"We must learn from the experience of online working during the COVID-19 pandemic to meet the needs of all mental health service users."
During the COVID-19 pandemic there has been a rapid and quite remarkable take up of information and communication technologies that have facilitated the continued provision of critical mental health services, both for adults and for children and young people. An abrupt and dramatic switch to working from home and remote provision of services has been necessitated by the physical distancing and lockdown policies. This has been enabled by technologies such as video conferencing platforms and cloud storage, laptops and smart phones, in ways that would not have been possible even a few years ago. People have commented on how different lockdown would have been for the public without Netflix and Amazon Prime. Equally, how different would it have been in mental health services without Zoom, Microsoft Teams and remote access to patient records? As we begin to emerge from the initial phase of crisis response questions are being asked about what we can learn from this social and organisational experiment and what of these new ways of working should we retain as part of the ‘new normal’.
"What can we learn from this social and organisational experiment"
My doctoral research on the impact of technology on organisational processes, and experience of supporting child and adolescent psychotherapists responding to COVID-19, leads me to argue that the many potential benefits of technology and online working will not be realised if we do not learn fully from this experience. On the one hand, it might be seen as only a temporary aberration from which we have nothing to learn. On the other, the risk is that a narrow view of the efficiencies of online technology is implemented as being an ideal, but which does not meet the needs of many service users and places an excessive burden on staff. We need to engage thoughtfully and creatively with these new opportunities so that decisions are clinically led rather than technologically determined.
Technology use is essential to achieving greater efficiency and effectiveness in health service delivery and is a major plank of the current government’s long term plan for the NHS. It is likely that health service planners and provider organisations will seek to build on the, ostensibly positive, switch to technology in response to COVID-19 to transform services in ways that might otherwise have taken many years and met with considerable resistance. However, Professor Robert Wachter's 2016 review of IT implementation in the NHS made the point that lessons about the complexity of the task and the need to understand processes of adaptive change have not been fully learned, and this threatens current efforts to digitise the NHS. We must avoid simplistic solutions in complex services.
"The risk is that a narrow view of the efficiencies of online technology is implemented as being the ideal"
Technology is incredibly powerful: it has the capacity to shift the workspace from office to home. This has of course been immensely useful during the pandemic, but it also encroaches across the work/home boundary and in so doing shifts workload and anxiety onto individual staff. It makes clinicians and services more efficient. But in the circumstances of mental health services what do we mean when we talk about efficiency? If it is about making staff work harder and faster, then what is the cost and what is the impact on the provision of care? We can turn practitioners into robots or superheroes, but is that going to result in more effective treatment of people with mental illness? Technology makes staff more agile but in so doing may destroy a sense of team-working and a place where anxieties can be shared and discussed. Mental health care is essentially a human service and must be organised in ways that support human resources and the capacity to care. Technology use needs to assist that rather than disrupt it.
"Technology is incredibly powerful"
The current technology-enabled way of working during lockdown, effective though it has been, is a reduced and simplified service that works well for some people but not others. For some their illness is too severe for them to access appropriate treatment by video or telephone. Working with younger children in this way can be difficult. Some parents may not be able to support the treatment through the provision of a confidential space or the required equipment. It is crucial therefore that the next steps are informed by a genuine assessment of what worked for whom and what did not during this enforced experiment.
How people respond to new technology and processes of change is driven by a complex interaction of conscious and unconscious factors. Technology may be taken up and used in ways that are as much about managing anxiety as they are about service development. In responding to the changes brought about by the current crisis situation we need to reflect on the capacity of individual staff, and the system as a whole, to work with the disturbance that is an inevitable product of looking after people with often severe and long-standing mental illness. We need to understand when and where technology can help us with the primary task of health services – to care for the specific needs of individual service users. This is a responsibility for managers and system leaders as well as frontline staff.
"Technology may be used in ways that are as much about managing anxiety as they are about service development."
This article draws on a webinar that can be viewed here: https://childpsychotherapy.org.uk/online-technology-and-provision-mental-health-services
For references and more see doctoral thesis: https://tinyurl.com/techthesis
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