Mental illness is the biggest single cause of misery in UK society, affecting one in four people and with an economic and social cost estimated at £105 billion. Communication is a critical issue for mental health care, and treatment outcomes depend on the quality of communications they receive from their doctor.
Every 36 hours, the NHS deals with over a million patients, generating multiple spoken interactions between patients and care teams.
The quality of these interactions can have a huge impact on treatment outcomes; in mental health care, communication failure is both common and frequently safety critical.
Researchers from Queen Mary's Cognitive Science Group, including Professor Pat Healy and Dr Matthew Purver, set out to analyse and improve communication in a clinical setting.
Working in collaboration with colleagues at the University of Exeter's Medical School and the University of Warwick, their research focuses on the basic mechanisms that underpin human communication, and the processes through which people detect and recover from miscommunication.
Improving the quality of health communication
DIALOG+ is a mobile application designed by Professor Healy, in collaboration with Queen Mary's School of Medicine and Dentistry. The application structures conversation in patient-clinician meetings around a series of questions designed to elicit patients' views on their quality of life and treatment, and ensure clinical follow-up.
Tests from random control trials in six European countries found repeated use of DIALOG+ over six months improved quality of life, reduced symptoms, and achieved a better outcome for independent living, work and social relationships.
It was also reported the cost of treatment for each patient reduced by approximately £1,500 a year.
DIALOG+ in the real world
DIALOG+ has been in routine use across all secondary care patients in East London, Luton and Bedfordshire, Norfolk and Suffolk, and all health boards in Wales since 2015. The app has been downloaded over 700 times by care teams and has been used in over 5,000 sessions.
From 2016, DIALOG+ was recommended for use in the mandatory evaluation of all early intervention teams in England, totalling more than 5,000 patients. It also forms part of the NHS Outcomes Programme and has been recommended for all patients receiving mental health services in London (more than 100,000 patients).
Internationally, the app has also been translated into 15 languages, implemented in 18 countries, and is available on both the Apple and Android platforms.
Providing the patient perspective
As part of their research, the team studied the effectiveness of particular conversational strategies in clinical interactions. Using their findings, they created a communication training programme for clinicians treating psychosis, known as TEMPO. TEMPO helps clinicians understand how it feels to experience psychosis by using simulations of 'hearing voices'.
Dr Michelle Gilmore, consultant psychiatrist at Sunshine Coast University Hospital, Australia, reported that TEMPO helped psychiatrists and medical students understand how to assess and build rapport with patients presenting with psychosis. She said: "This is crucial for engaging these patients in treatment, many of whom do not consider themselves to be unwell or in need of treatment. When doctors can engage these patients in treatment, they are much less likely to relapse and end up back in hospital."
Clinicians also reported a change in their perspective on how patients feel the need to talk about and make sense of their experience. As a result of the training, doctors became around six times more engaged with their patients.
Based on this success, TEMPO is now being delivered by 23 NHS Trusts nationally and 41 institutions internationally, with more than 600 clinicians treating over 550 patients each a week.
Analysing communication to predict clinical outcomes
Research from the team also illustrated the importance of using natural language processing (NLP) in clinician-patient interactions. They found that NLP could be extended to treatment for depression and anxiety, and discovered features of the language used in cognitive behaviour therapy (CBT) that could help automate diagnosis and predict recovery.
Working in collaboration with IESO Digital Health Ltd, the team further developed their NLP methods and applied them to their online typed service for cognitive behavioural therapy for depression and anxiety (available via the NHS).
This approach has proven effective for the automatic diagnosis of the severity of the condition, the prediction of the recovery at the end of the treatment, and to determine the quality of the therapist. To date, approximately a million patients have been treated in both the UK and US.
Schools, institutes and research centres
School of Electronic Engineering and Computer Science
With a 130-year history, our School offers a vibrant, multi-disciplinary learning and research environment. Our enthusiasm for research defines our programmes, keeping our teaching exciting and relevant.
Barts and The London School of Medicine and Dentistry
We are firmly embedded within our east London community, with an approach to education and research that is driven by the specific health needs of our diverse population.
Cognitive Science Research Group
We study human cognition, action and interaction on scales ranging from individual experience, through interactions between individuals, to the languages, cultures and dynamics of societies.