MENTAL HEALTH
Notes from South East London I
’m on a bus in CamberwelI attempting to distract myself from the grimness of the cyclists carefully navigating through their daily road challenges and I find myself thinking about the atmosphere in the NHS, where things are also pretty grim.
Only those plugged tightly into their iPods could have missed the impact of the credit crunch on their health and social services. Our local social care teams are planning 25 per cent reductions to front line teams.
The local authority, which grants supporting mainstream child and adolescent mental health care in our communities, is a shadow of its former self. Commissioners are looking at outpatient DNA (did not attend) rates and wondering if capping patient access at one DNA only
(rather than three or four) would be better. Might be a little unfair if it’s the memory disorders clinic.
Though it’s not all grim. As ever, patients and staff continue to surprise me every day with their compassion, energy and commitment, by combining well- known skills and techniques with new processes and protocols.
Increasingly, at the South London and Maudsley NHS Foundation Trust (SLaM), technology is the tool we are using to help us navigate our way through our own daily challenges and think differently about our patients and their care.
Our use and knowledge of technology is ever expanding; some teams are using it to reshape our processes and promote recovery while others are using technology to see if rapid triage for autism spectrum disorder (ASD) is viable through brain scanning.
Buddi is a military grade, global GPS tracking device, invented by Entrepreneur of the Year (2009 Orange National Business Awards), Sara Murray, and her team. Enclosed in an ankle bracelet, the device sends a signal to Reliance, our monitoring and tracking team.
Patients in our medium secure units road tested the ankle bracelets while out on leave during our initial pilot. They welcomed (and suggested) a reminder vibration 30 minutes before home time and when edging towards an exclusion zone.
Those late back from leave are tracked by Reliance who send a live feed to SLaM and our local
42 nhe
police operational room who dispatch a car to pick up the patient.
Big Brother? Not really, just a sensible modern way to reduce risk. Public safety and patient well-being is paramount. Patients absent without leave raise concerns and create unnecessary costs.
The absconding of a high risk client in 2008 resulted in a stranger homicide. The poor supervision of a client in 2009 led to a national media alert and a full police search, where the helicopter and police focus alone cost £300,000.
Patients routinely late or purposefully breaching leave often find their clinicians and the Ministry of Justice less inclined to support increased leave, thus slowing the therapeutic process towards discharge and self- management. Before bringing Buddi into our medium secure units we had late or absconding issues with 0.5% of all patient leave.
Current figures suggest our late returns and abscond rates are reduced to 0.25%. More patients are getting leave and most welcome the tracker technology and the prompts it provides.
In our recent autism research findings (by SLaM and the Institute of Psychiatry), MRI scans (a quick brain scan taking about 15 minutes), have been successful in identifying ASD with over 90% accuracy.
With an MRI, the scientists and doctors can use biological markers, rather than personality traits, to assess whether or
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www.national.slam.nhs.uk
Nov/Dec 10
not a person has ASD. These disorders affect up to 1% of the population and are traditionally diagnosed using patient and family interviews to collate an understanding of the person’s early presentation from childhood through to adult years.
These interviews are time- consuming and clinic waiting lists are long. People without family networks and a history of their childhood developmental markers often struggle to achieve a confirmed diagnosis. The MRI method could allow these clients a clarified diagnosis and lead to reduced waiting times for clinics, speeding up access to treatment and advice.
These technological advances are helping us to cut through the current grimness in the NHS, alongside traditional care and communication. While dissenters suggest patient tagging technology and MRI diagnostics may reduce the need for nurses and clinical teams, we could argue it frees them to focus on the care essentials.
Finding an equilibrium between technology and person-centred engagement has long been a challenge for cancer and cardiology services and now, in mental health services, we find ourselves attempting our own careful navigation.
Jill Lockett is service director – behavioural and developmental psychiatry South London and
Maudsley NHS Foundation Trust – in partnership with Kings Health Partners Academic Health Sciences Centre
Jill Lockett
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