Developing a digital innovation to support the mental health care pathway: establishing the evidence
From idea to app
Amy Manning is a social worker specialising in mental health, and regularly carries out ‘Section 12’ assessments, the process by which people in mental health crisis are assessed under the Mental Health Act (1983). The Act allows for individuals to be detained against their will, and the process for doing so requires an Approved Mental Health Professional (AMHP) and two doctors, one of whom must know the individual, with the other having specific expertise in the diagnosis and treatment of mental disorder.
Obtaining Section 12 doctors has in the past meant calling round those known to them to find someone who can attend, a process often taking several hours. While this is happening, the individual is being held, perhaps in a police cell, awaiting their transfer to a psychiatric facility or hospital, distressed and confused. Clearly, any delay is not ideal for them.
Amy became frustrated with this paper-based system and began researching digital solutions in 2016, speaking with professionals involved with the process to come up with a better alternative.
Amy explains, ‘I wanted to explore what other options might exist. I found that there weren’t any, so I decided to develop an app myself.’
‘Over the next six months we registered the company, took the platform to proof of concept stage, and started to build a team,’ says Amy. ‘We negotiated six-month pilots with seven clinical commissioning groups (CCGs) in Cumbria and South West London, all of whom commissioned the platform. This gave us a huge amount of user feedback to develop our idea.’
Establishing the evidence
While Amy had heard of Academic Health Science Networks (AHSN), she wasn’t sure how they would be able to help her. After the pilots were completed, Amy approached the South West AHSN in 2018. This marked the beginning of a period of intensive connection-building and helped with another key factor in the development of the work: creating an evidence-base. The South West AHSN helped Amy to look more closely at the evaluation work that had already taken place, and introduced her to Wessex AHSN, where S12 was piloted by West Hampshire CCG with Wessex AHSN carrying out an independent evaluation of a pilot in Hampshire and Southampton. The AHSN are delivery partners of the Accelerated Access Collaborative.
The connections Amy made through the AHSN snowballed. Along the way, Yorkshire & Humber AHSN and the Health Innovation Network (the AHSN for South London) provided pitching opportunities at mental health digital events, while Kent Surrey Sussex AHSN also acted as a critical friend.
Game changing connections
Amy was also introduced to further organisations which could help develop her innovation, and to programmes which could release additional funding and support. The SetSquared four-day Health Innovation Programme provided valuable insight into the NHS as a marketplace and how new services and products are commissioned.
Wessex AHSN and the Health Innovation Network supported Amy's successful applications to the NHS Innovation Accelerator (NIA) programme in 2019, and to the Accelerated Access Collaborative's Innovation and Technology Payment (ITP) programme, which makes it easier for trusts to purchase new technologies.
'The ITP has been a huge game-changer for us. To have that strategic backing from NHS England and NHS Improvement has really helped,' Amy says.
Another significant milestone was being accepted onto the Clinical Entrepreneur Programme, an entrepreneurial workforce development programme run by the Accelerated Access Collaborative, part of NHS England and NHS Improvement.
The most important elements that were missing in the early days, Amy believes, were knowing how to generate meaningful evidence, and knowing where to get help.
'Identifying a genuine problem and a genuine solution is half the story. You also need to find strategic leaders or clinicians who will back you and help to open doors for your idea. If you still think it's the right thing to do, contact your local AHSN and they'll help you find a network of people to support you.
'Knowing the right people to speak to takes out all the time-consuming traffic,' Amy adds. 'The independent evaluation from Wessex was fundamental. I'm also hugely grateful to the NIA programme for their mentorship and the support from the other innovator fellows to keep going. And endorsement from schemes like the ITP takes the procurement challenge out of the conversation with trusts.'
Looking to the future
Currently, the innovation is used by around 75% of NHS mental health trusts. They are developing new features, this time with the right networks and knowledge of what will help their ideas progress. Amy's next challenge is to keep developing, and evolving, so that S12 remains the solution of choice for the Section 12 process, not simply because it is the only solution.
Managing a company employing 20 people, and making sure it is a great business to work for, is new for Amy, who never set out to be an entrepreneur, and still practises social work to maintain a connection to the people who started her on the journey in the first place.
Amy’s advice to anyone in a similar position is firstly, to believe in your idea. ‘Clinicians often get in touch with me to ask about my innovation experience and to share their ideas. My advice is to start by undertaking robust research, to explore what others have already tried to solve the problem and ensure that the problem you are solving is genuine.’
‘My journey has had great highs and horrible lows, and has been a huge learning curve in my life. I am incredibly proud that we have made it easier in many cases for Approved Mental Health Professionals to find the best available assessing team for the person being assessed.’
- Seek the support of clinicians who believe in your idea.
- An independent evaluation and patient feedback are fundamental.
- Academic Health Science Networks can help connect you to the right people.
- Speak to national leaders in this space, to see whether they would back your work.