An interview with Professor Richard Drake: The role of CareLoop in the past and in the future

An interview with Professor Richard Drake: The role of CareLoop in the past and in the future 

When it comes to supporting people experiencing psychosis, timing is crucial. Catching early warning signs of relapse, understanding suicidal ideation, and responding swiftly to changes in symptoms can make the difference between crisis and stability. But traditional monitoring approaches – three-monthly reviews and scheduled appointments – often miss crucial moments when intervention could be critical. 

Prof Richard Drake, a consultant psychiatrist with Greater Manchester Mental Health NHS Foundation Trust, was involved in CareLoop’s early development around 2010. He trialled the platform with a small group of people receiving treatment at his community rehabilitation unit, and his experience shows how digital monitoring can transform care for people with psychosis. 

Real-world impact: the case of hidden suicidal ideation 

One of Prof Drake’s most compelling experiences with CareLoop involved someone who had spent decades “essentially institutionalised in the community” – living independently but with minimal social contact and increasingly negative symptoms. 

As part of a rehabilitation programme, he volunteered to use CareLoop. The system revealed something that hadn’t emerged in standard clinical assessments, nor the time he had spent in rehabilitation: ongoing suicidal ideation that had been present for at least a decade. 

“He didn’t think to mention it because it was a regular thing,” Dr Drake explains. “Insofar as it functioned as a way of underlining his choice to be involved in life at all – ‘I don’t have to do this, but I am doing it’ – it was a private thing he didn’t particularly want to share.” 

Rather than indicating acute risk, the ideation functioned as what Dr Drake describes as a “protective response”. Through follow-up conversation prompted by CareLoop’s data, the team gained crucial understanding of how the patient had coped with years of isolation and what they needed to address in his rehabilitation. 

“I was glad we’d been able to check what his suicide schema looked like,” Dr Drake reflects. “It helped me understand quite how he’d dealt with the years of institutionalisation in the community, and therefore what we were trying to help him with as we rehabilitated him.” 

The future: agile treatment and partnership 

More than a decade on from these early pilots, CareLoop is now being rolled out in NHS Trusts. When asked about his vision for CareLoop in the future, Prof Drake explained that he envisions it becoming integral to a more responsive approach to treatment, particularly in early intervention.  

His team follows an evidence-based algorithm that checks for clinical response within two weeks of starting or adjusting medication – because if there’s no improvement by then, there’s an 80% chance the treatment won’t deliver substantial benefit at six to twelve weeks. 

“We always check in with people after a couple of weeks to see if it’s working,” he explains. “If it’s not, we will make a further change, maybe an increase in dose, and that allows us with people who are low enough risk to take a gradual approach.” 

But it can take a little time to contact people, and CareLoop could speed up this process. “Being able to do this within the time scale is very attractive,” Dr Drake notes. “It means that you can cycle through different treatments much more rapidly than people traditionally have.” 

Dr Drake also values how CareLoop can transform the therapeutic relationship. He describes patients in previous digital monitoring studies who “would look at their scores over time, think about what that related to and then make judgements accordingly. It was empowering for them – and consciously empowering.” 

“It allows you to develop a partnership where the two of you can look at the scores and discuss what you make of them and how you might deal with that,” he added.  

Challenging assumptions about barriers to using technology 

Prof Drake’s current service is an Early Intervention in Psychosis Service that works predominantly with young people for whom smartphones are a natural mode of communication. Assumptions have previously been made that people living with psychosis may struggle to use phones to monitor symptoms, but Dr Drake’s experience, and published research, show this is rarely the case.  

There is a similar assumption that also needs to be challenged about specific, marginalised communities affected by psychosis using technology. Many of Dr Drake’s refugee patients are already digitally literate, having conducted business via smartphone in West Africa and other parts of the world where mobile technology leapfrogged landlines.  

The real challenge isn’t capability but preference. “Some people don’t find it their preferred method of communicating with us,” Dr Drake acknowledges. This means a hybrid approach is needed, maintaining traditional contact whilst offering digital monitoring to those who prefer it. 

“For people who want a bit of an arm’s length intervention, who are doing stuff and don’t mind occasionally checking in on their smartphone from the bus but don’t want to come to clinic, it’s much easier,” he notes. “You’ll get much more engagement.” 

A necessity, not a luxury  

Dr Drake’s team currently manages 40% more patients than intended because surrounding community mental health teams are not able to manage the demand. In this context, innovation isn’t optional. 

“I don’t see it as a luxury,” he states. “At any given time, team managers often feel it is, but I think in the medium, let alone the long term, it isn’t.” 

CareLoop offers a way to maintain quality whilst managing higher caseloads. “The advantage of this sort of approach is that people needn’t be forgotten if they’re not having crises,” Dr Drake explains. “You can still be looking at how people are functioning without having to have them as the focus of a lot of input.” 

Most importantly, earlier detection of deterioration could prevent the hospital admissions that patients experience as “disruptive and disempowering” and that cost the NHS approximately £10,000 per admission – whilst also being the highest risk period for suicide and violence. 

“We often try and sell engagement and adherence to treatment on the basis of ‘let’s work together to prevent readmission’,” Dr Drake says. “I think we can with CareLoop as well, but it’ll be easier if we engage people when the going is good.” 

Much like engaging relatives early rather than only during crises, introducing CareLoop when patients are stable builds a resource that becomes invaluable during difficult periods. 

For services under pressure, digital monitoring isn’t about replacing human contact – it’s about making that contact more meaningful, timely and effective. As Dr Drake’s experience demonstrates, technology like CareLoop can reveal what traditional assessments miss, enable more agile treatment, and empower patients whilst supporting overstretched teams to deliver better care.