Using VR at the NHS to Reach Out to a Traumatized Community

Conversation between Ross O’Brien, NHS and Denise Silber, VRforHealth

Ross O’Brien is both the Digital Innovation Director at Central and North West London NHS Foundation Trust in the UK and the Programme Lead of the NHS England London Digital Talking Therapies Programme, where they work to establish a digital single point of access for all Londoners using NHS psychological therapy services. Ross holds a Human Rights Masters from the University of London and is a graduate of the Digital Health London Digital Pioneer Fellowship.

DS: Ross, you have two roles at the NHS. Is this common?
RO: As you’ve guessed, it’s not too common. My primary job is to work on the provider side as the director of innovation. I support innovation in health by setting up new services: VR, AI, Robotic Process Automation. In my other role, I oversee digital Talking Therapy Services (TTS) for London. We offer a range of psychological therapies: cognitive behavioral therapy, counseling, emdr etc. The NHS Trust I work in provides hundreds of services from cradle to grave, with a focus on mental health and community. Our territory in Central and Northwest London corresponds to nearly a fifth of London. We don’t do specialist care, so There is no Acute & Emergency care, although we do have some secondary care bed units. At the moment, we have 100 Covid beds.

DS: At what stage is the NHS in the deployment of therapeutic VR? When might we start to see some of the NHS trusts begin to deploy VR?
RO: We are seeing many small scale trials of therapeutic VR in the UK, from mental health and wellbeing interventions to pain management, pulmonary rehabilitation and beyond. What the UK needs to do next is to bring all of this good work together, support impressive projects that are occurring in isolation, and get serious about investment, scaling up, and sharing good practice.

DS: In your Talking Therapy Services role, you used Virtual Reality after the tragic Grenfell Tower fire, where a fire in a residential building led to many deaths, many injuries and a traumatized community. Would you tell us about that?
RO: The 24-storey Grenfell Tower is in North Kensington, West London. In June 2017, a fire broke out, leading to 72 deaths. More than 70 other people were injured, and 223 people escaped. I was the manager for the Kensington and Chelsea Mental Health Services, and the fire happened in North Kensington. My role was to set up a bespoke trauma bereavement and mental health services for those affected. We can say that beyond the injuries and deaths, eleven thousand people were traumatized.

After the fire, the Grenfell community was unsurprisingly mistrusting of government and authority figures. So our role in Mental Health services to support people became even more difficult. We would go as usual to West London, on Portobello High Market Street in Notting Hill, which, before Covid, was a very busy area. Normally we would stand there and begin to engage people with NHS leaflets, banners, pens. But, after the fire, no one would talk to us.

This changed when we came there holding VR headsets in our hands. Everyone came up asking “Why are you here? Why the VR headsets?” At first, the content we offered was a trip to the international space station, the jungles of Columbia with Richard Attenborough. The favorite was a ride on a roller coaster. Everyone wanted that.

DS: And the conversation started…?
RO: Yes, if I had started with “I’d like to talk to you about mental health,” they would run away. But they were wowed by the VR content. And then they literally just started to talk to us candidly. They might say “My son’s not sleeping any more. Is the fire the reason?” or “I can’t look at the tower anymore.”

This was groundbreaking. As a result, we normalized the use of Virtual Reality in that community in that part of London. Now when they see us, they think we’ve got a VR headset with us, rather than ‘those are the people I should avoid’

DS: And chances are you do have that headset?
RO: Indeed. We are now working on a memorial for the tower. The tower still stands. It’s shrouded in white behind scaffolding. In the next couple of years, it is likely to be taken down carefully, piece by piece. In its place, there will be a memorial, and our intention is to use primarily Virtual Reality, with some Augmented Reality as well, to give people the chance to think about, build and create their own memorial in VR. So that people can move forward with their wellbeing, we will make it possible for them to experience their own personal memorial and have a greater chance of gaining closure.

DS: How did you come up with the idea of this particular use of VR?
RO: At the first anniversary of Grenfell, there was a lot of memorialization happening. We provided a space for kids to do VR and we observed that adults were going in and using our VR program to draw the Grenfell heart, the symbol of Grenfell. They were writing eulogies, leaving RIP graffiti. So we could see that they were using this as a medium to memorialize the tragedy.

We then went out and talked to the community and asked how they would see the memorial. A picture perfect photo, thanks to photogrammetry, is one in which the viewer can zoom in to the environment. We realized that if we could take such a photo of the base of the tower and remove the tower, we would have a 6k (high) resolution of the environment, in which each person could create their own memorial.

DS: You were saying that the community had remained quite connected despite the move?
RO: Yes, each household was given a new home, and there is a cohesive bereaved or survivor community, an action group called Grenfell United, following the ongoing Inquiry very closely. They follow the Inquiry proceedings in (in person pre COVID) and/or remotely and we work with them every day the Inquiry sits.

DS: So glad you have a vehicle for working them. Can you tell us about your other VR-related projects?
RO: We are taking VR headsets into Covid wards to support staff well-being. We are also putting together a white paper with NHSX, who are responsible for the digital transformation of the NHS. That paper will include a roadmap towards an NHS XR strategy. This will include VR for clinical skills and education, for mental health, for physical health, such as pain. For each of those pillars, the paper will show the business case for VR and feature the work already happening across the NHS with various organizations and start-ups.

DS: I understand that a start-up has to get individual buy-in from each NHS trust. Will this change in the future?
RO: You are right. A VR startup like any startup has to go from one locality to the next, and be approved by hundreds of NHS Trusts. This is slow and laborious. There’s no central repository for NHS VR. We would like to develop a purchasing mechanism for the apps. With NHSX in place since 2019, I think there’s a good chance we’ll get there.