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Idea Description
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Innovation 'Elevator Pitch':
GRiST is a web-based mental health risk identification and safety management service. It works alongside assessors to evaluate risks and formulate care plans for service users based on expertise developed over 17 years.
Overview of Innovation:
GRiST (www.egrist.org), is a web-based system designed to assess and manage mental health and wellbeing, including risks of suicide, self-harm, self-neglect, vulnerability, and harm to others. Developed by cognitive and computer scientists at Aston University over a period of 17 years, it was recently spun out into its own company, eGRiST Ltd.

GRiST allows IAPT practitioners to work collaboratively with service users on improving mental health and wellbeing. It integrates patient data, mental-health practitioners’ expertise and empirical evidence to support comprehensive clinical risk evaluations, formulations and safety plans. The built-in machine learning algorithms working on a million separate risk assessments from trained clinicians, enables it to flag up areas of concern and point people to the most appropriate resources for addressing them. These can be configured to their local availability within each IAPT service as well as to the specific life circumstances of each service user.

Service users also have access to a self-assessment version, myGRiST. It allows them to see how their plans and interventions are impacting their mental health and wellbeing on a continuous basis. The reports produced can be shared with IAPT counsellors if agreed, to help both parties ensure care plans are working and to focus therapies on the most important concerns.

The goal is co-creation of mental health that encourages services users to monitor and manage their own wellbeing. It was the original intention for developing GRiST: to disseminate expertise where it does not exist and empower people to identify and address their own mental health issues. People are thus connected to mental health services without having to rely exclusively on face-to-face appointments, which creates the opportunity for more effective use of resources.

The GRiST innovation has been adopted by a number of mental-health NHS Trusts, charities, and private organisations. It currently holds almost two million individual risk judgements in 400,000 completed assessments from 200,000 patients. These assessments cover all ages and the complete care pathway, from screening to full and focused repeat assessments. Versions have been developed for IAPT in primary care through to specialist forensic services and learning disabilities. All assessments are easily accessible at any point on the care pathway so that IAPT practitioners, for example, can see a person’s full GRiST history wherever it was recorded.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
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Innovation 'Elevator Pitch':
We run a Suicide Crisis Centre in Gloucestershire, which was set up and is run by a person with lived experience. We've been providing services for 3 years and have never had a suicide of a client under our care.
Overview of Innovation:
The charity Suicide Crisis was set up in December 2012. It was set up by a woman who experienced suicidal crisis following a traumatic experience in March of that year. She couldn't find the right kind of help so she created what would have helped her. Our services have evolved to become what our clients have said they want and need. They have shown us what additional services we have needed to provide.

First we set up a Trauma Centre in May 2013 and this continues to run as part of our charity. This is about early intervention: supporting people to try to prevent a descent into crisis. After she was discharged by the NHS crisis team in the summer of 2012, the founder of Suicide Crisis was told that there would be an 8-month wait before she could access psychological therapy. Whilst waiting for therapy, she attempted suicide twice. This highlighted the need for ongoing support after a traumatic experience.    

The Suicide Crisis Centre opened in autumn 2013 and is based in the centre of Cheltenham and serves the whole of Gloucestershire. Clients can come in every day when at high risk. We provide face to face individual support.

A client at particularly high risk will have access to 24-hour support.

We have never had a suicide of a client under our care and have identified a number of reasons why. We believe that it's because of a combination of the way that our services are set up and our ethos. We're happy to give presentations about our work to explain this.

We often look to psychiatrists and professors for possible ways of reducing the number of people who die by suicide. We are different in that it is a 'mental health patient' who came up with the idea of our Suicide Crisis Centre, set it up and who continues to run it. Although she had no contact with mental health services prior to 2012, she has since been diagnosed with bipolar disorder and a posttraumatic syndrome. We have gone beyond co-production. This has been originated by a service user.

Our work is now starting to attract national attention. We have been visited by Helen Garnham, the national lead on suicide prevention at Public Health England. She has described our work as "inspiring" and asked us to address a suicide summit in February in London. Luciana Berger, the former Shadow Minister for Mental Health, asked to visit us in January and met staff and clients. The South West Zero Suicide Collaborative's steering group has described our work as "inspirational" and "extraordinary". 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Wellness and prevention of illness
Benefit to NHS:
We are providing something very different from NHS services but have found that mental health professionals are interested in understanding why our clients survive and how we have achieved zero suicide.
Initial Review Rating
3.40 (2 ratings)
Benefit to WM population:
Our Suicide Crisis Centre is helping people to survive who may have died by suicide. We are also helping to prevent crisis by providing trauma services (early intervention).
Current and planned activity: 
We have been contacted by the NHS and CCG in another part of the country as they are interested in having a Suicide Crisis Centre in their county. This is outside the West Midlands.
What is the intellectual property status of your innovation?:
To be confirmed
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
3
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Innovation 'Elevator Pitch':
A two tiered awareness training aimed at raising awareness of the risk of ligatures and hanging, what to do in ligature scenarios, and raising awareness of suicide risk.
Overview of Innovation:
(On behalf of Marie Nicholls, CWPT Lead for Clinical Risk and Suicide Prevention)

Hanging is the most prevalent suicide method for men and women in the UK. In Coventry & Warwickshire Partnership Trust, ligature related incidents have risen over the past two years.

In response to this, a two fold awareness programme has been developed around ligature/hanging risks. Firstly a basic awareness for all Trust staff (including non-mental health colleagues), which is an overall suicide prevention message; and secondly an enhanced training, which includes a film showing the use of ligature cutters in practice with staff testimonials and advice on supporting staff.

We are hoping to market this programme to other Trusts and health and social care providers. We are currently investigating methods of distribution and delivery, and whether we might be able to get this programme accredited by an organisation such as NICE. 
Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Education, training and future workforce / Wealth creation / Patient and medicines safety
Benefit to NHS:
Suicide has traumatic effects for everyone, not only for those personally involved, but for professionals as well. Suicide touches the lives of many people, and the impact on the NHS is significant in regard to the cost of trying to prevent suicide, supporting those bereaved, and the NHS' reputation.

Suicide is preventable, and yet investments into programmes to prevent it are not well resourced or popular. This needs to change; it is simply not acceptable that suicide kills more men in the UK under 35 than accident, illness and injury. Hanging is a significant risk and probably the hardest suicide method to restrict.

This is why this awareness programme is hitting this risk head on by telling NHS staff, many of whom don’t work with mental health services, about ligatures and where the risks of ligatures are greatest. It also raises awareness- this programme links into overall suicide prevention. Someone who has the ligature awareness session may just think about a neighbour or friend and recognise that there may be a risk.

The training is split into both basic and enhanced training, so that it can be applicable to as many people as possible. Basic ligature awareness training is now included in Coventry & Warwickshire Partnership NHS Trust’s Statutory and Mandatory training, and will hopefully lead to a point where all staff in the Trust (whether they work in inpatient areas or not) will have a degree of awareness about ligatures, ligature points, and what to do if they suspect a suicide risk or encounter a live ligature emergency, even outside of the Trust.

Prevention is key for NHS services and this project is about just that.
Benefit to WM population:
The training packages will be first delivered to staff within Coventry and Warwickshire Partnership NHS Trust. We are primarily a mental health Trust that operates across Coventry and Warwickshire.

The West Midlands has the third-highest suicide mortality rate across England and Wales at 11.6 deaths per 100,000 population, and the second-highest rate of male suicide, with a rate of 18.5 deaths per 100,000 population. Moreover, the suicide rate had the biggest percentage increase between 2013 and 2014, rising from 9.8 deaths per 100,000 population to 11.6. Over half of all suicides in the UK are by hanging or ligatures.

The Ligature Awareness Training packages we have developed have a clear benefit to the West Midlands population when viewed in light of these figures. Training staff that work with vulnerable people to react appropriately in ligature emergency situations, and to be aware of where ligature cutters are kept and how to use them, will mean that many potentially fatal situations can be avoided in inpatient areas.

The benefit can spread even further- as all staff in Coventry and Warwickshire Partnership NHS Trust will be given the training as part of their Statutory and Mandatory training, the chances of them recognising risks outside of the Trust are greatly increased as well, whether they work in inpatient areas or not.

Currently, there are not many well-resourced or popular programmes to tackle the prevalence of preventable suicide risks. Through this training package and video, we hope to not only raise awareness of ligature risks, feeding into a larger suicide prevention initiative, but also provide an efficient, inexpensive and effective method for health and social care workers to be properly briefed on how to handle situations around ligatures and to mitigate ligature risks. 
Current and planned activity: 
The basic awareness session has been launched and is currently being delivered to 4,500 staff as part of Statutory and Mandatory training.

The enhanced training including the film is about to be shown to around 1,000 appropriate staff.  Evaluation of the basic awareness is good, and this is being collected via the training.

Evaluation of the film will be completed once delivered and will be encompassed in the Trust's commitment to the zero suicide agenda.
What is the intellectual property status of your innovation?:
Training film watermarked. Copyright held on basic awareness training. 
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
N/A
Ease of scalability: 
Simple
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Innovation 'Elevator Pitch':
Big White Wall provides accessible, evidence based online therapy via a secure platform. Sessions are available 7 days a week between 7am and 11pm, providing enhanced accessibility. KPI's are fully reportable and the service is CQC regulated. 
Overview of Innovation:
Big White Wall (BWW) is a digital mental health support service which has been operating since 2007 and has supported 150,000 members in distress.

BWW provides Live Therapy, which is face to face therapy via the secure platform. Our clients, can complete sessions via video, audio only or text only. We provide NICE guided, evidence based interventions for common mental health disorders, such as OCD, Social Phobias, PTSD, Panic, Depression, GAD, Health Anxiety and Specific Phobias.

Many of our existing commissioners are IAPT services and we are fully IAPT compliant in our delivery including the sessional collection and reporting of the minimum dataset (MDS). Performance data can be submitted by the referrer themselves, either by collecting and inputting data from our platform or through the IAPTus PRISM integration, which feeds session data (clinical notes, attendance data and MDS) directly into the referring IAPT service's own IAPTus system. Or BWW can also submit data through the BWW IAPTus system which allows us to report data directly via an N3 connection, into NHS Digital under the appropriate service code.

We provide both NICE guided evidence based CBT and Counselling interventions and all of our Counsellors are additionally trained in Counselling for Depression. We also have a team of Long Term Conditions specialists (IAPT LTC Top Up trained) who can provide specialised interventions for those experiencing physical health issues. All of our therapists are professionally accredited and are experienced with at least 2 years post-accreditation.

We are CQC registered for our Live Therapy provision and remain the only digital service to have received this registered status. Our governance systems are therefore acknowledged to be safe and robust. We are included in the NHS Apps Library, requiring stringent assurance that we meet national standards, regulations and industry best practice.
 
Live Therapy at BWW is available between the hours of 7am and 11pm, seven days a week. We are able to meet an accessibility standard that many IAPT services are unable to achieve.

We are able to scale up or scale down provision according to demand and our waiting times to assessment / first therapy session are often measured in days rather than weeks or months. We are able to implement new contracts at pace. 

We also provide clinically moderated peer support on the platform 24/7, which can augment patient self-management and provide intersession and pre . post treatment support.

 
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
The benefits to the NHS of using BWW to deliver services include;

a) Eliminating unwarranted variations in health indicators and the outcomes of care - through the utilisation of national standardised measures and KPIs.

b) Improving and increasing equitable access as outlined in the Five Year Forward View for Mental Health, by providing digital interventions, not reliant on geographical location, not limited by affordability or complexity of transport. Available nationally online to all, removing socio economic barriers, with hours of service availability outside the scope of normal IAPT service provision. Clients can access high quality support from the comfort and safety of their homes.  

c) Giving the best possible experience for patients and carers by providing a high level of customer support and service satisfaction. Measured by standardised Patient Experience Questionnaires (PEQs) and survey data.  

d) More cost-effectively integrating care and resources around the needs of patients and populations though specialist LTC interventions.

e) Reducing healthcare utilisation costs (survey data reveals usage of BWW (peer support network) reduces GP / acute service usage across populations).

f) Reducing social isolation, stigma and associated costs in decreased in wellbeing, and increases in physical health decline and frailty

g) Population based access to BWW, provides early and easy access to mental health support, which aids the prevention and early identification of MH issues.

h) Use of BWW to provide services improves patient choice. Members can choose to remain within the sphere of clinically moderated peer support and self-manage using resources and self-directed courses or can engage with Live Therapy and can select a modality and mode of treatment.


i) Provides an embedded, scalable, evidence based solution which is cost effective, high quality and safe.

 
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
Benefits to the WM population as outlined for the NHS
Current and planned activity: 
BWW provides services for several CCG's, Local Authorities and NHS Trusts, augmenting IAPT service provision. BWW has recntly completed a successful single point of access pilot for a London CCG, which allowed for population based self-referral into BWW Live Therapy. BWW submitted monthly data to NHS Digital and reported monthly recovery rates as high as 68% against a nationally set target of 50%. 

BWW is contracted by the MOD and the Home Office to provide Support Network peer support services and is currently commissioned by over 70 UK Universities. BWW is also comissioned by governement in Canada (Ontario Telemedicine Network) and New Zealand to provide Support Network access. OTN video linked here; https://youtu.be/OLG_OMHU4-s

BWW continues to grow and use technology for good and is currently undergoing a refresh of the platform - which  will enable an enhanced user expereince as well as improve the capability to innovate, scale and incorporate new technologies which augment care. 
 
What is the intellectual property status of your innovation?:
Intellectual Property is owned by BWW.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
0-6 mon
Ease of scalability: 
Simple
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