A visual step-by-step guide for clinicians to use video consultations in mental health services: NHS examples of real-time practice in times of normal and pandemic healthcare delivery

Measuring the digital divide among people with severe mental ill health using the essential digital skills framework

AIMS

Amid the vast digitalisation of health and other services during the pandemic, people with no digital skills are at risk of digital exclusion. This risk might not abate by the end of the pandemic. This article seeks to understand whether people with severe mental ill health (SMI) have the necessary digital skills to adapt to these changes and avoid digital exclusion.

METHODS

Two hundred and forty-nine adults with SMI across England completed a survey online or offline. They provided information on their digital skills based on the Essential Digital Skills (EDS) framework, sociodemographic information, and digital access. This is the first time that the EDS is benchmarked in people with SMI.

RESULTS

42.2% had no Foundation Skills, and 46.2% lacked skills for daily life (lacking Foundation or Life Skills). 23.0% of those working lacked skills for professional life (lacking Foundation or Work Skills). The most commonly missing skills were handling passwords and using the device settings (Foundation Skills) and online problem solving (Skills for Life). People were interested in learning more about approximately half of the skills they did not have. People were more likely to lack Foundation Skills if they were older, not in employment, had a psychosis-spectrum disorder, or had no Internet access at home.

CONCLUSION

A significant portion of people with SMI lacked Foundation Skills in this objective and benchmarked survey. This points to a high risk for digital exclusion and the need for focused policy and tailored health sector support to ensure people retain access to key services and develop digital skills and confidence. To our knowledge, this is the first time this has been described using the EDS framework. Services, including the National Health Service (NHS), need to be aware of and mitigate the risks.

Communication skills training in psychiatry

Good communication skills are the basis of all effective doctor–patient relationships, and psychiatrists in particular have to manage many types of complex interaction. Research shows the benefits of communication skills training. This article describes strategies for teaching relevant clinical communication skills to trainee psychiatrists on MRCPsych courses and in local centres. The authors set out a sustainable training framework using higher trainees as tutors. There is a need for more widespread teaching of clinical communication skills in psychiatry and at an early stage of specialist training.

Perspective on digital communication with health professions from close supporters of young people with long-term health conditions (The LYNC Study)

Objective

To understand the impact of digital communication using email and text between young people and their health care team on those in close supporting roles.

Methods

Twelve people (nine parents and three partners) of young people with long-term health conditions were interviewed between November 2014 and March 2016. Thematic analysis was performed followed Braun and Clarke's (2006) 6-phase method.

Results

Four main themes were identified. Close supporters felt that digital clinical communication was useful for young persons’ self-management. As well as young patients, close supporters would also like to have direct access to the clinicians, but it was necessary to build up a trusting relationship between close supporters and clinicians initially. Video appointments were suggested for future digital communication technology.

Conclusions

Close supporters were encouraging digital communication for their young person with diabetes. Clinicians should put an emphasis on establishing trusting relationships with both young people and close supporters which would be beneficial for their digital clinical communications.

Early evidence and lessons learnt from an NHS Wales Video Consulting Service

Background: The use of video consulting (VC) in Wales, United Kingdom (UK) has expanded rapidly during the COVID-19 pandemic. Traditionally, VC has been the subject of small-scale projects and evaluations. In response to the pandemic emergency, there was an opportunity to roll out and evaluate VC on a larger and more representative scale, across a wider range of National Health Service (NHS) specialities.Aims: This paper presents an overview of a dataset captured by the 'The NHS Wales VC Service'. The purpose of this study was to capture perspectives of healthcare professionals only (including clinicians, administration and management) on the use of VC and explore lessons learnt from the national implementation process.Methodology: Using an online, mixed methods retrospective survey capturing descriptive and narrative data.Results: A total of 1256 NHS healthcare professionals shared their VC experience. Overall, responses were positive, and healthcare professionals expressed optimistic views regarding the use, value and benefit of VC, even when faced with challenges on occasions.Conclusions: A lesson learnt, is that difference occurs in innovation, even in a small country like Wales, yet it is not necessarily a negative outcome, but rather, respecting and incorporating difference, can improve long-term sustainability.

Taming the chaos: NHS professionals' perspective of using video consulting during COVID-19 in Wales

The use of video consulting (VC) in the UK has expanded rapidly during the COVID-19 pandemic. Technology Enabled Care (TEC) Cymru, the Welsh Government and Local Health boards began implementing the National Health Service (NHS) Wales VC Service in March 2020. This has been robustly evaluated on a large-scale All-Wales basis, across a wide range of NHS Wales specialities.

AIMS

To understand the early use of VC in Wales from the perspective of NHS professionals using it. NHS professionals were approached by TEC Cymru to provide early data.

METHODS

Using an observational study design with descriptive methods including a cross-sectional survey, TEC Cymru captured data on the use, benefits and challenges of VC from NHS professionals in Wales during August and September 2020. This evidence is based on the rapid adoption of VC in Wales, which mirrors that of other nations.

RESULTS

A total of 1256 NHS professionals shared their VC experience. Overall, responses were positive, and professionals expressed optimistic views regarding the use and benefit of VC, even when faced with challenges on occasions.

CONCLUSIONS

This study provides evidence of general positivity, acceptance and the success of the VC service in Wales. Future research studies will now be able to explore and evaluate the implementation methods used within this study, and investigate their effectiveness in being able to achieve better outcomes through VC.

Before the 2020 Pandemic: an observational study exploring public knowledge, attitudes, plans, and preferences towards death and end of life care in Wales

BACKGROUND

Understanding public attitudes towards death and dying is important to inform public policies around End of Life Care (EoLC). We studied the public attitudes towards death and dying in Wales.

METHODS

An online survey was conducted in 2018. Social media and the HealthWiseWales platform were used to recruit participants. Data were analysed using descriptive statistics and thematic analysis.

RESULTS

2,210 people participated. Loss of independence (84%), manner of death, and leaving their beloved behind were the biggest fears around death and dying. In terms of EoLC, participants sought timely access to care (84%) and being surrounded by loved ones (62%). Being at home was less of a priority (24%). Only 50% were familiar with Advance Care Planning (ACP). A lack of standard procedures as well as of support for the execution of plans and the ability to revisit those plans hindered uptake. The taboo around death conversations, the lack of opportunities and skills to initiate discussion, and personal fear and discomfort inhibited talking about death and dying. 72% felt that we do not talk enough about death and dying and advocated normalising talking by demystifying death with a positive approach. Health professionals could initiate and support this conversation, but this depended on communication skills and manageable workload pressure. Participants encouraged a public health approach and endorsed the use of: a) social media and other public platforms, b) formal education, c) formal and legal actions, and d) signposting and access to information.

CONCLUSIONS

People are ready to talk about death and dying and COVID-19 has increased awareness. A combination of top-down and bottom-up initiatives across levels and settings can increase awareness, knowledge, and service-utilisation-drivers to support health professionals and people towards shared decisions which align with people's end of life wishes and preferences.

Debate: COVID crisis, natural capital and clinical care - 'building back better' for a new values-based CAMHS

The COVID-19 pandemic has meant upheaval for child and adolescent mental health services and for children, young people and their families. We look at this disruption through the lens of values-based practice. We also briefly examine the concept of natural capital and the opportunity for 'Building Back Better' post-COVID. We suggest that as well as losses, there are also opportunities to rethink and reshape our practices to make them more value-based.