From Ward to Home: Using Data, AI & Live Wearables to Improve Access, Patient Experiences, Outcomes & Flow Across the Mental Health Care Continuum

Over the last reporting year, flow across the UK’s Mental Health (MH) care providers sat at 102,366 being admitted and 100,452 being discharged, for a net of 1,914 admissions. Let's assume that 2% of patients are Clinically Ready for Discharge (CRFD), sitting at 38 patients. There we have it our trajectory and profile of the challenge. We then have the challenge of exploding waiting lists for MH providers, which sits at more than 1.8 million nationally as of September 2023. With staffing challenges for both MH and acute providers, how do we ensure that more patients have better experiences within their care pathways, better access, improved outcomes, and more? With the UK sitting at 13th on the best places to live, how do we improve MH services as part of improving the UK as a better place for people reside?

The potential utility of technology and remote approaches in revolutionising physical and mental healthcare is one that most of us are at the very least familiar with. Over the last 5 years, there has been an accelerated boom in adoption to cope with rising and immense public health pressures. Be it providers seeking to optimise their pathways and capacity with support from the technology available, or patients themselves seeking more convenient, home-based routes to support, telehealth use for mental health services alone from 2019 to 2022 – more than doubling from 39.4% to 88.1%.

Despite this, mental health providers, much like their physical health counterparts, continue to face challenges across the pathway. With tight budgets and building pressure, exacerbated by Covid backlogs and yearly Winter surges, many organisations are facing immense capacity and resource issues. Last year alone, one mental health trust spent £3.1m on bed and breakfast rooms in an effort to reduce the pressure on trust bed spaces. With workforce retention and wider discharge problems forming a critical underlying driver in these issues, it is clear that beyond the injection of additional resources – a challenge in and of itself in light of NHS budgets and the sometimes unsustainable nature of what can, without careful planning, simply be a quick fix – there is a need to innovatively transform current pathways in a way that can truly cement improvements into the long-term.

In my ongoing discussions with leadership teams and those on the ground in some of the NHS’s largest mental health trusts, a number of key factors have been at the forefront of many colleagues’ minds when considering the current challenges and how to solve them. Visibility across the pathway, understanding of responsibilities and interworking between teams, as well as data-driven decision-making at each stage, have been stressed as universally vital.

Moreover, we have seen teams across the board emphasise the need for enhanced, expanded, and better managed Step-Down services as holistic approaches to care that facilitate earlier discharges from hospitals and, as such, shorter lengths of stay on acute wards. With a focus on enabling patients to safely reintegrate back into the community, supported by a multi-disciplinary team to ensure patient recovery within each element of their journey, innovative approaches to ensure patients continue to be supported and prevented from deteriorating outside of hospital form a core component of this offering.

Ultimately, admissions upstream have profound impacts on capacity downstream, coupling with the need to remodel and optimise community pathways that enable stronger avoidable admission prevention and discharge support. So how do we implement new ways of leveraging accelerated discharge models, innovation, and technology to transform care for patients and teams on the ground?

Pathway Approach Innovations in the Mental Health Sector

With varying levels of maturity in terms of established approaches between organisations and geographies, there is much that we can learn and in turn implement from the excellent work being accelerated across global health systems.

Already in the US, a recent partnership between online mental health platform, SohoMD, and clinical-grade health device organisation, Withings Health Solutions, has seen promising steps towards wider integration of remote physical observation as part of the assessment and diagnostic process in mental health care provision. Combining both a licensed psychology platform and a connected at-home health offering, this collaboration seeks to monitor factors such as extreme fluctuations in weight, high blood pressure, and other key physiological metrics linked to psychiatric challenges and medications as a new layer of insight within patient mental health support – outside of hospital settings.

 Closer to home, the NHS has seen a number of programmes that enable the delivery of innovative mental health care through community-integrated models. Indeed, work in the North East and Yorkshire saw the implementation of remote ECG devices in an effort to support mental health service users in the region, through the introduction of a new approach to tracking the side effects of specific medications. Removing the need for GP or hospital-based ECG readings through devices that enabled faster readings to be taken in community settings, the initiative supported a more efficient route to essential outcomes observation that reduced clinical time, created a more convenient and less obtrusive experience for patients, and enabled faster assessment of the resulting Bluetooth-shared data by clinical teams for triaging and follow-up.

Similarly, in the South West, an integrated team of primary, secondary, and community care specialists launched an initiative to tackle health inequalities and improve clinician and carer collaboration to drive improved patient outcomes for those with learning disabilities. Utilising digital tools, this sought to empower patients to better manage their own health, while improving the ability of health and care teams to work together on their behalf. With a 2x higher likelihood of dying from an avoidable medical cause of death for those with learning disabilities, such initiatives are truly critical in allowing patients to better self-manage their conditions, while providing safe, community-based care and visibility for their care teams. With increasing workforce challenges across the NHS, need indexes frequently not aligning with available supporting capacity in key teams, such approaches provide a promising avenue for relieving NHS pressure, while putting power into the hands of patients themselves.

In a similar vein, work to increase support and drive better service design for those with severe mental illness (SMI) has seen the launch of a digital, data, and people-driven approach in Greater Manchester that seeks to enrich the lives of these individuals. As patients who are statistically more likely to experience poorer health than the general population, with a 15–20-year shorter lifespan and a steadily increasing prevalence in multiple regions across England, the need for new pathways to detect preventable conditions earlier and enact proactive interventions formed a key goal for the initiative. While focusing on point-of-care testing (POCT) digital services for result turnaround times of minutes as opposed to days, this programme highlights the importance of approaches that detect early signs of preventable diseases such as diabetes, and opens up the potential for the utilisation of technologies that enable continuity of care following discharge, step-down, and into the community for improved patient outcomes.

Indeed, such work has set strong precedents for the wider use and integration of similar approaches into health systems, yet stresses the need for engaged, trained, and multi-disciplinary teams to ensure that innovative approaches truly deliver on their potential to improve patient experiences and care.

Changing the Mental Health Landscape with Technology, Innovation, and Dedicated Care Teams

 From the point of a successful discharge, including into step-down and community services, it remains critical to ensure that patients continue to be well enough not to require hospital care in the near future. Supporting patient outcomes in the community and outside of traditional ward environments is vital in providing the guidance and care required to ensure that they are able to avoid admission – remote approaches forming a powerful and real-time tool that enables this from patients' own homes.

To date, our approach to supporting patients and teams within the mental health space has seen us apply technology not only to vital data-driven decision-making processes around admissions and discharges, but also to support teams with the confidence needed to overcome traditional risk-averse models that harm patients in the long run. Reducing lengths of stay and avoidable admissions, this further sees support for patients into step-down services and in the community through advanced digital ecosystems. From electronic patient-reported wellbeing and quality of life measures (ePROs), to wearable-captured biometrics that remotely and continuously track vitals linked to both mental and physical health, our goal is to ensure that patients who are clinically ready for discharge are able to stay well at home and in the community – underpinned by a clinical safety net that allows for the early detection of any challenges and swift, preventative action.

By driving stronger care collaboration and continuity across teams along the pathway, reducing traditional physical limitations to provide better patient access, enhancing patient engagement, and generating new psychological and physiological data insights for evidence-driven decision-making, such models truly hold the potential to revolutionise the mental health landscape and improve patient outcomes for service users. For those who wish to learn more about our work in this space, we welcome you to reach out at info@saniushealth.com.