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Accessibility and inclusion in digital health
Accessibility and inclusion in digital health

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2 Accessing mental health in Wales

In 2014, the Department of Health made improvement in mental health a key priority. Its first objective was to ensure that mental health had equal priority with that of physical health and its second was to reduce the gap between people with mental health problems and the rest of the population (Department of Health, 2014). Their vision was that everyone who needs it should have access to an intervention, through the ‘Improving Access to Psychological Therapies’ (IAPT) programmes including children and young people. While the Department of Health aimed to reduce waiting times in accessing services, more people were being offered the service and as a result, waiting lists significantly increased. This is a particular issue in Wales, where a significant amount of the population reside in rural areas and at considerable distance from psychological therapeutic services.

In Cardiff, research is currently ongoing to evaluate the potential of digital technology to both reduce waiting times in accessing services and provide people experiencing mental health problems access to much-needed support.

Activity 2 My 24 hour app

Watch the video below, which features Sarah Cosgrove talking about her use of digital technology to help her to obtain support due to Post Traumatic Stress Disorder (PTSD).

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Transcript: Video 1 Digital support for PTSD

[MUSIC PLAYING]
SARAH COSGROVE
So I met with the team at Cardiff University, and we had to go through a bit of a process to see if I was suitable. So was it one single event that caused my PTSD? Yes, it was. And was I prepared to put the hard yards in and do this work myself, which I was more than prepared to do, because I wanted to stop being a victim and be active in my recovery and get back.
NEIL ROBERTS
So PTSD is a serious mental health disorder that can develop for some people through exposure to very threatening events or traumas. Standard therapy for PTSD would normally involve appointments that last 60 to 90 minutes over around three months. I guess the difference with guided self-help is that a lot of the work that service users would do is self-directed. So we've developed a package that takes them through a number of steps.
SARAH COSGROVE
When I told my family that I would be going on to this trial using an app, they were a bit worried about doing everything remotely with no support. But I was very supported. I would meet regularly with a therapist, either in person or on the telephone. And that would happen at least weekly. But the app was particularly good at illustrating what PTSD can mean in a civilian context. It helped me learn about my PTSD, and it helped me understand that what I was experiencing was totally normal. So things like heightened anxiety, palpitations, getting very hot, perspiring, breathless, all of those things were explored in the app. And so it was great, because I was able to realise that this is normal, and this is what having this condition means.
NEIL ROBERTS
The appointments are briefer, and the focus for the therapist is more on ensuring that the service user is engaged with the programme. It's a different way of working. So normally we would-- I guess relationship building is an important part of the therapy process and trying to help.
SARAH COSGROVE
So there are tips like how to ground yourself. They are basically techniques to bring you into the moment to stop your mind from going back and reliving that traumatic event over and over. One of the major symptoms of my PTSD was anxiety. And the app was really good at giving me ways, techniques to manage my anxiety. And slowly I was able to enjoy socialising again.
I'd also always wanted a dog, and we got a dog. And that was a fantastic thing to do. So the app guides you to a point where you need to come to terms with your trauma. And it takes the form of writing a present-tense, very detailed account of what that trauma was. And then you read it. And you read it over and over and over and over again, until eventually you become desensitised to it. And I think really that was one of the most powerful steps in the app.
And so because I was guided by the therapists, they were meeting me regularly, I felt confident enough to take those steps, that if I was feeling particularly anxious or traumatised again, that I could talk it over with them. The app gets you to write a letter to a friend as if that friend was you. And so you're able to take an external perspective. And I find that hugely helpful, actually. The talking sessions are brilliant. So if you are feeling a bit uncertain or you're having a bit of a wobble, you know that you've got that added reassurance of talking to a real-life human being.
The flexibility of the app is really wonderful, because you have it when you need it. So if I was having a moment, I could just reach into my pocket, get out my phone, and bring it up. But also I didn't have to take loads of time off for medical appointments. I could do the preparatory work from my own home. I could do it when my daughter was in bed. I could do it on the weekends. And so again, it was a really important way to help me get control back, because I was at the heart of that recovery.
NEIL ROBERTS
We don't know at the moment if this is the right intervention for everyone. I think we know clinically that people with more complex presentations, with more severe symptoms will probably need longer interventions and probably also the direct face-to-face nature of standard therapy.
CATRIN LEWIS
The guidelines in the United Kingdom say that we should be using psychological therapy rather than medication. The only problem is that we have very long waiting lists to access psychological therapy. And unfortunately, there are a limited number of therapists that are able to deliver these sorts of interventions, as we know. And technology is evolving. And it's very important for interventions of this sort to keep up with technology and to be able to be used on the latest devices and so forth.
So for example, here in Wales we have individuals that live in rural, remote areas that simply aren't able to access psychological therapies. So these sorts of interventions enable the opportunity for people that wouldn't normally be able to get access to psychological therapies to engage in treatment such as this. But we're still undergoing clinical trials to try and establish enough evidence in order that it can be used routinely at the NHS. But the trial that we have ongoing at the moment is actually a multisite trial. So we're testing it here in Wales, but also in England and in Scotland. And we're hoping that the results will support our ongoing work.
End transcript: Video 1 Digital support for PTSD
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Video 1 Digital support for PTSD
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Next, answer the following questions and complete the grid below.

In what ways has the use of digital technology increased Sarah’s confidence, skill and knowledge in managing her symptoms? In what other ways has the use of digital technology led to improvements in care delivery?

Confidence
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Skills
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Knowledge
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Other ways
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Discussion

Confidence:

Since using the app, Sarah has grown more confident in applying what she has learned in her everyday life; in particular, about managing her symptoms and realising they are a part of her condition. She also knows that she has a therapist available, and this knowledge gives her confidence that she has backup, should she need it, to manage her condition. Her confidence has increased significantly because now she feels able to socialise and has even got a dog which was a long-term goal for her to aspire towards. 

Skills:

The app has taught Sarah a number of strategies in which she can manage her condition such as being able to feel calm. She has also learned to be reflective by writing about what led to her PTSD and going over it again and again until she feels that she is less impacted by the events that led to it.

Knowledge:

The app has assisted Sarah in finding out about her condition and the symptoms associated with it, and this has enabled her to normalise what is going on for a condition that sounds overwhelming at times and prevented Sarah from socialising.

Other ways:

The app has afforded Sarah a great deal of flexibility. She can use the app at any time, day or night, and is reassured that she has access to an intervention that makes her feel safe. Without the app Sarah may not have had timely access to psychological services when she needed it, which could have worsened her condition considerably. The app also gives Sarah more time, as the appointments she has with her therapist in person are not as long as they would normally be, but they still allow Sarah sufficient time to build a good relationship with her therapist which is an important part of therapy. 

The researcher in the video also demonstrated the power of the app for people living in rural areas who would not be able to access psychological therapies.

Digital technology has the power to improve mental health and transform people’s quality of life.

You’ll continue with this theme in the next section, as you explore ways in which digital innovation is being used to enhance the wellbeing of babies in Scotland.