From specialist centres across the UK, the Huntercombe Group looks after almost 800 people with mental health problems, a learning difficulty or brain injury. Led by a specialist team of psychiatrists, therapists, support workers, nurses, teachers and social workers they support patients with a personal treatment plan. Their goal is to help patients to be as independent as they can and to live a life as healthy and fulfilling as possible.
The Group continuously looks for new ways to further enhance its care, including the use of technology enabled care (TEC). It identified Brain in Hand, an on demand support system that gives people access to detailed personalised support from their smartphone. Huntercombe spotted that offering patients quick and easy access to personal support could help patients feel more in control of their treatment and so increase ownership of their recovery. Specifically, the team anticipated that the system could help reduce anxiety and crisis incidents, especially when patients are in the local community, and help patients safely and successfully transition along their care pathway.
Based on well-established therapeutic principles such as CBT, solution focussed therapy, and recovery based rehabilitation, Brain in Hand gives each patient access to their own personalised support from their phone. This includes a diary and reminders to ensure important parts of their day aren’t missed; quick access to their best coping strategies for many of the problems they face and a traffic light system to monitor their anxieties and request additional help if needed.
To test Brain in Hand, the Group introduced the system at its Cedar House low secure facility, near Canterbury. Here patients learn how to cope with and manage their difficulties so that they can hopefully move on to a less restrictive environment.
A multidisciplinary team was established to deliver the programme, including psychologists, occupational therapists, nurses, support workers, and a programme lead to drive progress. A director from Brain in Hand with specialist knowledge in mental health service provision worked closely with the team to train them on the system and establish an approach that would achieve the best results. It was important that the technology was not viewed as stand-alone, but integrated into wider patient care processes.
The Brain in Hand traffic light feature was an important part of this integration. It allows staff to see the anxiety levels of all Brain in hand users and receive an alert when a patient presses red. It was agreed that a named Huntercombe staff member would be responsible for monitoring the Brain in Hand system and when a red alert was received, would contact the most appropriate support worker or nurse for that patient, who could then go and support them in resolving their problem. It was also clear that this wouldn’t be a replacement to emergency call buttons, but a tool to use when feeling anxious.
More than 80 staff were trained on the system, including support workers, nurses, members of the conflict management team and psychologists. It was vital that everyone was aware of its capabilities, how to get the most from it, and how it integrated into existing systems.
Once systems and training were in place, ten patients were identified who the team felt would benefit most from using Brain in Hand; this included patients with Learning Disabilities, Autism and Mental Health conditions. Over a number of one to one sessions, assistant psychologists and nurses worked with the Huntercombe Brain in Hand lead to set-up these patients on the system. This ensured that the information and advice on the Brain in Hand system reflected the strategies developed in psychology sessions.
Every week, each patient has a session with the Brain in Hand lead and on some occasions, a psychologist will also attend. Together they look at the patient’s Brain in Hand usage tracker. This shows exactly when they have been feeling anxious and what coping strategies they have used. This informs discussion, helping to spot any new areas of concern or develop new coping strategies. They also take this time to add any upcoming events or reminders to their diary, such as a day trip.
In everything it does, Huntercombe takes a measured approach. Therefore throughout the programme the team has tracked and monitored the impact of Brain in Hand, looking to identify the difference it has made to patients, operations and outcomes.
Patients have engaged well with the system. Every month patients use Brain in Hand almost 2,000 times to help with events and approximately 750 times to solve a problem. When keeping a note of their anxiety using the traffic light system, patients mainly pressed green, indicating they felt OK, and on average only needed to press red and ask for extra help once every 3 days.
Staff noticed a difference and reported that wards feel a lot more settled, as patients have been either self-managing, or asking for help before they become too distressed. Chris Davis, Senior Support worker, explains: “It gives patients the chance to express themselves, even if there are unfamiliar staff, or the ward is unsettled. They’re not going to want to come and find help if the ward is unsettled, but now they can use their device for that.”
For patients on days out from Cedar House, Brain in Hand is seen as a valuable safety net, giving the patient the comfort of knowing someone is there to help if they need it and providing the Huntercombe team with greater visibility of how their patient is feeling. One of the patients is currently learning how to become more independent at navigating through unfamiliar areas, using google maps. Having brain in hand will help him to feel supported in the event of him getting lost once he is ready for unescorted leave.
Its impact is transforming patient experiences, including:
Engagement: Brain in Hand is helping one patient to engage with their psychologist more frequently. They had previously often declined most of their psychology sessions but have agreed to their psychologist joining their weekly Brain in Hand session, which the patient enjoys.
Communication: It is helping another patient, who would generally struggle to talk to most staff, to communicate with staff about his feelings for the first time. He is able to press red when he is feeling anxious, helping staff know he needs help. Before he would bottle-up his feelings, leading to destructive behaviour and physical aggression towards staff, before staff had time to calm him down.
Confidence: Knowing that he has “support in his pocket when he needs it” has led to a third patient to stop self-harming. He has proudly reported that since using Brain in Hand, he has built his confidence and no longer hurts himself. He previously would swallow objects he knew would cause him harm. He was even able to travel to London and share his experiences with the Chairman of Huntercombe, which he previously would not have been able to without his “Brain in Hand buddy.”
Safe discharge: One patient progressed so well with her care, she was able to move out of Huntercombe into a local NHS supported living facility in the community. To ensure a safer discharge and continuity of care, she has continued to use Brain in Hand. This means she can continue to access the coping strategies and knowledge she has built up. It also means her new support team will be able to access this valuable information, and pick-up the role of responding to red traffic light requests for her.
Feedback from patients has been extremely positive. When asked about Brain in Hand, patients have shared that: “It helps with communication’’ and “I like Brain in Hand because it helps me to stay calm.” “I like my Brain in Hand, it helps me if I’m agitated or stressed. It makes me happy that staff can come to me.”
Vikki Cleaver is one of the team who regularly is responsible for monitoring the Brain in Hand system and alerting the most appropriate member of staff when a patient presses red. She commented “It doesn’t feel like an extra responsibility; it’s helping us to better guide patients in the right way and give them a better quality of life. I’ve seen a real difference on the wards. Patients are calmer and able to do things they couldn’t before, be it make a cup of tea or control their anger rather than become physical with staff.”
Hospital data appears to support this feedback, indicating a decline in disruptive behaviour, a reduction in incidents and fewer physical restraints amongst users. The Brain in Hand programme will continue and be extended within the Cedar House setting and teams are looking to identify other settings where Brain in hand could improve patient experience.
Commenting on the programme, Emma Harrison, Hospital Director, said: “We all use technology in the form of Apps in our day to day lives, whether it be to pay for car parking or to book exercise classes, this is the world we live in now. It therefore makes perfect sense to turn to an app to find innovative ways of supporting our patients in the struggles they face every day, when coping with issues such as trauma and illness. We are proud to be working with Brain in Hand and will continue to promote its use for the benefit of the vulnerable adults within our care”