Louise Morpeth, CEO of Brain in Hand, analyzes the balance between the use of technology and in-person support when treating mental health.
Hybrid care – the combination of human interventions and digital tools – is fast becoming the norm in post-covid health and social care services. With NHS and local authorities at breaking point – 222,000 vacancies in health and social care in 2019, an exhausted workforce (44% do not feel well because of work-related stress) and the highest number of people awaiting treatment (4.7 million) since records began in 2007  – hybrid care that reduces the burden on staff, frees up capacity and promotes patient self-management must be part of the future service landscape.
At Brain in Hand, digital hybrid media has been at the heart of our products and services from the start, before hybrid became a healthcare buzzword. From our experience working with people with autism, we know that practical and hybrid support personalized to a person’s needs can make a significant contribution to their autonomy and independence. Yet the current failure to adequately support people with autism costs the UK more than £ 32 billion a year in lost productivity and service delivery.. This is quite outside the human cost of the wasted potential.
Well used by people with autism, our digital hybrid solution combines virtually solution-oriented coaching, digital tools and on-demand human support 24/7. We focus on the needs of each person, helping them develop practical and tailored strategies to achieve their independence goals. By providing a safety net of human support, people are able to do more for themselves knowing that someone is available if they need it.
This approach disrupts the traditional model of service delivery: (1) available when the user wants help, no matter the time or day; (2) giving them control – it is up to them to determine their own needs, (3) providing them with ongoing practical support rather than time-limited interventions.
As a hybrid solution, we are constantly seeking to find the right balance between human and digital. A fully digital solution is cheaper and more scalable, but adherence to even very sticky stand-alone digital tools is low. However, digital tools can do things that human intervention simply cannot duplicate. For example, our software provides users with feedback on mood, activities and their strategies for in-depth thinking – an essential skill for self-management.
We believe the digital hybrid is all about harnessing the best of technology to perform repetitive, everyday, time-consuming tasks – reminding people to eat or take medicine – while adding the value of in-depth data analysis and AI, and combining that with the Best of Human Intervention – tailored, paced, user-driven advice that empowers a person to flourish and grow toward independence.
We see at least four places in the clinical journey where digital self-management could bring added value: in addition to clinical interventions; as a tool for people awaiting diagnosis / treatment; support the reduction of services; or maintaining mental health and preventing escalations.
The challenge for innovators in medical technology is to provide credible evidence to commissioners. Not only impact, such as improving quality of life and maintaining jobs, but also economic benefits. We need to prove that hybrid self-management is an investment in health and social services, not a cost. It is up to us, I believe, as the medical technology industry, to advocate with the public sector commissioners.
ORCHA’s recent Standards of Evidence report lays bare the challenge of applying the unique approach of randomized controlled trials and traditional health economics analysis to the extremely heterogeneous array of digital health technologies.
They argue that the assessment should be proportionate to the complexity and risk of the technology (the principle of proportionality) and should take into account the agile and iterative approach to product development (the lifecycle challenge). They propose a requirement (1) for evidence of comparative efficacy (2) of human factors analysis – how end users engage and use the technology and (3) evidence of economic benefit. All of this is reflected in the NICE proof standards for digital technologies..
With the help of the NHS Innovation Accelerator Fellowship and a Phase 2 grant from the NHS England Small Business Research Initiative, we are grappling with the challenge of achieving Level 3 status on the standard. As an innovation that spans health and social care, and can be deployed in multiple avenues, we are setting the roadmap to demonstrate return on investment and working closely with our commissioners to gather that evidence. I believe this is essential to evolve hybrid care solutions and support a sustainable and profitable healthcare system.
 Lemmi, V, Knapp, M and Ragan I (2017) The Autism Dividend London, London School of Economics and Political Science. https://nationalautistictaskforce.org.uk/wp-content/uploads/2020/02/autism-dividend-report.pdf
 National Audit Office (2009) Supporting people with autism through adulthood, London, The Stationery Office