ICS development: the digital opportunity to improve population mental health

Integrated Care Systems (ICSs) will come into formal existence across England this year bringing much needed integration of planning, commissioning, and delivery of health for local populations. As they become established, ICSs have a real opportunity to prioritise the mental health of their local populations.

Integration provides opportunities to tackle the wider determinants of poor mental health and reduce health inequalities. Population mental health support has long required a whole system approach; one that breaks down barriers between agencies, joining up health, social care, public health, voluntary and community agencies working together across a whole integrated ecosystem of services and supports from promotion and prevention, to care, treatment and on-going support for recovery. Digital mental health services can play an important part in this local ecosystem.

Five commissioning priorities to consider

Change will likely take time and will not happen uniformly across the country. Areas that have already started to integrate will have a likely advantage to move quicker and drive local innovations. To get ahead and prepare for the transition to ICS, there is a lot that local teams will need to do, to help improve population wellbeing. Five components are likely to be key:

• Planning – Integrated planning and delivery between the NHS and local authorities, alongside local community, and voluntary sector agencies.

• Structure – Local arrangements in place with key personnel identified for leading on mental health across local agencies with a lead commissioner for mental health.

• Public involvement – Engaging with the public in planning services to make full use of local assets, care pathways and services. This includes having mechanisms and processes in place for engaging with the public and community sector.

• Needs-based approach – Understanding the needs of local populations and finding ways to promote good mental health, prevent mental health problems and ensure access to effective care and treatment services. In short, building an ‘ecosystem’ of integrated services from promotion and prevention, to care and treatment.

• Crisis intervention – Finding ways to reach populations at greater risk and concentrate efforts on those who are most vulnerable as well as those struggling with mental health difficulties.

The pandemic’s impact

The Centre for Mental Health has estimated that up to 10 million people in England may need some form of mental health support arising from the disruption, the uncertainty, and the pressure caused by several waves of the pandemic and the continuing uncertainties caused by the emergence of new variants.

What is becoming clear, is that scaling up existing models only will be insufficient. With current service models focused mainly on downstream care and treatment, there is not yet in place an affordable or sustainable way to address support needs at scale.

What is more likely to help are population-wide solutions that:

• Are accessible
• Intervene early
• Provide clinical competence and assurance
• Support people when and where they need support

To build an impactful and scalable ecosystem of support that addresses population-wide mental health needs, digital services can play a key role.

Turning to digital

According to ORCHA, the first wave of the pandemic saw a 200% increase in the use of mental health apps and platforms and, despite predictions based on the re-opening of face-to-face services, growth has continued at an average rate of 55%.

In the light of the Covid-19 pandemic, it has only affirmed what we knew from the beginning – digital mental health is critical to help scale much-needed population wide service coverage. More people are now comfortable accessing a wide range of services to help with meeting their mental health needs. Digital systems can also help assess population needs with real time data and insights, alongside understanding the needs and capacity of local populations. Digital services will be a key component in population mental health services for ICS’s.

Togetherall’s recent panel discussion with healthcare commissioners explored examples of local strategies to embed digital services to address population needs as part of a wider support ecosystem.

Getting digital right

There is a significant growth in services that take therapeutic techniques from proven face-to-face models and developing these into engaging and interactive content experiences; this model promotes self-management which delivers scale. Such tools can also provide support around related needs including substance misuse, alcohol, domestic violence, debt, housing and employment.

In planning  and commissioning for population mental health needs however, ICSs could consider a greater range of criteria to select digital mental health services and supports:

Safety

• Tools under consideration should firstly ensure safe and effective care that is able to support people who are at risk or in distress or crisis.
• Measures in place should include access to clinical support as and when required and an ability to engage local services for active rescue.
• Digital providers must also meet key quality and assessment standards. For example, through the Organisation for the Review of Care and Health Apps (ORCHA).
• Approved tools for self-care, Prevention and effective early intervention means that scale and population-wide support is a key benefit of a digital approach.

Pathways

• Digital mental health support tools should have the ability to link with local pathways of care. Joined up service pathways allow for different needs to be addressed in a single ecosystem, rather than through a menu of disconnected tools, which places more responsibility on the individual in need.
• Digital solutions can be an effective part of ‘wrap-around’ care that complements all local services, care and treatments rather than separate to them.
• Digital services can be a core component of supporting recovery, preventing relapse and being available when other local services may not be operating and as a way of providing an intervention whilst on a waiting list for support.

Community

• Providing the ability to interact with others with similar lived experience provides wellbeing benefits often not provided for in traditional models of care. Offered in addition to self-guided tools and professional support where necessary, peer interaction can be powerful to create normalisation, belonging, validation and self-acceptance.
• An approach based on lived experience and peer-led support also means users are exposed to stories and learning they can relate to. This is important for designing a more inclusive approach to mental health support. One-quarter of members on Togetherall identify as being from an ethnic minority background meaning a diversity of experiences are represented in the support provided.

Due diligence

• With much new innovation to the market, commissioners should check the long-term sustainability of digital services under consideration and the investments made by digital providers to update and improve their platforms. Togetherall is one of the longest-standing digital mental health services in the UK – first established in 2007.

Final thoughts

One of the by-products of the pandemic, is that people are now more comfortable operating remotely and digitally and have the most to gain from a fast-evolving digital world, that offers huge potential to change the current nature of provisions for the better and in ways that complement existing services.

With innovation comes some inevitable risk-taking. It can sometimes mean stepping out of the known and our own comfort zones. As ICSs begin to take shape, the digital mental health landscape provides real opportunities for ICSs, local commissioners, and others to complement traditional forms of mental health care treatment and support with effective, safe, high quality and well linked digital offers.

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Gregor Henderson is an independent consultant and advisor on mental health and served as Director for Mental Health and Wellbeing for Public Health England from 2013-2021. He is a board member of the eMental Health International Collaborative and an active member of the International Initiative for Mental Health Leadership. He works as a strategic advisor for Togetherall and Chairs Togetherall’s research programme.