 I'm here with James Willard from NHS England. James, where are we now with digital mental health interventions? Are we at the point now where we've actually got effective, safe interventions that we can use in the NHS? So we have some digital interventions that we have the evidence to demonstrate they are safe and effective and I think David in his talk really focused on the idea of therapist assisted digital interventions and I think that's where we're focusing at the moment because that's where the body of evidence is. I think beyond that there are groups of technologies that are up and coming so virtual reality, the evidence for that is certainly growing and I think that's been helped by the kind of unit cost of VR headsets coming down so it actually gets cheaper to do that research. I think the further stuff out in terms of artificial intelligence I think looks promising. I think it's in that kind of zone of anxiety for quite a lot of people and I think that's where the structures and frameworks that colleagues in NHSX are coming up with in terms of the code of conduct to really help us kind of manage that anxiety, stay thoughtful and logical in how we're approaching that in order to kind of manage the hype but not kind of lose 10 years in taking benefit from those technologies. I remember talking to you, it must have been about five years ago at the MindTech conference about the general response that we get to digital from psychologists and psychotherapists which is you're not going to replace me with a robot. Do we still have that response or is that kind of mature a little bit? I think that we're getting much more sophisticated in our understanding of digital and I think my definition of digital, I think it's other people's definition of digital but the digital I hold on to is the cultures and practices of the internet age and I guess for me increasingly digital mental health is the clinical cultures and practices of the internet age so it's that kind of blending of those two kind of domains if you like in cultures and practice and I guess what we're seeing is that there's increasing technology that augments the experience both of the therapist and the patient. I mean I talked about in the panel about how I think robots if you like robots are going to replace some of the administrative tasks, the logistics tasks around getting people in the right place at the right time but I think technology is going to just only augment the kind of therapeutic process and I think that's going to be like that for some time to come. And then also from the patient perspective seems to be this narrative which is that I don't want digital, I want proper terribly and David Clark said in the panel discussion earlier well of course patients don't want digital, maybe I was misinterpreting that I'm not sure but what's your view of how the public now are viewing digital interventions? So I think the wider cultural kind of movement is much more around personalisation and choice and really being the centre of attention of a kind of shopping experience if you like so we're used to the emails from Amazon telling us our delivery driver is called John and he's 25 minutes away and he'll be with you and then we get updates and so forth so I think there's an expectation in wider society of those kind of experiences which are going to filter through into IAT and other mental health services so I think those expectations are going to have to be met in some way in healthcare services and I talked about robots taking over logistics but I think that could be an area where we could improve or technology could readily improve our customer experience I think in terms of, but that's then going to translate into choice so I already have families bringing the sleep data from their child's wearable into my clinic to show me that I can't stop that from happening and I've got to learn to deal with it and I think that's what's going to happen is we're going to have to stay adaptive and flexible when actually people bring that technology to us we're going to have to be able to feel confident and be able to respond to that so I think it's going to be a gradual process where it just becomes more normal for that technology to be in the room used in some fashion to augment but I also think there are always people who want to choose a high fidelity like face-to-face experience where there's a high touch experience as they say in terms of those communication skills I think there are others who would be quite happy to chat away to their therapist forever on an internet-based platform So it's by far the most digitally enabled child psychiatrist I know you're aware of all the others I know How do you respond when parents come with the sleep data of their child? In a very excited way if I'm honest because it's great I mean we've developed a digital platform for our families that allows them to track sleep data and keep a diary about their child's behaviour when they come proactively in an very activated way bring that data using a wearable device I'm thinking how do I plug that into the platform because they've got access to our platform as well and that's sort of frustrating but actually it's really helpful I think what you've got to do is obviously there's a lot of concern about the accuracy of these wearables at times and is it always reflecting I think it's about taking the kind of broad overview approach looking for patterns for significant change in that data over time I think that's helpful it's about the variability if you like rather than the actual well on that night the device says they've got 7 hours and 19 minutes sleep of which 2 hours with deep sleep I think we've got to take that up with pinch of salt let's look at the bigger picture and that's my approach to it We've spoken quite a bit this morning about the lack of skills in the workforce what do you think needs to be done to make sure that the people are actually delivering this stuff are able to so I think one of the approaches that I'm interested in trying in fact I've just got some health innovation network funding for this is high fidelity simulation so NASA try out their people and their technology in this place called the neutral buoyancy lab which is a large swimming pool and then they kind of send their people and tech up into space because they know it's going to work I think we've really got to hang on to that idea giving people those kind of high fidelity simulation experiences where they can they can play with the technology in a safe way that's not going to reflect on their appraisal at the end of the year or their performance data on the dashboard but actually gives them an experience that allows them to get it wrong but also to get it right and work out how to get it right so I think that's a fundamental key to me I think that that's keeping people in that zone of proximal development if you like is really important and that takes courage to some extent it takes a little bit of investment it's about taking people away from the front line long enough that they can have that experience now fretting about the pain what else they've got to go back and do so it's a bit about safeguarding that experience enough that people can be in a safe place to live so that's a kind of simulation lab so in the same way that we train mental health professionals currently in simulating doing that with digital interventions absolutely so whether it's trying out virtual reality or perhaps a piece of technology that allows you to remove monitor vital signs or an app on a mobile device that you might work through with a patient on a ward or in the clinic it's helping us find out what's the best combination of those technologies in the spaces that we really work in rather than some office in Silicon Valley Thanks a lot for taking us on to the street just