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Digital mental health
Digital mental health: challenges and next steps
  1. Katharine A Smith1,2,3,
  2. Charlotte Blease4,5,
  3. Maria Faurholt-Jepsen6,7,
  4. Joseph Firth8,9,
  5. Tom Van Daele10,
  6. Carmen Moreno11,
  7. Per Carlbring12,
  8. Ulrich W Ebner-Priemer13,14,
  9. Nikolaos Koutsouleris15,16,17,
  10. Heleen Riper18,19,20,
  11. Stephane Mouchabac21,22,
  12. John Torous4,
  13. Andrea Cipriani1,2,3
  1. 1 Department of Psychiatry, University of Oxford, Oxford, UK
  2. 2 Oxford Health NHS Foundation Trust, Oxford, UK
  3. 3 Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
  4. 4 Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
  6. 6 Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
  7. 7 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
  8. 8 Division of Psychology and Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
  9. 9 Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
  10. 10 Expertise Unit Psychology, Technology and Society, Thomas More University of Applied Sciences, Mechelen, Belgium
  11. 11 Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, Universidad Complutense de Madrid Facultad de Medicina, Madrid, Spain
  12. 12 Department of Psychology, Stockholm University, Stockholm, Sweden
  13. 13 Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
  14. 14 mHealth Methods in Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
  15. 15 Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, München, Germany
  16. 16 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
  17. 17 Max-Planck Institute of Psychiatry, Munich, Germany
  18. 18 Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
  19. 19 Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, Duivendrecht, Netherlands
  20. 20 Department of Psychiatry, University of Turku, Turku, Finland
  21. 21 Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
  22. 22 Infrastructure for Clinical Research in Neurosciences (iCRIN), Brain Institute (ICM), INSERM, CNRS, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
  1. Correspondence to Dr Katharine A Smith, Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK; katharine.smith{at}psych.ox.ac.uk

Abstract

Digital innovations in mental health offer great potential, but present unique challenges. Using a consensus development panel approach, an expert, international, cross-disciplinary panel met to provide a framework to conceptualise digital mental health innovations, research into mechanisms and effectiveness and approaches for clinical implementation. Key questions and outputs from the group were agreed by consensus, and are presented and discussed in the text and supported by case examples in an accompanying appendix. A number of key themes emerged. (1) Digital approaches may work best across traditional diagnostic systems: we do not have effective ontologies of mental illness and transdiagnostic/symptom-based approaches may be more fruitful. (2) Approaches in clinical implementation of digital tools/interventions need to be creative and require organisational change: not only do clinicians and patients need training and education to be more confident and skilled in using digital technologies to support shared care decision-making, but traditional roles need to be extended, with clinicians working alongside digital navigators and non-clinicians who are delivering protocolised treatments. (3) Designing appropriate studies to measure the effectiveness of implementation is also key: including digital data raises unique ethical issues, and measurement of potential harms is only just beginning. (4) Accessibility and codesign are needed to ensure innovations are long lasting. (5) Standardised guidelines for reporting would ensure effective synthesis of the evidence to inform clinical implementation. COVID-19 and the transition to virtual consultations have shown us the potential for digital innovations to improve access and quality of care in mental health: now is the ideal time to act.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjment-2023-300670

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @TomVanDaele, @JohnTorousMD, @And_Cipriani

    • Contributors KAS, AC and JT prepared the manuscript. Other coauthors critically reviewed the typescript. All authors contributed to the consensus meeting and approved the final submitted version of the paper. JT and AC are joint last authors.

    • Funding KAS and AC are supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility. AC is also supported by an NIHR Research Professorship (Grant RP-2017-08-ST2-006), by the NIHR Oxford and Thames Valley Applied Research Collaboration and by the NIHR Oxford Health Biomedical Research Centre (Grant NIHR203316). JF is supported by a University of Manchester Presidential Fellowship (P123958) and a UK Research and Innovation Future Leaders Fellowship (MR/T021780/1). CM is supported by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (ISCIII, PI21/01929), Consorcio Centro de Investigación Biomédica en Red (CIBER, CB/07/09/0023), cofinanced by the European Union and ERDF Funds from the European Commission, ‘A way of making Europe’, financed by the European Union–Next Generation EU (PMP21/00051), Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds, EU Seventh Framework Program, H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking: Project c4c (Grant Agreement No 777389), Horizon Europe (HORIZON-HLTH-2021-STAYHLTH-01-02 No 101057529; HORIZON-HLTH-2021-STAYHLTH-01-02 No 101057454; HORIZON-HLTH-2022-STAYHLTH-01-01-two-stage No 101080238), National Institute of Mental Health of the National Institutes of Health, Fundación Familia Alonso and Fundación Alicia Koplowitz.

    • Disclaimer The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR or the UK Department of Health.

    • Competing interests MF-J has received support from Angelini Pharma within the past 3 years. JF has received honoraria/consultancy fees from Atheneum, Informa, Gillian Kenny Associates, Big Health, Wood for Trees, Nutritional Medicine Institute, ParachuteBH, Richmond Foundation and Nirakara, independent of this work. UWE-P has received consultant fees from Boehringer Ingelheim and lectures including travel fees from Angelini Pharma. PC has received honoraria/speaker fees from Angelini Pharma, Koa Health and Lundbeck within the past 3 years. CM has received honoraria as a consultant and/or advisor and/or for lectures from Angelini, Esteve, Exeltis, Janssen, Lundbeck, Neuraxpharm, Nuvelution, Otsuka, Pfizer, Servier and Sunovion, outside the submitted work. SM has received fees from Ethypharm, BioSerenity and Angelini Pharma. AC has received research and consultancy fees from Italian Network for Paediatric Clinical Trials (INCiPiT), CARIPLO Foundation, Lundbeck and Angelini Pharma, outside the submitted work. JT is co-founder of a mental health company called Precision Mental Wellness.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.