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Improving care for people living with mental illness through the pandemic

Prof Fiona Gaughran explains how informatics research has helped ensure people with serious mental illness who contract COVID-19 have access to an early-intervention service: COVID Oximetry @home.

Fiona Gaughran172x207Prof Fiona Gaughran, Lead Consultant Psychiatrist, National Psychosis Service and Director of Research and Development at South London and Maudsley NHS Foundation Trust, is supporting vital research as lead for applied informatics research at the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London.

We spoke with Fiona to learn how informatics research has highlighted the impact of the COVID-19 pandemic on patients in south east London living with severe mental illness and an initiative that could help.

What is meant by 'applied informatics'?

At the NIHR ARC South London, applied informatics focuses on the introduction and evaluation in practice of technologies such as digital tools, mobile health technologies, machine learning or artificial intelligence (AI), and the application of knowledge from routine observational data. Our technological capabilities are extensive now, but what we need to develop is evidence about how best to use such technologies in routine health and social care.

How has informatics research helped to reveal the impact of the COVID-19 pandemic on those living with serious mental illness in south London?

Ongoing analysis of our large observational datasets, led by Prof Robert Stewart, Clinical and Population Informatics lead for the Maudsley NIHR Biomedical Research Centre, showed early on that there was a significant increase in mortality rate during the first wave of the pandemic in people who have used South London and Maudsley NHS Foundation Trust’s services, compared to the same period the year before.

This provided data to strengthen our concerns that people with serious mental illnesses might be especially vulnerable to the effects of COVID-19 and highlighted the need for intervention. This is how discussions began with the national deterioration lead and the local team supporting the COVID Oximetry @home programme.

Can you tell us about the COVID Oximetry @Home service and why you wanted to get involved?

The Oximetry @home service identifies people with COVID-19 and who are most at risk of becoming seriously unwell and provides them with Pulse oximeters. Patients or their carers are trained to measure their oxygen saturation frequently so the service can identify people who are deteriorating. This is important as early intervention is key to improving patient outcomes.

As our data identified an increased number of risk factors for those living with severe mental illness, that could result in poorer health outcomes, it became clear that our patients would benefit greatly from inclusion in this service.

How is collaboration across the south east London health network supporting this project?

Successfully delivering this service to patients across south east London relied on effective collaboration. Our Applied Research Collaboration came together with South London and Maudsley NHS Foundation Trust to build upon work already started by the Health Innovation Network (HIN) alongside local primary care leaders.

It was great to have support from South London and Maudsley NHS Foundation Trust leadership. The Trust provides the widest range of NHS mental health services in the UK, and through the pandemic has continually worked across London to highlight the additional needs and risks of people with serious mental illnesses in the context of the COVID-19 Oximetry @home services. 

Together we have been able to develop practical yet flexible suggestions about how to implement inclusion of serious mental illness as a risk indicator in practice and share those with our colleagues across the country.

What lessons have you learnt from the programme at this early stage?

People with serious mental illnesses suffer health disadvantages across the board, and by this stage we have robust data to demonstrate their needs. The illnesses themselves can compromise people’s ability to communicate their health needs or follow complex management plans and so services need to be flexible and make reasonable adjustments.

While the impact of the Oximetry @home service is still under evaluation, we believe the possibility for early intervention that this initiative establishes for people with severe mental illness will improve their health outcomes. 

Routinely linking with existing initiatives like this, designed to manage either long term conditions or deteriorations in health would be hugely beneficial. With a wider understanding of services operating in south east London, we could identify which of these could benefit from adjustment to meet the needs of those with complex mental disorders so that we can deliver the best possible care.

Visit the NIHR Applied Research Collaboration South London website to learn more about the service.

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