Using real-time data to drive reform (For the users: access and quality!! For the funder: sound investments & accountability) Prof Ian Hickie AM MD FRANZCP FASSA FAHMS Co-Director, Health and Policy Brain and Mind Centre, USYD Ian.hickie@sydney.edu.au The University of Sydney Page 1
UK Govt Office for Science 2008 The University of Sydney Page 2
Key Issues for early intervention with adolescents and young adults 1. Improving the range of key outcomes A. Maximising economic, educational and social participation OECD focus on NEETs in the 18-25 (30) year old age group B. Reducing self-harm, accidents and suicidal behaviours Requiring much more specific focus C. Preventing development of alcohol/substance misuse Major community and personal issue D. Improving physical health outcomes Cardiovascular (smoking) and metabolic risks E. Prevention of syndrome progression The most contentious but perhaps the least important The University of Sydney Page 3 3
Key Issues for the future 2. Developing more personalised care regimes Major conceptual, biological and psychological challenge Role of TRAJECTORIES AND STAGES of illness Models of key pathophysiological pathways NOT DX (e.g. anxious, circadian, impaired development) 3. Delivering evidence-based and personalised care at scale Designated services (Headspace +) E-health developments (full range, not just existing services online) The University of Sydney Page 4 4
Percentage distribution of YLD by mental disorders and nervous system disorders, Australia 1996 70 60 Percent of total YLD 50 40 30 20 Mental disorders Nervous system disorders 10 0 0-14 15-34 35-54 55-74 75+ Years of age The University of Sydney Page 5
Uberization of (Mental) Health Care!! Access: Demand is driven by the user with their own personal technology, in their own time frame, at their convenience Empowering: Consumer has choice often use both and go on comparing Availability of Service: Particularly attractive in areas where current demand is not met by highly-regulated systems and where current services focus on high-profit areas Cost: Reduces upfront direct and indirect costs compared with traditional services Quality of Service: comparable or exceeds current offerings Accountable: Each interaction is rated by the USER for quality: the system removes underperforming operators i.e. Doesn t require any more enquiries into the regulated (selfregulated) industry the existing industry either adapts or ends (by improving quality and/or reducing costs) The University of Sydney Page 6
Economics: Planning economies vs Smart Regulations and continuous measurement of outcomes Health Care is part of the real economy!! In Australia: mixed economy, chaotic, live and changing!! Role of Govt: Yet more plans???? Alternative view: 1. Regular Reporting: independent, annual, meaningful Role of National Mental Health Commission (2012- ) 2. Smart Regulation: Anti-competitive practices, quality controls, user-focused 3. Continuous, real-time and targeted outcome data collection Big new systems: New personal technologies Input: Needs Driven into every system Outputs: Experiences of care and functional outcomes The University of Sydney Page 7
Recommendations 10/0 8 The University of Sydney Page 8
NATIONAL MENTAL HEALTH COMMISSION OUR RECOMMENDATIONS ON TECHNOLOGY The University of Sydney Page 9 9
$40m Co-operative Research Centre for Young People, Technology and Wellbeing The University of Sydney Page 10 1
Project Synergy Online Ecosystem Currently, the integrated Synergy Online Ecosystem includes: 1. HAPPINESS CENTRAL (HC) developed by The University of Sydney s Brain and Mind Centre in collaboration with Young and Well CRC, end-users identify their current needs (eg. managing stress) and through the use of smart algorithms and interoperable apps and etools, develop a personalised wellbeing plan ; 2. ReachOut.com Next Step (RONS) developed by ReachOut.com Australia, The University of Melbourne and 13 youth service partners in collaboration with Young and Well CRC, RONS is a web-based tool that uses creative algorithms designed to help end-users work out what s going on, find free and paid support services, as well as suggest practical tips for immediate help; and, 3. Mental Health eclinic (MHeC) developed by The University of Sydney s Brain and Mind Centre in collaboration with Young and Well CRC, the MHeC is a real-time primary care clinic that offers end-users immediate online assessment, as well as timely support and programs, via a video-visit with a health professional and share plan. The University of Sydney Page 11
Mental Health eclinic: example dashboard of results The University of Sydney Page 12
Priority case and suicidal escalation I The process used to prioritise cases and determine appropriate suicidal escalation for those at significant risk. Figure 1. Suicidality escalation protocol Synergy Online system Initial assessment Suicidality algorithm Clinical service No suicidality Low suicidality High suicidality Individuals data reviewed by clinical team No action Real time online alert Email contact within 24 hrs No further escalation required Urgent Follow up and/or escalation required The University of Sydney Page 13
Comparisons of assigning to Stage 1b+ (attenuated and actual syndromes), n=73 Online assessment (survey and video visit ) Stage 1a (help-seeking subjects with mild-moderate severity of symptoms) Stage 1b+ (attenuated syndromes) headspace appointment Stage 1a (help-seeking subjects with mild-moderate severity of symptoms) 24 19 Stage 1b+ (attenuated syndromes) 4 26 Cells representing concordance are highlighted in bold red font Actual agreement 50/73 unweighted observed kappa = 0.40 Note: maximum possible unweighted kappa (given observed marginal frequencies) = 0.61 The University of Sydney Page 14
Share plan (decision tool) wireframe - clinical support The University of Sydney Page 15
Configuring the MHeC for an inpatient unit The University of Sydney Page 16 1
The proposition..in five years from now every teenager thinking of suicide, will be able to access high quality, personalised care and social support, facilitated by innovative technologies (the reality: it will require sustainable investment, community and setting based engagement, smart effective tech systems operating at scale, wellinformed and tech-competent clinicians) The University of Sydney Page 17 1
The University of Sydney Page 18
Project Synergy Moves to USYD Innovation Hub 1. Turnbull Govt commitment to $30m over three years to implement Project Synergy 1. National partnerships Model with health services agencies 2. Professor Jane Burns appointed to Faculty of Health Science and BMC to lead the project 1. First three trials completed next six planned 2. International partners Canada and South America 3. SYD supports the next CRC bid for mental wealth and technology to be decided in Nov 2016 4. Key opportunity to bring together major centres with content knowledge, tech skills, data and analytic capacity at USYD and health system partners extensions into early child development and community-based ageing studies The University of Sydney Page 19
HOW READY ARE YOU FOR CHANGE??? USERS: Already have the technology in their pockets. Those with the financial capacity are already headed to alternatives Very keen to exercise the evaluation options Keen supporters of integration into practice Serious roles in co-design, deployment and evaluation Providers: Highly ambivalent. Some distinctly hostile: An add-on at best Investors: Ready to go!! Need the right technology-user-provider relationships Govts: High level officials already headed there. NZ and Aus examples. The University of Sydney Page 20
Questions Ian Hickie and Jono Nicholas What is the chance that e-mental health can transform both access to and quality of mental health care in your country? How could e-mental health services be optimally maintained in your country? What are the sources of greatest resistance to the uptake of e- mental health in your country On a scale of 1-10 (where 1= totally unprepared & 10 = fully prepared) how well prepared is your country, region or service for technology disruption? What is ONE opportunity to maximise the benefits of technology for your country? What is ONE innovative idea to foster international collaboration and drive mental health reform through technology?