Using video consultation in a mental health setting Dr Laura Stevenson Dr Rebecca Chubb

Serves 470,000 people of all ages in Stoke-on-Trent and across North Staffordshire Recognised limited use of technology to engage patients Vision: pilot scheme for video consultation to determine what worked, evaluate, and identify barriers Based in neuropsychiatry and older peoples services directorate

What did we do? Pilot and survey Devised SOP and governance policies for using ‘Skype’ for patient consultations Identified vascular wellbeing team and older persons OP clinic as pilot areas 1 lead medic, 1 lead nurse 3 months duration, commenced Sept 2017 Promoted to relevant teams via discussion and emails Away day to explain and encourage staff participation

Who used it? VWB arm – all appropriate patients asked Tended to be younger Have memory impairment plus vascular risk factors, often a mood component also OP Clinic arm – nurses identified suitable patients Generally over 65 years Memory and /or other mental health issues At home or in care home setting Nurse present with them to facilitate consultation

Evaluation

Patient and carer feedback - supportive Carer felt this was a useful way to speak with a Dr Written information helpful and pitched at correct level Satisfied re: confidentiality Indications that would consider using again in future

Patient and carer feedback - challenges All suitable patients in vascular wellbeing team asked about participation - overwhelming message for not wanting to was not having access to or not feeling confident in using technology Technical issues for those that did participate affecting satisfaction Challenge with visual/ hearing impairments

Staff feedback - supportive “ was very useful to have flexibility with patients that would be difficult to attend a formal clinic setting had care home manager in appointment the consultation was considered to be very successful I had a home visit with him already planned so I called in as normal and the video-consultation was possible ”

Staff Feedback - challenges “I’m not sure we would have a big uptake to use this consultation method given the client group to access independently The connection could be difficult The appointment time probably makes this a longer contact than normal due to setting up and gaining contact but if the patient had to attend an appointment it would be even longer given travel arrangements ”

Survey Questionnaire compiled and disseminated to patients on all IP wards and 4 CMHTs Some general adult (18 – 65yrs), some old age (> 65yrs) participants Scoping exercise to determine attitudes, thoughts and practicalities around using technology to see a mental health professional

Survey Findings Overall 81% access to internet 66% knew what skype/ video consultation 35% knew how to use it In OA cohort 64% access to internet 41% knew what skype was 9% knew how to use it Overall 65% email, 60% use FB, 13% twitter 30% willing to use it to see a MH professional- majority indicated preference for standard face to face appt

Reflections Use of video consultation within healthcare is increasing Ideally all patients should have this available as an option, whilst recognising the perceived benefit of accessing services in person for some In terms of a future work, evidence suggests focus within general adult population may aid uptake ? Focus in CAMHS - linked to use greater use of technology, patient expectations etc

Future thoughts Skype for business Address training needs - both patients and staff Encourage wider use within the trust generally to increase staff confidence Ideally offer as an option for clinic appointments and for relatives to skype into important consultations – practicalities would need to be considered Expand use within care home settings