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Digital Mental Health Implementation Challenges

Digital Mental Health is information and communication technology used in mental health services delivered or boosted through the Internet and related technologies, smartphone and wearable technologies as well as immersive solutions (e.g., Virtual Reality and video games). It is predominantly used as self-help services or with the assistance of a (para-)professional and/or artificial intelligence for the provision of mental health promotion as well as mental ill-health identification, prevention and intervention.

  • COVID-19
  • digital mental health
  • implementation
  • challenges
  • technology
  • human-computer in-teraction
  • explainable artificial intelligence
  • integrated methodologies
  • efficacy
  • evaluation
Mental healthcare resources have been inundated during the economic and biopsychosocial recovery from COVID-19 [1][2]. Although in use since the early 2000s, an opportunity has arisen for digital mental health to fill unmet needs [3][4][5] and answer calls to improve the quality of and accessibility to mental health care [6][7][8]. It was already on a trajectory to regular practice, but COVID-19 added to demand outstripping supply of mental healthcare resources making a review of digital mental health more urgent. There has been a marked rise in the use of online self-help and telehealth interventions [9][10][11][12]. Systematic reviews found telehealth to be an effective and acceptable form of service delivery at least in the short term [13]. More generally, there are calls for higher levels of evidence, ongoing evaluation, and effective embedment [9][14][15][16]. A rapid meta-review found telehealth, internet-based, and app-based mobile digital interventions are well-placed to mitigate psychosocial consequences at the population level with good quality evidence on usability, safety, acceptance/satisfaction, and effectiveness [17]. Mixed levels of evidence were noted: lacking for apps having successful retention strategies; limited for mental health promotion; and lack of preliminary evidence for the long-term effects, process quality, and cost-effectiveness of digital interventions [17]. This integrative review synthesizes evidence from Scopus, ScienceDirect, CrossRef and Google Scholar searches of the challenges, systemic and practical issues, new progress, ongoing problems, and approaches of digital mental health as well as a focus on young people.
There is a need for rapidly deploying and efficiently integrating effective and evaluated digital solutions for users at individual, organizational, and governmental levels [6][18][19][20]. However, there are hindering issues in enacting a hybrid model of care e.g., the quality of digital mental health solutions needs to be better discerned and there is a need for more studies with vulnerable and at-risk populations [18]. Two systematic reviews and meta-analyses examined the effectiveness of digital mental health interventions. The first, for young adults with depression or substance misuse in low-income and middle-income countries, found moderate effectiveness when compared with control interventions [21]. The second, for anxiety and depression in perinatal patients in high-income countries, found nonspecialist providers may be effective in delivering counseling interventions [22]. However, only two online interventions were included. Further studies are required for digital intervention implementation processes to inform the optimal delivery and scale-up of these services.
There are a range of digital mental health interventions available for various mental health needs and conditions, from substance abuse recovery to suicide prevention [23]. Stronger evidence and new models of care will be necessary for higher accessibility, equity, and successful clinical implementation [5][20][24][25]. Predictive technologies (e.g., real-time machine learning algorithms) are useful for monitoring but should be deployed carefully as decision support tools [20][25][26]. On an operations level, there is the issue of integrating technology into mental health care delivery for diverse populations. The European Commission addressed organizational barriers (e.g., interoperability, and technical and legal issues) through a consortium action plan that also prioritized digital mental health research to target the most prevalent mental health problems and disorders [27]. Users need assistance to make informed decisions around the efficacy of digital mental health tools [13] as well as the intervention characteristics (e.g., convenience, suitability, reliability, user-friendliness, presentation, organizational integration, and cost). The adoption of digital tools has been hindered at the organizational and policy level—user-friendly workflows, decision models and protocols have been offered as solutions [19][28]. Suitable information, training, infrastructure, clinical guidelines, and policies may counter excessive information/workloads, ambiguous policies, mixed implementation, and a struggle to maintain systems [19][20].

References

  1. Pirkis, J.; John, A.; Shin, S.; DelPozo-Banos, M.; Arya, V.; Analuisa-Aguilar, P.; Appleby, L.; Arensman, E.; Bantjes, J.; Baran, A.; et al. Suicide trends in the early months of the COVID-19 pandemic: An interrupted time-series analysis of preliminary data from 21 countries. Lancet Psychiatry 2021, 8, 579–588.
  2. Rettie, H.; Daniels, J. Coping and tolerance of uncertainty: Predictors and mediators of mental health during the COVID-19 pandemic. Am. Psychol. 2021, 76, 427–437.
  3. Torous, J.; Keshavan, M. COVID-19, mobile health and serious mental illness. Schizophr. Res. 2020, 218, 36–37.
  4. Balcombe, L.; De Leo, D. An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19. JMIR Ment. Health 2020, 7, e21718.
  5. Gleeson, J.F.M.; Riper, H.; Alvarez-Jimenez, M. Editorial: Transforming Youth Mental Health Treatment Through Digital Technology. Front. Psychiatry 2020, 11, 606433.
  6. Saxena, S.; Thornicroft, G.; Knapp, M.; Whiteford, H. Resources for mental health: Scarcity, inequity, and inefficiency. Lancet 2007, 370, 878–889.
  7. Whittle, E.L.; Fisher, K.R.; Reppermund, S.; Lenroot, R.; Trollor, J. Barriers and Enablers to Accessing Mental Health Services for People with Intellectual Disability: A Scoping Review. J. Ment. Health Res. Intellect. Disabil. 2018, 11, 69–102.
  8. Rudd, B.N.; Beidas, R.S. Digital Mental Health: The Answer to the Global Mental Health Crisis? JMIR Ment. Health 2020, 7, e18472.
  9. Torous, J.; Myrick, K.J.; Rauseo-Ricupero, N.; Firth, J. Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow. JMIR Ment. Health 2020, 7, e18848.
  10. Guinart, D.; Marcy, P.; Hauser, M.; Dwyer, M.; Kane, J.M. Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey. JMIR Ment. Health 2020, 7, e24761.
  11. Guinart, D.; Marcy, P.; Hauser, M.; Dwyer, M.; Kane, J.M. Mental Health Care Providers’ Attitudes Toward Telepsychiatry: A Systemwide, Multisite Survey During the COVID-19 Pandemic. Psychiatr. Serv. 2021, 72, 704–707.
  12. The Lancet Digital Health Digital tools for mental health in a crisis. Lancet Digit. Health 2021, 3, e204.
  13. Barnett, P.; Goulding, L.; Casetta, C.; Jordan, H.; Sheridan-Rains, L.; Steare, T.; Williams, J.; Wood, L.; Gaughran, F.; Johnson, S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J. Med Internet Res. 2021, 23, e26492.
  14. Whelan, P.; Stockton-Powdrell, C.; Jardine, J.; Sainsbury, J. Comment on “Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow”: A UK Perspective. JMIR Ment. Health 2020, 7, e19547.
  15. Wind, T.R.; Rijkeboer, M.; Andersson, G.; Riper, H. The COVID-19 pandemic: The ‘black swan’ for mental health care and a turning point for e-health. Internet Interv. 2020, 20, 100317.
  16. Sorkin, D.H.; Janio, E.A.; Eikey, E.V.; Schneider, M.; Davis, K.; Schueller, S.M.; Stadnick, N.A.; Zheng, K.; Neary, M.; Safani, D.; et al. Rise in Use of Digital Mental Health Tools and Technologies in the United States During the COVID-19 Pandemic: Survey Study. J. Med. Internet Res. 2021, 23, e26994.
  17. Rauschenberg, C.; Schick, A.; Hirjak, D.; Seidler, A.; Pätzold, I.; Apfelbacher, C.; Riedel-Heller, S.G.; Reininghaus, U. Digital interventions to mitigate the negative impact of the COVID-19 pandemic on public mental health: A rapid meta-review. PsyArXiv 2020.
  18. Balcombe, L.; De Leo, D. Psychological Screening and Tracking of Athletes and Digital Mental Health Solutions in a Hybrid Model of Care: Mini Review. JMIR Form. Res. 2020, 4, e22755.
  19. Ganapathy, A.; Clough, B.A.; Casey, L.M. Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals. Telemed. e-Health 2021.
  20. Wies, B.; Landers, C.; Ienca, M. Digital Mental Health for Young People: A Scoping Review of Ethical Promises and Challenges. Front. Digit. Health 2021, 3, 697072.
  21. Fu, Z.; Burger, H.; Arjadi, R.; Bockting, C.L.H. Effectiveness of digital psychological interventions for mental health problems in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Psychiatry 2020, 7, 851–864.
  22. Singla, D.R.; Lawson, A.; Kohrt, B.A.; Jung, J.W.; Meng, Z.; Ratjen, C.; Zahedi, N.; Dennis, C.-L.; Patel, V. Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries. JAMA Psychiatry 2021, 78, 498.
  23. Kozelka, E.E.; Jenkins, J.H.; Carpenter-Song, E. Advancing Health Equity in Digital Mental Health: Lessons From Medical Anthropology for Global Mental Health. JMIR Ment. Health 2021, 8, e28555.
  24. Mohr, D.C.; Lyon, A.R.; Lattie, E.G.; Reddy, M.; Schueller, S.M. Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment. J. Med. Internet Res. 2017, 19, e153.
  25. Balcombe, L.; De Leo, D. Digital Mental Health Challenges and the Horizon Ahead for Solutions. JMIR Ment. Health 2021, 8, e26811.
  26. Schueller, S.M. Grand Challenges in Human Factors and Digital Health. Front. Digit. Health 2021, 3.
  27. Jacobi, C. Special issue internet interventions: Editorial “integrating technology into mental health care delivery in Europe (ICare)”. Internet Interv. 2019, 16, 1–4.
  28. Bucci, S.; Berry, N.; Morris, R.; Berry, K.; Haddock, G.; Lewis, S.; Edge, D. “They Are Not Hard-to-Reach Clients. We Have Just Got Hard-to-Reach Services.” Staff Views of Digital Health Tools in Specialist Mental Health Services. Front. Psychiatry 2019, 10, 344.
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    Balcombe, L. Digital Mental Health Implementation Challenges. Encyclopedia. Available online: https://encyclopedia.pub/entry/15175 (accessed on 22 May 2022).
    Balcombe L. Digital Mental Health Implementation Challenges. Encyclopedia. Available at: https://encyclopedia.pub/entry/15175. Accessed May 22, 2022.
    Balcombe, Luke. "Digital Mental Health Implementation Challenges," Encyclopedia, https://encyclopedia.pub/entry/15175 (accessed May 22, 2022).
    Balcombe, L. (2021, October 20). Digital Mental Health Implementation Challenges. In Encyclopedia. https://encyclopedia.pub/entry/15175
    Balcombe, Luke. ''Digital Mental Health Implementation Challenges.'' Encyclopedia. Web. 20 October, 2021.
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