Stop 3: Copenhagen, Denmark.
Let me set the scene.
It’s 8.45pm and still light on a crisp, but clear Copenhagen evening. I step on the pedal and start cranking my rusty (but trusty) steed forward, knees creaking and the wind in my hair. Everyone rides in an orderly fashion. It was all ‘hand signals’, ‘keeping right unless overtaking’ and the occasional rather polite ‘ding’ of a bell to announce one’s presence. Immaculate pavements, an architectural dreamland and cycling infrastructure that would have Lance Armstrong absolutely fizzing.
This pretty much sums up Copenhagen: clean, polite, orderly, and overall a pretty bloomin’ nice joint!
This will be a briefer than usual update, but an important one nonetheless as I prepare to fly to Portugal for the WHO’s 2nd Symposium on the Future of Health Systems in a Digital Era. You can read the program here if interested.
My time in Copenhagen was relatively short, but strategic. I wanted to investigate a few key things:
- integration, regulation and use of digital mental health tools in Denmark
- meet with representatives from the Mental Health and Digital Health Flagship Programmes from World Health Organization (WHO) – both of which are housed in UN City, Copenhagen – to learn more about their targeted policy work in the European Region.
I headed to UN City once I landed. It plays host 11 UN agencies and is an architectural marvel winning multiple accolades for its design and sustainability features, including no fewer than 1,400 solar panels on the roof and plant-based materials in the walls that reflect the sunlight and reduce the temperature inside the building.
First up was a meeting with Clayton Hamilton, Regional Technical Officer at WHO’s Digital Health Flagship. I was really looking forward to this chat and Clayton kicked off with an overview of the Flagship’s work and regional digital health strategy, along with some interesting cultural context as to why the Nordics in particular have excelled at integrating digital technologies into healthcare and welfare services.
There’s apparently a long-standing history in the Nordics of government entities (in addition to The Church!) keeping meticulous records / data for all manner of things. This cultural norm of data collection has again led to good trust in government and public service data exchange has osmotically filtered into the healthcare system, and subsequently the its people have largely benefited.
Clayton mentioned that the levels of data integration are so high that it has become ultimately convenient for citizens to do anything from registering their car for insurance, get a script for medications or engage with just about any other social service. This is also true of digital mental health provision where a patient’s care team have good access to patient data across primary and tertiary care to support streamlined care. The Danish were also early adopters of online CBT and tele-psychiatry which has now become a permanent fixture of their publicly-funded health system.
The takeaway message from our discussion was that tactile and reactive systems are a key feature in Denmark and this has led to the seamless flow of information and better integration of digital health tools for its citizens.
I bid Clayton farewell (hopefully catching him again in Portugal at the conference) and headed off to meet an old, but familiar acquaintance.
In the evening, I cycled over to uber-cool Reffen and caught up with a school friend Stephen Whiting. As it turns out, Steve has been a WHO Technical Officer in Non-Communicable Diseases for more that 10 years working in Moscow, Solomon Islands, Geneva, Kyiv and now Copenhagen. While much of his work is focussed on nutrition and physical activity, he spoke at length about the increasing realisation that mental health, physical activity and diet are intrinsically linked to a person’s overall wellbeing. The benefits of keeping fit and physically healthy are all there: reduced social isolation, better weight control, improved cognitive function and reduction of anxiety and depression.
Steve shared several good examples of how city design in particular can have an enormous effect on citizens’ overall well-being and support improved mental health outcomes (think Copenhagen, with its cycling infrastructure and green open spaces). Similarly, many of the behavioural change techniques used in digital mental health tools are also being applied to chronic disease management. Is there an opportunity for a more coordinated approach to deploy better integrated digital tools targeting multiple health issues at once?
It was now Friday, the sun was out and I met with Dr Marie Paldam Folker, Chief Executive Officer of Denmark’s Center for Digital Psykiatri . Marie’s charismatic and passionate approach to digital mental health was on full display and I could have spent all day listening to how her efforts have aided both Denmark and the Centre’s advancements in this space. It was a really inspirational discussion.
One key takeaway for me was some research conducted by Marie and her team on engagement with consumers using digital mental health tools. The Centre regularly conducts qualitative surveys and many Danish citizens have consistency demonstrated strong sentiments for integrated services and online tools. Marie’s research also indicated a strong plea for better data sharing across primary and secondary care, with citizens reporting a preference for greater options of mental health service delivery (both digital and in-person) and a system with multiple entry points. Addressing these patient-centric features in Denmark’s mental health care system have ultimately been crucial to its success.
My final meeting was back at UN City with Dr Cassie Redlich, Technical Officer for Child and Adolocsent Mental Health. A fellow Aussie, Cassie’s work mostly spans policy implementation and county-level support for the 53 European Region Member States.
This was an important conversation for me as I wanted to get a sense of which aspects of mental health policy WHO was prioritising in the region. Cassie talked about WHO’s Comprehensive Mental Health Action Plan (2013-2030) and how recent revisions shifted to focus to how digital technologies could augment a sector which is underfunded, has variable levels of service integration and chronic workforce shortages, all the while being compounded by the pandemic’s hangover.
WHO’s work also involves supporting the scalability of digital mental health interventions in the region and Cassie impressed upon the importance of ensuring these tools are tailored to meet the needs of citizens, they fully consider the cultural context in which they are deployed and be mindful that good consumer engagement with an intervention inside an RCT / trial environment does not always translate to patient compliance.
With Copenhagen wrapped up, it was time for the next adventure. On a personal note, the home sickness finally kicked in for the first time on Father’s Day. It’s been hard to be away from family and I miss Kehlsa and my little ones, but the magic of FaceTime softened the blow somewhat and it was good to see their smiling faces and lots of “Happy Father’s Day!” wishes from the kids.
Next Stop: Porto, Portugal.
Chris Boyd-Skinner: Churchill Fellowship 