This story caught my eye over the weekend – some proposals by an NHS trust to outsource mental health therapy to workers abroad who would communicate with service users via Skype. The BBC report says the idea – which was not at all well received – has already been dismissed, but the part that struck me was the way in which the idea of using Skype was attacked alongside the plans for outsourcing. One quote says for example “”That [the trust] could even consider Skype shows how little the board understands of the work of its staff and the needs of its service users.” So, what’s so bad about Skype?
First off, I should say that I agree with the union that this would have been a bad plan. But we disagree on an important issue. I think this looks bad because of the outsourcing, not because of the Skype. I think with the challenges mental health services are facing they need to keep a skilled and experienced workforce, and they certainly don’t need to threaten jobs and create insecurity. I’m sad though that the defence employed is to suggest that therapy itself is threatened by the idea of digital contact, and that people receiving therapy in anyway that isn’t the traditional face to face delivery would be a bad thing.
The fact is that services will need to change and evolve. This could mean letting go of established ways of working with patients. It doesn’t have to mean letting go of staff however. Integrating digital services into current treatment models should be about getting the best of both, in combination – not creating an either/or trade off. Technology should be used to complement the way therapists work, not replace it.
In the research this is referred to as “blended protocols”, where treatment involves digital services being providing in addition to or interaction with therapist contact, and reviews of online therapies find this way has better effects compared to standalone therapies with no therapist involvement. One thing to notice however is that this ‘blending’ can happen digitally – for example by having therapist contact by email, phone, or indeed Skype. Blended therapy therefore doesn’t necessarily still mean providing traditional face to face support.
So – seems like I’m on board with the proposal? The problem however is that the trust isn’t looking to ‘blend’ digital services with its existing staff, but also to outsource the therapist’s work. Presumably this would mean that everyone gets ‘distance therapy’, which I think loses of the key aspects available by blending services: flexibility. A service which effectively manages a number of its users online may actually be able to provide more face-to-face time for those who need and prefer this. This would be efficient for the service, and also could achieve one of those amorphous ‘personalisation’ goals, of offering people the format of therapy they prefer.
This raises the next key point – that rather than just being about efficiency, it should be about what service users themselves want. If they express that they want and they need face to face contact over Skype then we should listen. Certainly some service users I’ve spoken to about online therapies have said exactly that. But others relished the opportunity to use online treatments. My concern is for those service users, the ones who would benefit from exactly those digital services, who risk having their needs ignored if we treat this only as a fight to keep therapists jobs. People who can’t take the time out to spend an hour in face to face therapy due to work, caring responsibilities, or problems travelling. People who actually feel more comfortable, would be more likely to engage with treatment, if they can use digital services. Those people don’t have a union, and as far as I know they can’t get a piece on the BBC. Framing this as an either/or issue, as an evil digital takeover at the expense of staff, isn’t fair to those patients. Again, the key is flexibility – the option of digital OR face to face should be there.
Nevertheless, it’s a cold hard reminder to those of us babbling eagerly about “the potential of blended protocols” that there are people eager to make ‘efficiency savings’ who will look at digital services as a super way of cutting out those burdensome, expensive, experienced and skilled staff. The research does not support this as an approach. And neither should we.