Authors: Michael P Craven (NIHR MindTech MedTech Technology Co-operative & The University of Nottingham, UK)
It is well known that mental health problems are highly prevalent whilst many people living with them are not getting help from health services. Greater use of technology promises solutions to improve efficiency and availability of interventions, to facilitate self-management by individuals and to support their recovery, and to help with prevention, maintenance or to manage crisis situations.
In particular, digital mental health refers to the use of computers or mobile devices such as smartphones or wearables and the internet in the mental health domain. Video calling and virtual reality platforms have also come of age for applications in mental health. However, as is typical with technology solutions, even when they are based on psychological or social intervention techniques that are known to work, many questions remain about the consequences of doing things digitally. Some of these are problems that have been revealed by or during prior research studies including randomized clinical trials or from studying technologies in practice (i.e., ‘in the wild’), whilst the process of generation of new evidence itself is challenged by the pace of innovation such that there are many new devices and software applications to try out.
Two years ago a James Lind Alliance Priority Setting Partnership (JLA-PSP) was initiated by the NIHR MindTech Healthcare Technology Co-operative (now MedTech Co-operative), in the Institute of Mental Health in Nottingham (UK), aimed at ‘Asking the Right Questions’ about digital mental health, the results of which have now been published . The PSP, which ran as a partnership with several other non-commercial organizations in England concerned with mental health research and innovation, brought together people with lived experience, practitioners and providers of services to identify the top ten unanswered questions with the ultimate aim of prioritizing and informing the funding of future research.
The priority questions from the PSP have revealed a set of unknowns about digital mental health including the benefits and risks of replacing face-to-face interventions with digital, or how to maximize benefit by using combinations of treatments (including digital, non-digital and medication), and finding out where digital is safe and effective in the treatment pathway. What will be the effects on services (capacity to deliver, access, timing of appointments and waiting times) and to their reach (specific demographics and rural areas)? Furthermore, how can social media be used more effectively to connect people with mental health problems to overcome isolation? There was also the question about how best to evaluate and endorse mental health apps. This has been a challenge for our National Health Service (NHS), which originally launched a Health Apps library in 2013, took it down in 2015 after concerns about the efficacy and data privacy of apps listed, and then relaunched a new one in 2017 with a renewed assessment criteria. The question still remains about how best to assess potential apps in a proportionate and timely manner .