Berkshire Healthcare NHS Foundation Trust - Case Study

The Access Group, with Rio Mood Diary, is helping revolutionise mental health care. Simple software is making record keeping and treatment planning quicker and more accurate, for better overall care.

Rio Mood Diary is being used by Berkshire Healthcare NHS Foundation Trust to drive much more impactful mental health care.

This software is easy for both patients and clinicians, meaning a better understanding of the patient’s state of mind and a more appropriate course of action to help care for them.

Psychiatric nurses, clinical leads, and care coordinators are at the heart of mental health care provision within the NHS. Their workload is heavy, and the case matter is heavy too, but a big challenge in the care process is accuracy of information and spotting trends in a patient’s condition.

INTRODUCTION

Mood Diaries are common within mental healthcare settings, however they can be ineffective as when they’re given to patients on a piece of paper to write on, patients can often forget to fill them out or not bring them to their next appointment. So, in partnership with Berkshire NHS Foundation Trust and Totalmobile, we created the Rio Mood Diary App.

Rio Mood Diary is a digital version of the Mood Diary, within an app, designed to support a patient’s wellbeing. Patients download it onto their mobile phones and use it to record their mood using smiley faces to register an initial level of happiness, before recording reasons for their mood. Reminders can be set so that patients don’t forget to record their mood.

This information then flows back into their patient record within Rio so it’s all there to discuss at their next appointment, meaning more meaningful conversation can be had.

The app is there to be a reassurance to the patient, with their personal safety plan visible alongside contact information for mental health phonelines and reminder alarms, but it’s also intended to benefit clinicians. Understanding the patient’s mood patterns on a daily basis is critical for the best care provision.

“It has allowed access to information that patients wouldn’t always be able to recall during a session as it documents a point in time which may have been forgotten by the time they next have an appointment. It allows for explorations of these points.”

Clinical Lead – Patient Safety and Quality

HOW ACCESS HELPED:

Capturing information has been difficult in the past given the amount of paperwork and the lack of immediacy in sharing data, but with Rio Mood Diary all of this is gone. The app communicates with clinicians and integrates with Rio EPR (electronic patient records) to provide an easy-to-follow history of a patient’s mood. This can then be delved into; which days were good, which were bad, were there specific times that problems occurred or specific events that acted as a trigger. With this information, clinicians are able to provide much more effective care.

Berkshire Healthcare NHS Foundation Trust are running a Zero Suicide Programme, which aims to reduce the risk of suicide and self-harm. Their wish was to understand daily patterns in patient behaviour and mindset, and to encourage closer engagement and regular connection between patient and clinician. The Access Group enabled all of this.

Thanks to the integration of Rio Mood Diary and Rio EPR, a user’s health record is updated quickly with information from the Mood Diary. Their own reporting is providing clinicians with a mood summary, which Rio breaks down into mood frequencies and patterns to be assessed. This input allows for more acute care and better care planning, but it also allows clinicians to spot any potential dangers with risk assessment included. Reports within Rio can flag any words or phrases of concern used within a patient’s Mood Diary and crisis teams can get in touch with patients to ensure that they’re safe.

The app is also an easy way to share a crisis plan with a patient. Berkshire struggled with ensuring good quality safety plans were being created and shared with patients. By implementing the Rio Mood Diary, clinicians were reassured that in a time of crisis a patient would be able to easily access their safety plan through the app. Safety plans deemed to hold good quality content rose from 74% to 93% as a result, which means that patients have the information they need at a time of crisis.

“The Mood Diary is easier to get safety plans to patients. With mobile working we don’t have to write it all down, it’s there for the patient on the app straight away.”

Community Psychiatric Nurse – Early Intervention in Psychosis

THE RESULT:

Rio Mood Diary was piloted alongside the Crisis Resolution and Home Treatment Team (CRHTT), Early Intervention for Psychosis (EIP), and Psychological Medicine Service (PMS).

The Berkshire Healthcare NHS Foundation Trust set out six goals that it wanted Rio Mood Diary to help them achieve:

Improved patient safety and access to plans

Rio Mood Diary empowered patients with the option to view information recorded in their safety plan. Accessibility is easy on any mobile device, meaning patients can quickly view important details and safeguards without relying on mental health care professionals.

Improved quality of safety plans

Independent audits show that safety plans were deemed 74% good quality and 26% poor quality content as of October 2019. Following Rio Mood Diary being implemented, quality dramatically shot up. As of March 2021, safety plans of a good quality accounted for 93% of all plans.

Improved safety plan distribution

Distribution of safety plans resulted in 100% of patients using Rio Mood Diary by March 2021.

Improved patient experience

Patient testimony said they felt that recording their moods and reasons was the most useful element of the app. Patients said that they like having access to the safety plan digitally, and 77% of patients surveyed felt their safety plan was co-produced with their clinician, rather than just given to them.

Improved treatment planning

The accessibility and difficulty of treatment planning in the past stopped clinicians from treating such mood tools as worth investing time into. Clinicians saw the benefits as a risk management tool but with such a simple app as Rio Mood Diary, the barriers to usage and collaboration are now gone and now mood tracking has become an important part of treatment planning.

Reduction in suicide and self-harm rates

Having access to information outside of appointment times is valuable to clinicians – especially in lockdown conditions as we’ve experienced in recent years. The flexibility of data access, as well as the new levels of contemporary detail, mean that

“I have been able to elicit times of the day when a client’s mood is low and also underlying concerns that may be triggering this. Client also has access to their safety plan through this app.”

Clinical Lead – Early Intervention for Psychosis (EIP)

Surveys amongst Berkshire Healthcare NHS Foundation Trust found that 84% of staff believed the content of the safety plans had improved, and 74% of staff ‘Strongly Agree’ or ‘Agree’ that safety plans are completed more directly now they have access digitally.

The success here, coupled with staff approval, means that the plan is to rollout Mood Diary across all mental health care teams in Berkshire in the near future.

“It gives a clear picture of what the patient felt at the time, which aids in determining what the root causes were.”

Care Coordinator - Early Intervention for Psychosis (EIP)

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