In this report on digital mental health, we explore key updates in this space over the past few months, from plans to improve data use within mental health services to how a chatbot can be utilised to support mental health referrals; and we’ll also take a look at some audience views, research, and mental health learnings from HTN’s network.
Firstly, let’s run through some of the main stories from the past six months with regards to digital mental health.
HTN explored the papers from NHS England’s latest board meeting this month, which involved discussion around expected data quality improvement for community mental health services and the urgent and emergency mental health pathway. In particular, the board highlighted a programme of work designed to improve these services by incorporating feedback from national surveys and complaints alongside partnership working with voluntary, community and social enterprise groups. NHSE also raised plans to launch a longer-term review in early 2025 into the whole system approach for community mental health service with the aim of improving quality and safety; this will examine the data, capital and resources required to meet demand, as well as exploring the changes required to help these services enable efficient flow and high quality care within and between services.
In September, we reported how SBRI Healthcare launched a new funding competition looking for work-related digital interventions for individuals with poor mental health, which focuses on supporting individuals to stay in work, return to work or overcome recruitment barriers. Up to £200,000 in funding is available per innovation for up to 12 months, with a closing date of 13 November.
September also brought a three-year plan to improve mental health services from NHS Cheshire and Merseyside, which highlights data as a key enabler in realigning services so that inpatient provision better fits population needs; and news of a partnership between University College London and YouTube Health, aiming to improve access and quality of mental health information on the site for young people. Future plans within the NHS regarding digital mental health were also shared in September, with North London Mental Health Partnership indicating intention to procure a digital local risk management and incident reporting system, and Oxford Health NHS Foundation Trust sharing plans to create a framework for the provision of online and digital mental health assessments, treatments and therapies across the region.
In the summer, HTN reported an update from NHS Coventry, Warwickshire and Solihull Talking Therapies which saw a new chatbot function launched on the service website, designed to take website visitors through an online conversation and exercises to process referrals to the service. Additionally, patients are encouraged to download a mental health app linked to the chatbot which can provide personalised support such as weekly reports and progress tracking. We also noted how the NHS 111 service was expanded to include a 24/7 “full package” of mental health crisis support, so that people in crisis or concerned family members can access trained support at any time.
Looking to spring, HTN shared how the charity Papyrus worked with the ORCHA to develop an app library containing “trusted apps” for young people to use to access a range of information, support, and advice on mental health. Additionally, we reported on the announcement that North London Mental Health Partnership would be moving to a single electronic patient record, with “comprehensive data migration of clinical data and consultation records from EMIS onto RIO” taking place from May.
Where should the priority be when it comes to digital supporting mental health services?
To gain audience views on the topic, we took to LinkedIn to ask a question. Where should the priority be when it comes to digital supporting mental health services: improving digital access, implementing new ways of reaching out, accelerating interventions, or improving data and information sharing?
43 percent of our respondents believed that accelerating interventions in this space should be the priority, with votes coming in from roles such as deputy chief nurse, director of performance and informatics, and digital culture and change lead.
26 percent thought the priority for digital mental health should be implementing new ways of reaching out, including practice manager, senior operations manager for a virtual ward, and deputy chief nurse.
17 percent wanted to focus on improving data and information sharing; here we saw votes come in from roles such as business change and improvement manager, data leader, and cyber security and information governance lead.
13 percent sought to prioritise improving digital access, including an EPR configuration analyst, health service researcher and psychiatrist.
Which option would you have voted for?
Digital mental health research: engagement challenges and attitudes to tech
A research study recently published in Frontiers sought to explore the engagement challenges faced by an online mental health platform in Brazil by exploring feedback sourced from focus groups, online surveys and ‘think aloud protocols’, whereby participants are asked to verbalise their thoughts whilst they work through a task. In particular, the research team sought to evaluate user satisfaction, identify barriers to adherence, and explore potential hybrid solutions.
Contextually, the study acknowledges that a “major research gap to overcome in using digital health programs is user adherence”, with the issue “particularly acute in low- and middle-income countries”. Therefore the researchers focused on Brazil.
The solution in question offers a self-guided digital education experience designed to enhance self-awareness and mental health for participants, providing personalised feedback on “key psychological factors” as a “core element of mental health education” and as a form to engage users.
The research team observed “substantial” dropout rates across all patient samples during the study, with users predominantly engaging for a “one-time, concentrated use of the platform”.
From the online survey given to participants, lack of time was the predominant reason given as to why they did not complete the platform journey, with criticisms focusing on “excessive number and extensive length of the instruments required to be completed”. The respondents also supplied a number of recommendations for enhancements for the platform overall. These included development of a mobile application for the solution; the implementation of periodic reminders; reduction in the overall length of the journey; and inclusion of meetings with healthcare professionals.
Participants who took part in focus groups and think-aloud interviews provided further insights; the main themes of disengagement here were incompatible time, lengthy questionnaires, the long journey required by the platform, a perceived lack of “dynamism” and the necessity of a specific audience. However, they expressed “significant overall satisfaction and a deep personal connection with the personalised feedback” offered by the solution.
The study also draws attention to one cohort of participants who became involved with the solution following a public online launch. There was a “significant bottleneck” at the early stages of engagement for this group, specifically after the signing of the consent form and the following of the initial segment of the platform journey. “This pattern suggests critical engagement challenges at the outset of the user experience,” the study notes, “indicating the need for targeted interventions to improve initial user engagement and retention.”
Discussing their findings, the researchers suggest that shorter activities might foster greater participant involvement; and future versions could benefit from “more image-centric and less text-heavy content to appeal to users”. Lack of dynamism and gamification elements are believed to have induced disengagement, with “persuasive” features such as self-monitoring, reminders, dialogue support and social support encouraged to support users in engaging and promoting adhere.
The team also draw attention to the four factors deemed to positively impact adherence in digital interventions in this space; personalisation, push notifications, user-friendliness, and personal support offered alongside the digital tool.
Citation: Moretti F, Bortolini T, Hartle L, Moll J, Mattos P, Furtado DR, Fontenelle L and Fischer R (2024) Engagement challenges in digital mental health programs: hybrid approaches and user retention of an online self-knowledge journey in Brazil. Front. Digit. Health 6:1383999. doi: 10.3389/fdgth.2024.1383999 Journal on Frontiers here, license here.
On another research note, HTN previously looked at research commissioned by the MHRA and NICE, which explored attitudes and experiences of current and potential users of digital mental health technology (DMHT).
The aim was to inform the design of future regulatory and evaluation frameworks for DMHT, with key findings including participants feeling that it can be used to “try and cover over failings in the mental health care system”; that use should generally sit alongside other treatment such as regular therapy; and that apps are often seen as a “temporary substitute”, though participants did acknowledge that “in some cases an app on its own might be all a patient needs”. Click here to read more.
Insights and learnings from health tech professionals
At a HTN Now event we were joined by Dr Joseph Firth, senior research fellow at the University of Manchester and honorary fellow at Greater Manchester Mental Health NHS Foundation Trust and Western Sydney University. Joe joined us to discuss his UKRI-funded programme of research on digital lifestyle interventions in mental healthcare, sharing key findings from his research. He provided insights on how his team are involving clinicians, patients and public feedback in their design and delivery of digital health interventions, and discussed ‘The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness’, in which Joe and his team highlight key issues and suggested actions for tackling fragmented and inaccessible physical health care for people with mental illness.
The HTN team also spoke with Dr Martin Dechant, lecturer at University College London, about his research around the use of digital interventions in mental health. Martin shared how he works with Master’s students on exploring game mechanics, particularly “looking at the power of games in improving motivation” and examining “mundane harms – how games might damage your mental health unintentionally”.
Additionally, Martin reflected on the potential and pitfalls of digital in the mental health space, in his view. “We have multiple levels where I think digital can help a lot, and also where it can be a negative, which is important to consider. On one side, through digital we have easy access to information; but on the other side, there is an incredible amount of information out there, so people start to have problems with figuring out what is trustworthy.”
Interested in hearing more about digital mental health from health tech experts? On 21 November (11am-12pm) we’ll be hosting a webinar as part of our live event series exploring how Leeds and York Partnership NHS Foundation Trust, a mental health trust, has digitised its patient records. This webinar will examine how the trust transformed paper-based processes into a fully digital system integrated with their EPR, sharing their challenges and how they tackled them as well as how they kept the process compliant with data protection standards. Register for your free NHS ticket here.
