Mental health and wellbeing in primary care services: resources

2. Digital Services

2.1 Introduction to digital services

Digital treatments and online resources are now an integral part of mental health service delivery across Scotland. All of our digital services are proven to be clinically effective and safe to use while providing self-help, self-managed treatments and technologically enhanced therapy. They are delivered within a stepped care model (section 2.4) targeted at different levels depending on the support required and are fully integrated into primary care, psychological and mental health services. Current services are focused on providing support and treatment; and are tailored to specific population groups, such as adults, young people and Health and Social Care staff across all areas of Scotland.

The impact of Covid accelerated the adoption of digital technologies [McKinsey Global Survey, 2020] across both the public and commercial sector. This includes increased use of a wide range of digital tools and services, including virtual telemedicine appointments, online meetings and remote learning.

In the context of mental health and wellbeing, digital tools and services have emerged that have gone beyond the replication of offline service models, to provide resources that offer choice and alternatives to face-to-face support. The digital wellbeing landscape has grown significantly and has seen the development and expansion of online resources to provide self-help tools, promote emotional wellbeing, and provide signposting to other mental health services and support.

2.2 Overview of digital services

There are several online or digital tools providing mental health support. How and when they are used will depend on the needs of each individual and the outcome they are aiming to achieve.

The digital tools included within this document are not exhaustive. Many are tailored to specific population groups, such as children and young people, and health and social care staff. The tools may also have several purposes, providing a mix of self-help tools, advice and signposting.

2.3 Potential benefits

Some of the proven potential benefits of using these products include:

• supporting individuals to find and access the appropriate service when and where they need it;
• improving the quality of service and levels of accessibility, while expanding capacity of existing service provision;
• improving equality of service access and support services to meet increasing demand;
• harnessing large scale data to enhance learning, understanding of service demand and service improvement; and
• working with a national framework aligned to strategic and policy priorities.

2.4 Digital step care model

All digital treatments are clinical assessed and integrated throughout local matched or stepped care models of service delivery.

2.5 What is Cognitive Behavioural Therapy?

• Thoughts - what we think affects how we act and feel.
• Feelings - what we feel affects how we think and do.
• Behaviours - what we do affects how we think and feel.
• Body - what effect do they have on our body?

Cognitive Behavioural Therapy (CBT) is a psychological therapy based on the relationship between what we think, what we do and how we feel. CBT teaches us how to recognise and tackle problems in the here and now, rather than in the past.

It is a time-sensitive, structured form of psychotherapy, which has been shown to be highly effective in the treatment of depression and anxiety, as well as a range of other psychological disorders.

The central concept of CBT is that our emotions, thoughts, physical reactions and behaviours are all linked and affect each other. An individual’s thoughts and behaviours can be changed, which will in turn will alter their mood.

2.6 What is Computerised Cognitive Behaviour Therapy?

Computerised Cognitive Behavioural Therapy (cCBT) is a highly effective, evidenced- based, self-guided digital therapy recommended by NICE and SIGN to help people experiencing mild to moderate mental health symptoms including depression and anxiety. It is available to adults aged 16 years or over and is a highly effective intervention, providing a suite of computer-based therapy options across all Health Boards in Scotland since 2018.

There are currently 35 cCBT based treatments available. Each territorial Board has a cCBT service, hosted in local psychology or mental health services. Please check locally for ability of treatments, see Appendix 2 for contact details.

A list of the current available digital therapies are shown in figure 1.

2.7 Referral Routes to cCBT

Referral routes vary depending on who is accessing support. There are numerous online self-help and self-management tools and resources available through health and care websites, providing access to those individuals who:

• are mentally well but would like further support for their wellbeing;
• are struggling with their mental health but have not approached a GP/Clinician; and
• have a diagnosed mental health disorder and need help with self-management or accessing further support.

Unsupported self-referral treatments (section 2.8) enable individuals to access therapies with no requirement for referral from a GP or any other mental health professional. The therapies are accessed via a web-link that the individual independently accesses. The treatments require no support from health professionals and there is no monitoring of risk. These are therefore suited to service users with mild symptoms (section 2.4) and designed for preventative treatment.

Treatment is self-managed by the individual and completed either in a community location or at home, at times of their choosing. cCBT can be delivered as a standalone treatment or in a blended approach, working in parallel with existing services both locally and nationally and offers service users more choice.

Supported treatments (section 2.9) require a referral through a GP practitioner or other MH Professional via SCI Gateway (electronic referral form or local health board protocols) or through other specialised services e.g. perinatal services. The treatments provide support in the form of regular online reviews and service users are monitored daily for escalating risk. These treatments are suited to service users who have mild to moderate symptoms (section 2.4).

2.8 Self-Referral Digital Therapies

2.9 National Digital Therapies, available through referral

Sections 2.8 and 2.9 outline what is generally available. Psychology services in certain boards, may have clear and specific local pathways for accessing all cCBT resources, and staff in those boards should follow those pathways. See Appendix 2 for board-specific information.

2.10 Video Consulting Services

The Scottish Government Near Me programme aims to offer the people of Scotland the choice to attend health, care and other appointments via video calls. In many instances the Near Me service, and engagement with NHS Inform online tools, are appropriate supports for lower-level mental health issues and for those living in remote and rural areas. Near Me has enabled the delivery of thousands of virtual consultations every week.

2.11 Near Me

Near Me enables people to attend appointments from home or wherever is convenient. The service is already widely used across NHS Scotland for health and care appointments. It has been available since 2016 and can be accessed by all population groups provided they have a device and the connectivity to support it. Appointments are generated by the service and a URL can be issued to the individual inviting them to the appointment in a variety of formats. Mental Health services have seen some of the biggest uptake of Near Me appointments.

The Near Me team have worked with partners, clinicians, service managers and service providers to develop guidance notes to support the setup of new Near Me services. The Guidance Notes and Case Studies are aimed at staff members. More information can be found in the further reading section, Appendix 3.

2.12 Waiting Well - NHS inform

People can benefit from taking a proactive approach to their waiting period and this site can give information and tools needed to look at their own health and wellbeing in this waiting time, to think about what matters to them and what health related areas they can focus on such as managing pain, poor sleep, anxiety, stopping smoking etc.

The Waiting Well Hub is available on NHS Inform, to support people who may be waiting to see a healthcare specialist or to get health and social care services. The Hub aims to provide access to better information to support people to proactively manage their health and wellbeing, to think about what matters to them and what health improvements they could make during this time.

The Waiting Well Hub has been delivered through the Preventative and Proactive Care (PPC) Programme, part of Scottish Government’s Care and Wellbeing Portfolio (CWP).

2.13 Group Therapy using Near Me

The initial introduction to group consulting therapy began in November 2021, allowing group consultations to take place with up to 30 participants. This enabled clinical services to deliver group therapy in a virtual setting, providing flexibility in the form of clinical support in remote and rural communities and assisting with reducing the need for face to face contact.

As we move forward and expand the services, features such as group chat and break out rooms are currently being developed.

2.14 Digital Health and Care website

The new Digital Health and Care website is aimed primarily at professionals working in the health, care and housing sectors with the aim of providing access to relevant strategic and policy related information, programme updates, news, blogs and events. Digital Health contacts can be found in Appendix 2.