Improving access to psychological therapies through online therapies and consultations
Berkshire Healthcare NHS Foundation Trust (Berkshire Healthcare) provides specialist mental health and community health services to a population of around 900,000 across Berkshire. The trust has 4,500 staff members and operates from more than 100 sites across the county, including community hospitals, clinics and GP practices.
Around 4,000 Berkshire Healthcare patients are now accessing psychological therapies online through their smartphones and tablets 24/7, using the Increasing Access to Psychological Therapies (IAPT) programme. The Trust's digital service is leading to reduced waiting times and improved patients’ clinical outcomes, as well as increasing efficiency and effectiveness for staff.
Access to evidence-based psychological therapies can be limited, especially for people with mental and physical health issues. Berkshire Healthcare’s strategic plan focuses on increasing access to IAPT for everyone, specifically those with a physical health problem, by 2020/21.
The Chronic Obstructive Pulmonary Disease (COPD) programme has extended direct access to IAPT in a cost effective digital way, bringing an alternative to increasing staffing numbers while providing a solution for patients suffering from long term conditions requiring support for anxiety and depression.
The aspiration was to provide accessible support for individuals suffering with mental health issues and concurrent long-term health issues in a timely and cost-effective manner.
Central to this was encouraging service users and staff to use remote technology that is accessible at any time, from anywhere, through a PC, tablet or mobile phone.
It was important to create evidence-based, remotely-delivered psychological therapies in line with NICE clinical standards.
Solution and impact
Berkshire Healthcare launched an online platform (SilverCloud) that allows service users to undergo self-guided psychological therapy with online clinical support, by text, or face-to-face as required.
There is direct access to the application through the service website, self-referral, GP referral or specialist respiratory clinician at any point in the treatment pathway. This offers greater flexibility for service users, whenever and wherever they are, such as lunch breaks, on the bus, in the evening or when at home by themselves.
The system offers evidence-based interventions, including activities and concepts from mindfulness, positive psychology and cognitive behavioural therapy, which are all recognised to have a positive impact on mental health (low mood and anxiety) and physical health (such as symptoms of chronic obstructive pulmonary disease).
The SilverCloud platform incorporates short videos, quizzes, personal stories and an online diary alongside other tools to engage and prompt service users during their journey. The system also allows services to collect the IAPT minimum data set and allows for key clinical outcomes and records to be securely integrated into the patient management system.
- Increased flexibility for service users to work at their own pace and at any time, from anywhere through mobile devices, with online clinical support
- Increased uptake of therapy by service users who find it hard to attend appointment or harder to reach groups due to stigma and work patterns
- Reduced demand on community, inpatient and physical health services
- ‘Did not attends’ down by 3%, better service user outcomes and reduced risk of self-harm
- Increased staff productivity and savings of around £37,000 in travel costs during the pilot
- Cost-effectively extended direct access to IAPT, providing a solution for those service users with long-term conditions and needing support for anxiety and depression, while not having to increase staffing numbers
The platform can be used from any computer, tablet or smartphone with internet access.
- The platform uses cognitive behavioural therapy (CBT) to help change the way people think and feel about things
- Once registered, service users work through a series of topics chosen by their therapist at their own pace, where and when it suits them to
- The therapist will check in about once every 2 weeks during the course to review progress
- The course features videos, activities, quizzes, audio guides and a personal online journal
- Full access to the platform for 1 year after activating an account
SilverCloud is designed to be used by service users in any environment to access prescribed online courses to help manage stress, anxiety and depression.
Find out more
Global Digital Exemplar (GDE) Programme
Dr Guy Northover, consultant child and adolescent psychiatrist, lead clinical director, chief clinical information officer, GIRFT national clinical lead CYPMH
These case studies summarise user and patient experiences with digital solutions along the relevant care pathway. Unless expressly stated otherwise, the apps and digital tools referenced are not supplied, distributed or endorsed by NHSX, NHS England and NHS Improvement or the Department of Health and Social Care and such parties are not liable for any injury, loss or damage arising from their use.
All playbook case studies have either passed, or are currently undergoing the Digital Technology Assessment Criteria (DTAC) assessment.
Please note the full legal disclaimer: NHSX playbook disclaimer