What will it take to implement effective digital mental health services?

Teachman, B. A., Silverman, A. L., & Werntz, A. (2021). Digital Mental Health Services: Moving From Promise to Results. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2021.06.014

Summarized by Ariel Ervin

Notes of Interest:

• Although many Americans fit the criteria for a mental illness throughout their life, a significant amount of them don’t receive sufficient treatments.
• Providing digital mental health services (DMHS) can help address this issue.
• This study reviews the advancements DMHS has made in the past two decades. It also examines how DMHS can be improved.
• All the papers reviewed either 1) highlight the importance of implementing accessible, quality, & evidence-based care; 2) how DMHS can create better treatments; or 3) what the current literature has to say about the usage of DMHS to address emotional disorders.
• Five lessons can be drawn from the findings.
  • Because DMHS can refer to many different services/platforms (like mobile apps, VR, telehealth, web-based programs, etc.), people should be cautious about making generalizations.
  • People cannot assume that DMHS will be equally effective for all users.
  • Establishing regulations and standards for DMHS can improve its effectiveness and reduce the likelihood of causing harm.
  • Making DMHS available won’t automatically increase its usage. Dissemination and implementation science need to be taken seriously to make DMHS more appealing.
  • DMHS designs need to focus on the delivery model and user experience, not replicating therapy sessions via technology.
• DMHS has the potential to make care more accessible. However, this depends on how persuasive and evidence-based the benefits are.
• It’s important to remember that DMHS won’t resolve the inaccessibility of mental health care by itself. More research needs to be conducted on this subject to promote DMHS, especially for underrepresented communities.

Introduction (Reprinted from the Abstract)

The papers in this special issue make a compelling case for the value of digital mental health services (DMHS; including technology-based interventions, assessments, and prevention programs) to help address some of the currently unmet needs in mental health care. At the same time, the papers highlight the work that needs to be accomplished for DMHS to fulfill their promise. We review the papers’ contributions in terms of (a) the imperative to increase access to evidence-informed, high-quality care, especially for underserved populations, both in the United States and globally; (b) ways to use DMHS to improve the ways that clinical care is provided to make treatment provision more effective and efficient; and (c) the current state of the research on DMHS for emotional disorders. We then consider lessons learned and recommendations to move the field forward, such as increasing (and making transparent) the research base on DMHS, adopting regulatory standards for DMHS, attending carefully to training issues for DMHS and best practices for dissemination and implementation, designing specifically for digital platforms, and being intentional about efforts to reduce disparities regarding who benefits from DMHS.

Implications (Reprinted from the Conclusion)

The potential benefits of advancing dissemination and implementation of DMHS are enormous but those benefits need to be well articulated and data driven. The articles in this special issue make clear the considerable progress that has been made in advancing DMHS, but also make clear the work that remains to make a more compelling case for DMHS. Investment in research and development, along with a shared commitment to rigor, transparency, open science, equity, and careful monitoring, will be needed to build a compelling case that DMHS should be a key element of our mental health care toolbox moving forward. We hope that in the not-too-distant future, the research and the field will have advanced such that a case can confidently be made that DMHS are cost-effective, well regulated, safe, widely and equitably accessible, and can prevent the worsening of mental health problems. We are thankful to the authors of the articles in this special issue for taking important steps to help make this case by highlighting both the progress made and critical gaps to be addressed.

To this end, as Himle and colleagues (this issue) outline, cost-effectiveness analyses that compare DMHS to in-person or other approaches are needed to meaningfully make the case that DMHS should be integrated into existing care pathways. Further, the field has to establish shared standards and be accountable to some form of regulation, or the public will lose trust, which will damage the opportunity for DMHS that are data driven and adhere to best practices (e.g., surrounding privacy) to be embraced. Relatedly, the field has to show that it is self-correcting—this means treating seriously the data indicating high rates of attrition from many DMHS and improving the ways we engage users across time. More generally, we need to be able to make the case for safety and use reliable methods to detect harmful effects. This means systematically tracking and reporting harms in terms of outcomes, loss of confidentiality or privacy, and so forth. Moreover, as noted, more research is needed to strengthen the case that DMHS will in fact increase access to care, especially for underserved populations. The accumulating data are helping to make a persuasive argument about the potential to increase access, and this needs to be a key focus for future research. Finally, as Muñoz (this issue) notes, we need to demonstrate that DMHS can fulfill their promise to identify warning signs for mental health problems earlier than occurs in most traditional care models, and further, that delivery of DMHS can then help prevent full onset of a disorder or reduce severity and impairment.

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