Written by Dr Janak Gunatilleke and Dr Victoria Betton.

“The COVID-19 crisis and global pandemic may be the defining moment for digital mental health, but what that definition will be remains unknown” (Torous et al, 2020).

What light does Covid-19 shed on the state of digital mental health pre-pandemic? What is the impact of the pandemic for digital mental health in the present? And what might it mean for the future? 

This post draws on an editorial in JMIR (Journal of Medical Internet Research) and is intended as a provocation for a webinar, hosted on the 2 June, in which leading thinkers and experts in the field of digital mental health will consider the future of the industry. 

Never has the role of digital in mental health been more important to get right – the mental health impacts of self-quarantine and social distancing are only just becoming apparent, and the consequences of economic recession are starting to unfold. Evidence suggests people with mental health conditions are at increased risk of worsening or relapse during lockdown[1] and risk is increased due to the reduction in available support. Half of the people in a recent KCL & Ipsos Mori survey[2] claim they are more anxious or depressed than usual, as a result of Covid-19. Over a third (38%) have slept less well and 19% drank more alcohol. 

Whilst governments around the world are attempting to ‘flatten the curve’ of the spread of the virus, Torous et al argue that now is the time to accelerate and bend the curve on digital mental health. They note that Covid-19 has accelerated the use of digital technologies at a time of social distancing. They make the case for telehealth, digital therapy programmes and mobile applications which generate sensor data that can support self-management, support and treatment.

Whelan et al have responded to the editorial, in a letter to the editor discussing a UK perspective on the implications of Covid-19 for mental health. They point to the NHS Apps Library and ORCHA curated apps to support self management during Covid-19. They also refer to progress in the development of evidence standards and the NASSS framework developed by Greenhalgh et al, to help the adoption of digital technologies in health and care. They advocate for digital health learning systems which are characterised by patient data which is used to support decision making, continuous improvement and enabling infrastructure, which are all embedded in the culture of the project or organisation.

Both sets of academics articulate concerns related to digital exclusion and exacerbation of health inequalities, although Whelan et al argue that technologies such as video conferencing can overcome pre-existing (or previously invisible) barriers to participation. They equally point to challenges with take-up and use of digital technologies in mental health, along with the still emerging evidence base. We are still in the foothills of digital mental health, with high expectations, but systemic barriers and challenges.

What might the changes born out of necessity mean for mental health services as the pandemic abates? And more specifically, what might they mean for the still emergent field of digital mental health? The question remains as to the extent to which the changes we have seen will stick and the extent to which they are transformational. Below are three possible scenarios for our new-normal, inspired by NESTA’s predictions for life post-pandemic:

Normality resumes – we see some shifts in take up of digital but by and large the take-up of technologies, such as video communications to provide remote treatment and support, are not embedded in practice. We will learn lessons about how to manage future pandemics but mental health services remain stretched and the promise of digital to offer flexible and personalised mental health services continue to be realised but in an incremental fashion and mired in barriers.

A progressive curve – the increased prevalence of mental health difficulties galvanises the government to invest in prevention and treatment services. Digital technologies are a key enabler in personalised, flexible, person-centred care. New roles such as that of digital navigator, help people access blended face-to-face and digital services. Data is used to personalise care and to plan services at a population level. In this new optimistic scenario, there is a renewed focus on generating sound evidence of what works, so the NHS can invest resources in proven technologies.

An authoritarian curve – in this scenario there is decreased money available for mental health services and we enter a crisis of provision combined with increased demand. Stretched mental health services rely on self-tracking data to provide remote only services and only those with the most acute need have access to a mental health practitioner. With predominantly online service provision, most socially and digitally excluded people find it even harder to access services. This constrained environment and lack of investment means less opportunity for entrepreneurs to develop new digital solutions.

Which of these scenarios is most likely? They combine realism and idealism, optimism and pessimism, a balance of benefits and risks, and are unlikely to be mutually exclusive. We may find some elements more likely or more appealing than others.

In our webinar, we will explore these possible scenarios and consider where the aftermath of the pandemic will leave digital mental health along with our hopes for the future. Our panelists are:

• John Torous is Director of the digital psychiatry division Beth Israel Deaconess Medical Centre in Boston 
• Pauline Whelan is Do-Director of the CAMHS.Digital research unit
• Kat Jackson is a community engagement worker at Xenzone and has been involved in digital mental health both personally and professionally for 18 years
• Chris Hollis is the Director MindTech and Professor of Child & Adolescent Psychiatry at the University of Nottingham and Consultant in Developmental Neuropsychiatry
• James Woollard is a consultant psychiatrist for a children and young people’s ADHD service and chief clinical information officers for Oxleas NHS Foundation Trust
• Simon Dixon is Head of Design at NHSX. 

The panel will be chaired by Victoria Betton, chief innovation officer at Mindwave.

The webinar takes place on Tuesday 2 June 4.00-5.00pm and you can book your free place here.

References

[1]  Yao, H., Chen, J.H. and Xu, Y.F., 2020. Patients with mental health disorders in the COVID-19 epidemic. The Lancet Psychiatry, 7(4), p.e21.

[2] KCL & Ipos Mori survey https://www.ipsos.com/sites/default/files/2020-04/coronavirus_in_the_uk.pdf