March 2009
Primary uses of mental health information
In this column I want to discuss the primary use of mental health information as a balance to the dominant paradigm of secondary use. The primary use of mental health information is designed to help a particular individual with their recovery and health. The secondary use is designed to aggregate information to support quality initiatives, research and monitoring of trends and patterns statistically over time. While the secondary uses of information is important the primary reason for collecting and using mental health information must always be seen as central.
The primary uses of mental health information can be discussed in terms of four areas:
- Directly helping service users monitor their own health and well being and plans for the future
- Assisting clinicians to directly help a particular service user
- Depicting the nature and quality of engagement occurring between clinicians and service users, and
- Ensuring multidisciplinary teams (MDT’s) are better informed when making decisions about particular service users.
We will consider each in turn:-
Service users can monitor their own mental health when they have access to good information. Monitoring their own mental health means taking more responsibility for their own health and wellbeing, possibly even developing an advance directive of what they would like to happen should they become unwell again in the future.
Clinicians have a difficult job to do. They need help doing it and information can - at its best - provide that help. Good information lets a clinician know who they are seeing and how they are progressing using activity and outcome information. It supports clinicians in making decisions which they have to make anyway.
Good mental health information can also indicate whether engagement is occurring between service users and clinicians. It’s often hard to get this information directly. The indirect use of case load numbers and length of appointments can miss the bigger picture. There are session review tools available which service users complete after seeing a professional and this can supply useful information about how well engagement is occurring.
Multidisciplinary teams are where the primary and secondary uses of information meet. At the MDT level individual service users are discussed as is aggregated information for workforce, quality and research purposes. When MDT’s are used to discuss or review one particular service user they need good information in order to function properly, since many in the team will not know the particular service user. Good information will provide a sense of the service user’s progress, what seems to be working (or not) and indicate future plans and how to achieve them.
So why is it that the secondary uses of information have a tendency to become more dominant over time?
I think the answer is simple. If mental health information is not being used by clinicians, service users and MDT’s as well as it might, it tends to be ignored and – in many cases – not even collected. While care and treatment would be greatly improved by the use of mental health information it can still get done without using it.
Such cannot be said for many of the support services which assist direct clinical care. Activities such as research, quality audits and benchmarking simply cannot occur without using aggregated information.
This is the dilemma we face. That the people who are using information are doing so in a secondary way while the people who really need to use it are broadly not doing so in a primary way. In developing more evidence that people are not using information in the primary sense we are using information in the secondary sense and - as a consequence – reinforcing the very trend we wish to avoid. This paradox, of primary use trends being based on secondary use information, becomes self fulfilling given enough time.
If the reason for the dominance of secondary uses of information is easy to locate the method needed to redress the balance is equally simple. We need people to start using information in the primary sense.
How might this happen? The best way is simply for people to start using it, however inadequate their IT systems or resources. Individuals and services use information in a primary use way throughout the country, but nowhere consistently or systematically. It’s time to stop the tail from wagging the dog!
Page last updated: 13 March 2009