people with a diagnosis of low to moderate depression and the benefit will be access to the cCBT in the patient's own home at their convenience.

What is particularly innovative about the project? 

The Programme focuses on how to improve the lives of service users and their families using a recovery and enablement approach through embracing technological advances to date and minimising the need to travel to treatment centres.

Why has the health board decided to offer this type of mental health services in Powys?

In recognition of the rural terrain and the ratio of the primary mental health practitioners to the population, funding was sought through the EU to pilot the scheme prior to it becoming mainstream. In this way, we will be able to make psychological therapies more widely available.

What kind of links is the health board making with mental health services in other European countries as a result of this work, and how could this be beneficial to people in Powys?

Sharing good practice and regularly monitoring reports shared across 11 European sites, taking advantage of networking opportunities sharing experiences.

When will the Mastermind service be made available and who will be eligible to access it and how?

The time schedule identifies November 2014 as the start date and the trial will run for 17 months. Eligibility will depend on the diagnosis of low to moderate depression by the general practitioner, primary mental health clinicians or secondary mental health service.

How does the project tie in with the aims of the Together for Mental Health (Welsh Government strategy) and Powys Hearts & Minds strategy?

Poor mental health and illness have a significant impact on individuals, society and the economy overall. Together for Mental Health (Welsh Government 2012) sets out the Welsh Government's ambitions for improving the mental health service and promoting better mental health wellbeing across the whole population. This project will widen the availability of psychological therapies.

If people want to find out more about the Mastermind Project, who can they contact?

The EU Project Office on 01874 712765 or email Tanya.Summerfield@wales.nhs.uk

Thank you Tanya and Menna for introducing us to the Mastermind Project in Powys. You can find out more about the Mastermind Project on the project website here, and also join the debate on Twitter here, or tell us what you think by commenting below.