George Tadros: The RAIDPlus Test Bed Vision

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Professor George Tadros, Consultant in Old Age Liaison Psychiatry and Clinical Lead, Rapid Assessment, Interface and Discharge (RAID) service, Birmingham and Solihull Mental Health Trust, shares lessons on testing digital innovations to reduce the incidence and intensity of mental health crises.

This presentation was recorded at our Digital Health and Care Congress 2017 on 11 July 2017.

Transcript

This are our partners and as everybody said, we have the HSN but with mental health crisis it’s not just mental health.  The police, the housing, the ambulance, the community trust so that was one of the challenges.  Other challenges as my colleague said, we have the only mental health vanguard and the test best and the STP and the whole thing going together and how can you actually make the best of everyone of it, by making it to fit together rather than having all these projects competing against each other. 

As I’m the last speaker I’ll just go though it quickly.  

You see the challenge here, just very quickly if you look at we’re trying to do, combine the researches together, technology together, a lot of disclosure from mental health does not exist and difficult to measure.  Mental health crisis, what is a mental health crisis?  You can end up with thirty different definitions.  You want a miserable definition afterward so we managed to find that and measure it and test it.  The other thing before I show you my next slide, don’t give me the answer, I guess I know it, why do you think of the mental health crisis management in the country?  Is it good enough?  Don’t tell me, right.  

But if you look at this, and I hope you are not a commissioner, just in Birmingham we have liaison team in the big hospital, seeing about 450 patients every month, another hospital, third hospital, fourth hospital, fifth hospital with liaison teams, is that good?  24 hours, 7 days a week, we have place of safety, we have street triage, we have home treatment, we have 111, we have crisis team, we have bed management, we have GPs, we have Samaritans, we have private sector; we have all of this.  What do you think, is that enough?

And in the middle of that, you have a patient at the time of crisis doesn’t know what to do. 

The cost is high, the pathway is absolutely chaotic, I don’t know when patients will fall into crisis, the only thing I have is phone call after phone call, patient in crisis, please ambulance, A&E, the whole thing. 

What I want to do, is the pathway to be like this.  So basically, we are developing a care coordination centre for the crisis care, it’s all digital technology and that care coordination centre, you have a number of technologies coming in.  One of my colleagues have already talked about like a patient’s portal, so now we’re communicating with the patients directly, putting for them their crisis intervention plan digitally.  We sent them the lithium level, the clozapine level, they send back to us all their scales we want from them.  But also we have other technologies which I’ll just focus into it. 

One is the predictive analytics, I’ll just get this, okay, so predictive analytics and as my colleague said earlier on, how can you predict a mental health crisis?  We’re working with a company called Telefonica but we had all the organisations paranoia, all the difficulties around commercialisation, data sharing with non-NHS, even with NHS becomes a problem, with non-NHS information governance, ICO the whole thing.  Even, we were just talking about commercialisation, something beyond my ability, to know who to talk to, how you get them.  But now, we actually have the agreement with them, we’re start seeing the predictive analytics coming, and just part of the evolution, we have primary objectives to know who’s going to fall into crisis, I started to see the secondary objectives becoming even more attractive than the primary practice.  How can you pave the pathway, how you can support people with packages of care, how you get your staff to accept all of this?  So that’s the predictive analytics.  

The other bit, I’ve shown you all these kinds of pathway and among all these liaison teams I have shown you, just the liaison team is almost about £5 million.  And then the home treatment team and then the PGU and then the street triage, you hit something like £10-12 million, but no communication.  I don’t know real time where the patients are, where the staff are, where the skill mix, who can do what.  So, we developed a CADDI , capacity and demand dash information, real time, you see where the patients are coming from, what the problem is on real time, where your staff skills are and how can you match the capacity and demand real time. 

My colleague there was talking about the psychology of the staff, the psychology of the organisation, how you get your staff to accept that, technology.  We have five years of electronic records and we’re good at using electronic records.  We use RIO, whatever’s good or bad, but the point is most of my staff will not use it real time.  So how can you develop thinking of real time technology and moving them around?  HR involvement, data sharing, data security, so hopefully, we are developing this new care coordination centre with the patients’ portal in it, predictive analytics in it, the CADDI in it, bed management tool and change the way you manage crisis care that very chaotic way in a straight pathway which depends on this technology.  

Thank you.