Digital Mental Health Care Research Articles

AB026. Cross-regional collaboration to promote digital mental health equity in the Asia Pacific in the context of coronavirus disease (COVID-19)

Background: The coronavirus disease (COVID-19) pandemic has led to an unprecedented shift to the use of digital mental health technologies. While this presents an opportunity to improve access to care, there is a risk of excluding populations experiencing barriers to digital health access. The APEC Digital Hub for Mental Health (‘the Digital Hub’) and the Research on Mental Health Equity in the Asia Pacific-Digital Research Cluster (REMAP-Digital) have developed a cross-regional collaboration to advance research on digital mental health equity in the Asia Pacific. The objectives of this presentation are: (I) to present the results of a study identifying barriers and opportunities for equitable digital mental health care; and (II) to introduce opportunities for cross-regional collaboration.

Impact of the first COVID-19 outbreak on mental health service utilisation at a Dutch mental health centre: retrospective observational study.

Previous studies into mental health service utilisation during the COVID-19 pandemic are limited to a few countries or specific type of service. In addition, data on changes in telepsychiatry are currently lacking. We aimed to investigate whether the COVID-19 pandemic is associated with changes in mental health service utilisation, including telepsychiatry, and how these changes were distributed among patients with mental illness during the first COVID-19 outbreak. This retrospective study obtained routinely assessed healthcare data from a large Dutch mental healthcare institute. Data from the second quarter of 2020 (the first COVID-19 outbreak period) were compared with the pre-pandemic period between January 2018 and March 2020. Time-series analyses were performed with the quasi-Poisson generalised linear model, to examine the effect of the COVID-19 lockdown and the overall trend of mental health service utilisation per communication modality and diagnostic category. We analysed 204 808 care contacts of 28 038 patients. The overall number of care contacts in the second quarter of 2020 remained the same as in the previous 2 years, because the number of video consultations significantly increased (B = 2.17, P = 0.488 × 10-3) as the number of face-to-face out-patient contacts significantly decreased (B = -0.98, P = 0.011). This was true for all different diagnostic categories, although this change was less pronounced in patients with psychotic disorders. Diminished face-to-face out-patient contacts were well-compensated by the substantial increase of video consultations during the first COVID-19 outbreak in The Netherlands. This increase was less pronounced for psychotic disorders. Further research should elucidate the need for disorder-specific digital mental healthcare delivery.

The development of National Safety and Quality Digital Mental Health Standards.

Digital mental health services offer innovative ways for individuals to access services but are not without risk. Our objective was to develop National Safety and Quality Digital Mental Health (NSQDMH) Standards that improve the quality of digital mental health service provision and protect service users from harm. The NSQDMH Standards were developed by adapting the National Safety and Quality Health Service (NSQHS) Standards and adding components highlighted through a national consultation process as critical to the safety and quality of services. Further public consultation and pilot testing assisted in refining the NSQDMH Standards. The NSQDMH Standards comprise three standards-Clinical and Technical Governance, Partnering with Consumers, and Model of Care-and were launched in November 2020. The NSQDMH Standards provide a quality assurance mechanism to improve digital mental health care in Australia.

The future of digital mental health care amidst the psychologization of the COVID 19 crisis

The COVID-19 pandemic has plagued the world, bringing everyday activities to a standstill. Many people are wrestling with the impact of the public health crisis on the connections they have with their environment (e.g., neighborhoods, cities), specific places (e.g., workplaces, places of worship), and people (e.g., loved ones, faith community) that are part of their daily lives. In this paper, we introduce the phenomenon of place attachment disruption as a common challenge for people who have been disconnected from their environment since the outbreak of SARS-CoV-2. We conceptualize place as a relational object and argue that the COVID-19 pandemic has disrupted the attachment that people have with the physical elements of their environment, the lifeforms of the environment, and to some extent the ‘soul’ of their cities. We then consider defensive responses that may be triggered by disruptions to place attachment during the public health crisis, including the emergence of spiritual/religious struggles. The experience of place attachment disruption is discussed as an opportunity to transcend place-related COVID-19 loss by detaching from ‘what no longer serves us’ in a way that builds resilience. We conclude by highlighting some practical approaches that could facilitate psychospiritual transformation (e.g., meaning-making) to disrupted place attachment during the public health crisis, as well as those that could support the formation of new (or renewed) connections to place in the aftermath of the COVID-19 pandemic.

Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-Enabled Stepped Care Delivery System: Cross-sectional Study.

BackgroundAccess to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options.ObjectiveThe purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform.MethodsThis exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities.ResultsData were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95% CI 1.70-3.59; P<.001). Individuals screening positive for anxiety (OR 0.73, 95% CI 0.62-0.86; P<.001) or depression (OR 0.79, 95% CI 0.66-0.95; P=.02) were more likely to prefer one-on-one care.ConclusionsOur findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care.

The role of research in evaluating and implementing digital mental health

Abstract BodyThe clinical evidence and cost-effectiveness of digitalised prevention and treatment of mental disorders such as depression, anxiety and alcohol misuse have been steadily growing over the last two decades. However, bridging the gap between evidence-based eMental-health interventions and their actual delivery, evaluation and implementation in routine care has proven to be more difficult and a longer process than previously expected thereby reaching the estimated forecast of Roger’s innovation cycle of 20 years. In contrast, during the appearance of COVID-19 in 2020 for many patients and therapists digitalized treatment was the only option. Meanwhile from a scientific and policy perspective the implementation and upscaling of digital mental health care innovations in routine care have gained momentum in terms of theoretical perspectives on organizational change, empirical research into how to effectively implement digital innovations from the perspective of a variety of stakeholders and organizational levels (micro, macro and meso). In this presentation an overview of these issues will be presented, and it will be discussed whether COVID-19 might act as a turning point for the provision of large scale access to and implementation of digitalized mental health care in the near future.DisclosureNo significant relationships.

Digital forms of service delivery for personalized crisis resolution and home treatment

HintergrundDie stationsäquivalente psychiatrische Behandlung (StäB) wurde 2018 als Krankenhausleistung für Menschen eingeführt, die die Kriterien einer stationären Behandlung erfüllen. Die rasanten Fortschritte im Bereich der Informations- und Kommunikationstechnologie bieten neue Chancen für innovative digitale Versorgungsangebote wie telemedizinische, eHealth- oder mHealth-Verfahren.Ziel der ArbeitDiese Übersichtsarbeit soll einen umfassenden Überblick über neue digitale Versorgungsformen geben, die zur Personalisierung der StäB bei schweren psychischen Erkrankungen beitragen und somit klinische und soziale Outcomes verbessern sowie direkte und indirekte Kosten reduzieren könnten.MethodeDiese Arbeit basiert auf einer selektiven Literaturrecherche (Narratives Review).ErgebnisseEs wurden vier primäre digitale Versorgungsformen identifiziert, die in der StäB gewinnbringend genutzt werden könnten: (1) Kommunikation, Behandlungskontinuität und -flexibilität durch Online-Chat und Videotelefonie, (2) Monitoring von Symptomen und Verhaltensweisen in Echtzeit durch Anwendung des ambulatorischen Assessments („ecological momentary assessment“ [EMA]), (3) Nutzung multimodaler EMA-Daten für die Generierung von personalisiertem Feedback über subjektives Erleben und Verhaltensmuster sowie (4) auf Person, Moment und Kontext zugeschnittene, adaptive ambulatorische Interventionen („ecological momentary interventions“ [EMIs]).DiskussionDigitale Versorgungsformen haben erhebliches Potenzial die Effektivität und Kosteneffektivität der StäB zu steigern. Ein wichtiger nächster Schritt besteht darin, die Anwendung dieser Versorgungsformen im Bereich der StäB zu modellieren und deren Qualität aus Sicht der Patient*innen, Sicherheit und initiale Prozess- und Ergebnisqualität sowie Implementierungsbedingungen sorgfältig zu untersuchen.

A critique of digital mental health via assessing the psychodigitalisation of the COVID‐19 crisis

Reading the report ‘The Digital Future of Mental Healthcare and its Workforce’ by the National Health Service (NHS) from the United Kingdom makes for a strange experience. Most centrally, it is utterly perplexing that no single argument is mounted in the report to wave aside accusations that it depicts a totalitarian world governed by a digipsy‐complex. As it seems to presage the COVID crisis in its assertion that digital mental health care will and should be the future, this paper takes the pandemic as its point of departure. However, it does not set out not from the apparent digitalisation of psy‐care under COVID‐conditions, but rather, from the psychologisation of the COVID crisis itself; that is, individualising and pathologising the discontents and socio‐subjective sufferings under COVID. The aim is to tackle from here the intertwining of the psychological and the digital, of psychologisation and digitalisation. This article engages in a close ‘symptomatic reading’ of the report and makes two points. The first concerns how digitalisation as such is closely connected to the neurobiologisation of subjectivity. The second point is about how digitalisation is also closely connected to the commodification of all things subjective and social. After discussing and interrelating these two issues, the article explores what a critical response could be, and what it should not be.

The relevance of digital mental healthcare during COVID-19: Need for innovations.

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The Digital Therapeutic Alliance and Human-Computer Interaction.

The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps.

Transitioning from face-to-face treatment to iCBT for youths in primary care – therapists' attitudes and experiences

BackgroundTo address the increasing mental health problems among young people, health care needs to broaden the spectrum of interventions and increase access to care. One particularly promising first-line intervention is cognitive behavioral therapy (CBT) delivered via the Internet (iCBT). The outbreak of the Coronavirus disease -2019 (COVID -19) has made the need for solid digital mental health care systems clear. This is the first published study exploring the transition among therapists of working with face-to-face treatment to using iCBT for youths suffering from anxiety treated in primary care. MethodsFourteen primary care therapists were included in the study. Semi-structured interviews (n = 26) were conducted on two occasions: before starting to use iCBT for youths, and at a subsequent follow-up after gaining treatment experience. Data was summarized into thematic categories. ResultsThe overarching themes that were identified were: Attitudes to iCBT before and after implementation; Experiences of treatment delivery; Characteristics of “the right patient;” and The role of the digital therapist. ConclusionThe participants generally had positive attitudes to iCBT for youths and saw it as a valuable alternative to face-to-face treatments. However, they identified challenges related to patient selection, and to motivating patients and maintaining a therapeutic relationship through mainly written communication. The participants appreciated the increase in variety that iCBT brought to their schedules, and also experienced iCBT as a relief from common challenges of therapeutic work, such as emotional stress and high cognitive demands. The participating therapists' positive experiences support the introduction of iCBT for youths in routine primary care.

How Have Public Safety Personnel Seeking Digital Mental Healthcare Been Affected by the COVID-19 Pandemic? An Exploratory Mixed Methods Study.

Public safety personnel (PSP) experience unique occupational stressors and suffer from high rates of mental health problems. The COVID-19 pandemic has impacted virtually all aspects of human life around the world and has introduced additional occupational stressors for PSP. The objective of this study was to explore how PSP, especially those seeking digital mental health services, have been affected by the pandemic. Our research unit, PSPNET, provides internet-delivered cognitive behavioral therapy to PSP in the Canadian province of Saskatchewan. When the pandemic spread to Saskatchewan, PSPNET began inquiring about the impact of the pandemic on prospective clients during the eligibility screening process. We used content analysis to analyze data from telephone screening interviews (n = 56) and descriptive statistics to analyze data from a questionnaire concerning the impacts of COVID-19 (n = 41). The results showed that most PSP reported facing several novel emotional challenges (e.g., social isolation, boredom, anger, and fear) and logistical challenges (e.g., related to childcare, finances, work, and access to mental healthcare). Most participants indicated they felt at least somewhat afraid of contracting COVID-19 but felt more afraid of their families contracting the virus than themselves. However, few participants reported severe challenges of any kind, and many (40%) indicated that they had not been significantly negatively impacted by the pandemic. Overall, the results suggest that PSP are not expressing significant concern at this time in meeting the novel challenges posed by COVID-19. Continued research will be required to monitor how diverse PSP populations and treatment outcomes are affected by the pandemic as the situation evolves.

In Case You Haven't Heard…

As the COVID‐19 pandemic impact on mental health continues to reveal more people than ever in need of quality mental health care, a new partnership and launch of in‐app coaching and therapy services seems to be occurring at a critical time. Sanvello Health Inc., a digital mental health care provider and a UnitedHealth Group company, announced Sept. 8 a new partnership with Olympic gold medal gymnast and wellness advocate Aly Raisman, Business Wire reported. The new strategic partnership also comes as Sanvello launches its new mental health coaching services and an expanded therapy offering, both available within the app. “Working with a professional therapist and building in self‐care practices to my everyday routine have really helped me through some very tough times,” said Raisman. “I want to help others create space to focus on their own mental health, and Sanvello is a great place to start.” Used by over 3.5 million people worldwide, Sanvello holds the No. 1 search position for stress and anxiety in the app stores and has a consumer approval rating of 4.8/5 stars. Officials reported that three‐quarters of Sanvello Therapy users saw a 50% improvement — clinically significant improvement — within 60 days.

Digital cognitive behavioural therapy for insomnia: the answer to a major public health issue?

Digital cognitive behavioural therapy for insomnia: the answer to a major public health issue?

Digital interventions in adult mental healthcare settings: recent evidence and future directions.

Internet and mobile-based interventions (IMI) can be used as online delivered forms of psychotherapeutic mental health treatments. These interventions can be an effective as well as time and cost-efficient treatment with the potential to scale up mental healthcare. In this review, we map implementation possibilities into routine mental healthcare settings and provide the most recent evidence. Fourteen articles on digital mental healthcare approaches published in the last 18 months were included. Despite the limited number, the studies provide evidence for the effectiveness of IMI in treating inpatients and outpatients with various disorders in different mental healthcare settings. IMI were investigated as stand-alone interventions, in combination with other treatment forms (blended-care), or as aftercare. Although there is encouraging evidence for the effectiveness of IMI in mental healthcare settings, several limitations have to be considered. The small number of studies conducted within the healthcare system, especially with inpatient samples, calls for more collaboration between researchers and clinical practitioners to unravel barriers and develop efficient protocols for the integration into routine care. Nonetheless, IMI are a promising tool for the endeavour of closing the treatment gap and should, therefore, be further explored in varying settings.

Internet access as a right for realizing the human right to adequate mental (and other) health care

Human rights protect the conditions of a minimally decent life of which mental health is an indispensable element. Adequate care for mental health is thus recognized as part of the human right to health. However, for populations living far from urban centers, adequate in-person (mental) health care is often extremely costly and thus not provided. Digital mental health care options have become an effective alternative to in-person treatment. Benefitting from these new digital opportunities, though, requires sufficient access to the internet. Because everyone has a human right to adequate health care, and digital mental health care is now an effective option for progressively realizing this human right for people who live in remote regions, these people also have to be understood to have a right to access to the internet. This right to internet access creates duties for public authorities and the international community to create the required digital infrastructure and (where needed) to cover the costs of internet access where this is the only feasible way of delivering, or progressively realizing, the mental health care that is indispensable for having the opportunity to lead minimally decent lives.

Promoting meaningful recovery with digital mental health care.

There is growing interest in digital mental health as well as accumulating evidence of the potential for technology-based tools to augment traditional mental health services and to potentially overcome barriers to access and use of mental health services. Our research group has examined how people with mental illnesses think about and make use of technology in their everyday lives as a means to provide insight into the emerging paradigm of digital mental health. This research has been guided by anthropological approaches that emphasise lived experience and underscore the complexity of psychiatric recovery. In this commentary I describe how an anthropological approach has motivated us to ask how digital technology can be leveraged to promote meaningful recovery for people with mental illnesses and to develop a new approach to the integration of technology-based tools for people with mental illnesses.

A model for digital mental healthcare: Its usefulness and potential for service delivery in low- and middle-income countries.

Background:Using digital technology to deliver mental health care can possibly serve as a viable adjunct or alternative to mainstream services in lessening the mental health gap in a large number of resource deficient and LAMI countries. Conventional models of telepsychiatric services available so far, however, have been inadequate and ineffective, as these address only a small component of care, and rely on engagement of specialists who are grossly insufficient in numbers.Aim:To describe an innovative digital model of mental health care, enabling and empowering the non-specialists to deliver high quality mental health care in remote areas.Methods:The model is powered by an online, fully automated clinical decision support system (CDSS), with interlinked modules for diagnosis, management and follow-up, usable by non-specialists after brief training and minimal supervision by psychiatrist, to deliver mental health care at remote sites.Results:The CDSS has been found to be highly reliable, feasible, with sufficient sensitivity and specificity. This paper describes the model and initial experience with the digital mental health care system deployed in three geographically difficult and remote areas in northern hill states in India. The online system was found to be reasonably comprehensive, brief, feasible, user-friendly, with high levels of patient satisfaction. 2594 patients assessed at the three remote sites and the nodal center represented varied diagnoses.Conclusions:The digital model described here has the potential to serve as an effective alternative or adjunct for delivering comprehensive and high quality mental health care in LAMI countries like India in the primary and secondary care settings.

A systematic review of technology-assisted interventions for co-morbid depression and substance use

Introduction Mental health interventions disseminated via, or accessed using, digital technologies are an innovative new treatment modality for managing co-morbid depression and substance use disorder. The present systematic review assessed the current state of this literature. Methods A search of the Cochrane Library, Embase, Pubmed, PsycInfo and Scopus databases identified six eligible studies (Nparticipants = 862), utilising quasi-experimental or randomised controlled designs. Reporting quality was evaluated and Hedges’ g effect sizes (with 95% confidence intervals and p-values) were calculated to determine treatment effectiveness. Process outcomes (e.g. treatment satisfaction, attrition rates) were also examined. Results Quality ratings demonstrated high internal validity, although external validity was low. Effect size data revealed medium to large and short-term improvements in severity of depression and substance use symptoms in addition to global improvement in social, occupational and psychological functioning. Longer-term treatment effectiveness could not be established, due to the limited available data. Preliminary findings suggest that there was high client satisfaction, therapeutic alliance and client engagement. Discussion Mobile phone devices and the Internet can help to increase access to care for those with mental health co-morbidity. Large-scale and longitudinal research is, however, needed before digital mental healthcare becomes standard practice. This includes establishing critical therapeutic factors including optimum levels of assistance from clinicians.

Towards a framework for the appraisal of digital products for mental health

Introduction: Mental health disorders are the largest cause of disability in the UK, affecting 1 in 4 people over their lifespan and demand for services already exceeds NHS resources. Advances in digital information and communication technology (ICT) offer the potential to transform mental healthcare through improved detection and access to services and more effective and flexible treatments. There are, however, unique risks associated with digital mental healthcare products that must also be considered. The huge potential that these products promise to deliver services in new ways and to hand more control to patients – is also the greatest barrier to their adoption. Services may need be reconfigured, and users must be assured about safety, security and effectiveness. A number of national, strategic initiatives are looking at this topic and this work is essential. Also required, however, are smaller projects that start to use these products in order to learn: • What patients, practitioners and commissioners want from digital products. • What information they need when considering using or purchasing them. • What barriers exist to adopting these technologies. • What should the role be of regulators, policy makers and initiatives such as the NHS Apps library. This paper describes such a project. Aims: This paper will describe: • The development of an initial framework for the appraisal of digital mental health products being considered for use in the NHS (complete). International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116559– http://www.ijic.org/ • How this framework was applied by the mHealth Habitat (a city-wide initiative in Leeds) and what was learnt from this (March – July 2014). • How the framework was refined following its use in mHealth Habitat and other clinical areas (July-August 2014). Results: In March 2014 a workshop brought together 20 individuals (practitioners, researchers, service users, technology developers, clinical and information governance managers and a digital health policy expert) from a range of organisations including MindTech, Leeds and York Partnership NHS Foundation Trust, The University of Leeds and Nottinghamshire Healthcare NHS Trust. Findings of workshop: A staged, proportionate approach to appraisal required. This should begin with basic requirements such as safety and quality and move to more advanced requirements such as clinical and cost-effectiveness if and when appropriate. There is not currently an effective marketplace for digital products that clearly defines NHS requirements and allows developers to demonstrate how they meet and exceed these. This could drive innovation and raise standards. An initial framework was developed, consisting of four categories, each with 7 10 ‘essential criteria’: Information Governance, Information technology and interoperability; clinical validity, research and evidence; safety and regulation; design, accessibility and usability. This is currently being applied by practitioners and service users across a number of trusts and will be refined based on the results of this. Conclusion: As the adage goes, necessity is the mother of invention. This project developed as a result of a number of organisations wanting to use digital mental healthcare products and discovering no existing guidance or leadership on how to appraise these. Our findings will have implications not just for practitioners and users but also for policy makers, regulators and developers. Many of the issues addressed in this project are not unique to mental health and are therefore relevant to other clinical areas.