scholarly journals Building the digital mental health ecosystem: opportunities and challenges for innovators (Preprint)

2021 ◽  
Author(s):  
Benedetta Spadaro ◽  
Nayra Anna Martin-Key ◽  
Sabine Bahn
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Care Pathway ◽  
Digital Health ◽  
Healthcare Delivery ◽  
Mental Healthcare ◽  
Digital Tools ◽  
Middle Income ◽  
Digital Ecosystem ◽  
Regulatory Flexibility

UNSTRUCTURED Digital mental health holds promise in tackling the growing demand for psychotherapeutic services. However, existing digital approaches are rarely integrated in clinical practice and rely on patients’ ability to self-diagnose and seek support. Digital health innovators are presented with opportunities and challenges to create an integrated digital ecosystem for mental healthcare. The uptake of digital tools depends on efficacy and engagement of end-users. To this aim, behavior theories offer the opportunity to identify behavioral drivers and address barriers to uptake. The agenda for innovators also includes building strong evidence-based cases for digital mental health, moving away from a one-size-fits-all wellbeing approach, to embrace the development of comprehensive digital diagnostics and validated digital tools. Innovators have the opportunity to make their clinical evaluation more insightful by assessing effectiveness and feasibility in the intended context of use with hybrid pragmatic trials. The COVID-19 pandemic has prompted regulatory flexibility and increased implementation of digital mental health, however equitable access remains a challenge, particularly in low- and middle-income countries, and the mental health gap is still present and increasing. A joint effort by digital health developers and providers is required to enable individuals to access care through digital technologies in communities where mental health services may be otherwise scarce. Shifting from the practice of designing for to designing with users will enhance traditional healthcare delivery and connect more patients to the appropriate care pathway. By laying these foundations, digital services can become integrated in clinical practice and set the scene for deeper technology-enabled changes.

scholarly journals Delivering race equality in mental health services

2008 ◽  
Vol 14 (5) ◽  
pp. 326-329 ◽  
Author(s):  
Annie Lau
Keyword(s):  
Mental Health ◽  
Care Pathway ◽  
Action Plan ◽  
Good Practice ◽  
Mental Healthcare ◽  
Policy Initiatives ◽  
Pilot Survey ◽  
The Past ◽  
Department Of Health ◽  
Clinical Engagement

‘Delivering race equality’ is a 5-year action plan for tackling race inequalities in mental healthcare in England and Wales, based on the main themes of improved services, better community engagement and better information. The perception is that clinical teams have not been sufficiently engaged with the plan and progress is slow. This article shares insights from the author's work across government departments over the past 2 years and explores the potential for linking up different initiatives across the patient care pathway in support of the plan's delivery. A summary of conclusions from a pilot survey of consultant psychiatrists, commissioned by the Department of Health in June 2007, addresses the main controversial areas in the action plan, with suggestions for improvement. Areas for clinical engagement are identified that exploit new funding, investment and policy initiatives. Examples of good practice are offered.

scholarly journals Preliminary Evaluation of the Engagement and Effectiveness of a Mental Health Chatbot

2020 ◽  
Author(s):  
Kate Daley
Keyword(s):  
Mental Health ◽  
Digital Health ◽  
Preliminary Evaluation ◽  
Real World Data ◽  
Post Intervention ◽  
Middle Income ◽  
Middle Income Countries ◽  
Cohen’S D ◽  
Cohen's D ◽  
Human Support

Background: Mental health difficulties are highly prevalent yet access to support is impeded by barriers of stigma, cost and availability. These issues are even more prevalent in low- and middle-income countries, and use of digital technology is one way to overcome these barriers. Digital health interventions have been shown to be effective but often struggle with low engagement rates, particularly in the absence of any human support. Chatbots could offer a scalable solution, simulating human support at a lower cost. Objective: To complete a preliminary evaluation of engagement and effectiveness of Vitalk, a mental health chatbot, at reducing anxiety, depression and stress. Methods: Real world data was analysed from 3629 Vitalk users who had completed the first phase of a Vitalk program (‘less anxiety’, ‘less stress’ or ‘better mood’). Programs were delivered through written conversation with the chatbot. Engagement was calculated from the number of responses sent to the chatbot divided by days in the program. Results: Users sent an average of 8.17 responses / day. For all three programs, target outcome scores reduced between baseline and follow up with large effect sizes for anxiety (Cohen's d = -0.85), depression (Cohen's d = -0.91) and stress (Cohen's d =-0.81). Increased engagement resulted in improved post-intervention values for anxiety and depression. Conclusion: This study highlights the potential of a chatbot to reduce mental health symptoms in the general population within Brazil. Whilst findings show promise, further research is required.

scholarly journals Efforts and Challenges to Ensure Continuity of Mental Healthcare Service Delivery in a Low Resource Settings During COVID-19 Pandemic—A Case of a Kenyan Referral Hospital

2021 ◽  
Vol 11 ◽  
Author(s):  
Edith Kwobah ◽  
Florence Jaguga ◽  
Kiptoo Robert ◽  
Elias Ndolo ◽  
Jane Kariuki
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Service Delivery ◽  
Mental Health Care ◽  
Healthcare Service ◽  
Healthcare Delivery ◽  
Mental Healthcare ◽  
Referral Hospital ◽  
Number Of Patients

The rising number of patients with Covid-19 as well as the infection control measures have affected healthcare service delivery, including mental healthcare. Mental healthcare delivery in low and middle income countries where resources were already limited are likely to be affected more during this pandemic. This paper describes the efforts of ensuring mental healthcare delivery is continued in a referral hospital in Kenya, Moi Teaching and Referral hospital, as well as the challenges faced. These efforts are guided by the interim guidelines developed by the Kenyan ministry of health. Some of the adjustments described includes reducing number of patients admitted, shortening the stay in the inpatient setting, using outdoors for therapy to promote physical distancing, utilization of electronic platforms for family therapy sessions, strengthening outpatient services, and supporting primary care workers to deliver mental health care services. Some of the challenges include limited ability to move about, declining ability for patients to pay out of pocket due to the economic challenges brought about by measures to control Covid-19, limited drug supplies in primary care facilities, inability to fully implement telehealth due to connectivity issues and stigma for mental health which results in poor social support for the mentally ill patients. It is clear that current pandemic has jeopardized the continuity of usual mental healthcare in many settings. This has brought to sharp focus the need to decentralize mental health care and promote community based services. Meanwhile, there is need to explore feasible alternatives to ensure continuity of care.

scholarly journals Understanding and Addressing the Treatment Gap in Mental Healthcare: Economic Perspectives and Evidence From China

2020 ◽  
Vol 57 ◽  
pp. 004695802095056
Author(s):  
Xuezheng Qin ◽  
Chee-Ruey Hsieh
Keyword(s):  
Mental Health ◽  
Public Investment ◽  
Mental Healthcare ◽  
Theoretical Argument ◽  
Treatment Gap ◽  
Treatment Benefit ◽  
Middle Income ◽  
Health Technologies ◽  
Mental Health Awareness ◽  
Healthcare Needs

A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face 4 major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the 4 barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies.

scholarly journals Brain drain: a challenge to global mental health

2016 ◽  
Vol 13 (3) ◽  
pp. 61-63 ◽  
Author(s):  
Bibilola D. Oladeji ◽  
Oye Gureje
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Brain Drain ◽  
Global Mental Health ◽  
Scale Up ◽  
Mental Healthcare ◽  
Psychiatric Training ◽  
Skilled Workers ◽  
African Countries ◽  
Middle Income

The brain drain of medical professionals from lower-income to higher-income countries contributes to the current inequity that characterises access to mental healthcare by those in need across the world and hinders efforts to scale up mental health services in resource-constrained settings, especially in Nigeria and other West African countries. The migration of skilled workers is driven by a combination of the globalisation of the labour market and the ability of highly resourced countries to attract and retain specialists from poorer countries. If we are to ameliorate the worldwide shortage of mental health professionals, we need to find innovative ways of attracting young doctors into psychiatric training in all countries. We must also introduce measures to improve health worker retention in low- and middle-income countries.

scholarly journals Smartphone Health Assessment for Relapse Prevention (SHARP): a digital solution toward global mental health

BJPsych Open ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Elena Rodriguez-Villa ◽  
Urvakhsh Meherwan Mehta ◽  
John Naslund ◽  
Deepak Tugnawat ◽  
Snehil Gupta ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Relapse Prevention ◽  
Global Mental Health ◽  
Digital Health ◽  
Phase 1 ◽  
Health Assessment ◽  
Digital Tools ◽  
Two Phase

Background Predicting and preventing relapse presents a crucial opportunity and first step to improve outcomes and reduce the care gap for persons living with schizophrenia. Using commercially available smartphones and smartwatches, technology now affords opportunities to capture real-time and longitudinal profiles of patients’ symptoms, cognition, physiology and social patterns. This novel data makes it possible to explore relationships between behaviours, physiology and symptoms, which may yield personalised relapse signals. Aims Smartphone Health Assessment for Relapse Prevention (SHARP), an international mental health research study supported by the Wellcome Trust, will inform the development of a scalable and sharable digital health solution to monitor personal risk of relapse. The resulting technology will be studied toward predicting and preventing relapse among individuals diagnosed with serious mental illness. Method SHARP is a two-phase study with research sites in Boston, Massachusetts, and Bangalore and Bhopal, India. During phase 1, focus groups will be conducted at each study site to collect feedback on the design and features available on mindLAMP, a digital health platform. Individuals with serious mental illness will use mindLAMP for the duration of a year during phase 2. Results The results of the research outlined in this protocol will guide the development of technology and digital tools to help address pervasive challenges in global mental health. Conclusions The digital tools developed as a result of this study, and participants’ experiences using them, may offer insight into opportunities to expand digital mental health resources and optimize their utilisation around the world.

scholarly journals Cultural adaptation: a framework for addressing an often-overlooked dimension of digital health accessibility

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Jayson S. Marwaha ◽  
Joseph C. Kvedar
Keyword(s):  
Mental Health ◽  
Cultural Values ◽  
Recent Work ◽  
Cultural Adaptation ◽  
Digital Health ◽  
Digital Tools ◽  
Communication Styles ◽  
Different Populations ◽  
Area Of Study

AbstractRelatively little is known about how to make digital health tools accessible to different populations from a cultural standpoint. Alignment with cultural values and communication styles may affect these tools’ ability to diagnose and treat various conditions. In this Editorial, we highlight the findings of recent work to make digital tools for mental health more culturally accessible, and propose ways to advance this area of study.

scholarly journals Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview

10.2196/25847 ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. e25847
Author(s):  
Susanna Lehtimaki ◽  
Jana Martic ◽  
Brian Wahl ◽  
Katherine T Foster ◽  
Nina Schwalbe
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Young People ◽  
Digital Health ◽  
Health Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mental Health Interventions ◽  
Meta Analyses ◽  
Low And Middle Income

Background An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. Objective This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). Methods We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. Results In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. Conclusions Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.

scholarly journals Challenges Encountered by Mental Health Workers in Rwanda; Current Situation and Future Needs

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Nkundimana Balthazar
Keyword(s):  
Mental Health ◽  
Data Analysis ◽  
Mental Health Professionals ◽  
Qualitative Data ◽  
Health Workers ◽  
Demographic Data ◽  
Mental Healthcare ◽  
Mental Health Workers ◽  
Mental Health Training ◽  
Middle Income

The burden of mental health has become a great concern for public health as the diseases caused by mental health is ranking second worldwide. According to the HWO countries of Low- and Middle-Income Countries (LMICs) don’t allocate enough financial means to mental healthcare. The lack of will or interest in mental health in these countries causes different challenges in this sector. Rwanda as one of LMICs is not served on the challenges although it might have its particularities. This study aimed to explore the challenges encountered by Rwandan local mental health workers within and outside of their demanding work. Method: An interpretative qualitative mixed with quantitative design. The self-administrated questionnaire with open-ended questions, demographic data as well as qualitative data was systematically prepared, explained, and given to respondents. The questionnaire was completed by sixty mental health workers from various institutions with mental health in Rwanda. SPSS was used in quantitative data analysis while the main part of data used Thematic analysis for qualitative data analysis. Results: The main results immersed in themes that consist of the shortage of; salary, poverty of mental health seekers, culture, and beliefs toward mental health, training, and professional development of mental health works. The study concluded with a better understanding of challenges in mental health practice in Rwanda and the outcome could be used to decrease challenges for mental health professionals and sustain of the mental healthcare system in Rwanda.

scholarly journals Mitigating COVID-19 impact on the Portuguese population mental health: the opportunity that lies in Digital Mental Health (Preprint)

2020 ◽  
Author(s):  
Cristina Mendes-Santos ◽  
Gerhard Andersson ◽  
Elisabete Weiderpass ◽  
Rui Santana
Keyword(s):  
Mental Health ◽  
Healthcare Delivery ◽  
Mental Healthcare ◽  
Intervention Strategies ◽  
Mitigation Measures ◽  
Equitable Access ◽  
Portuguese Population ◽  
Research Education ◽  
Health Strategy ◽  
Population Mental Health

UNSTRUCTURED COVID-19 mitigation measures present unprecedent challenges in mental healthcare delivery, posing high risk to the mental health of populations. Ensuring safe and equitable access to mental healthcare requires resorting to innovative psychosocial intervention strategies such as, Digital Mental Health. In this perspective piece, we discuss how timely implementation of a comprehensive Digital Mental Health strategy, coupling research, education, implementation and quality assessment initiatives, might strengthen the Portuguese mental healthcare system and, therefore, buffer COVID-19´s impact on the Portuguese society.

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