The evolving landscape of digital mental health: implications for research and practice

Over the past decade, digital mental health has been an emerging priority area for mental health practice and research (Hollis et al., 2018), with the spotlight dramatically shifting to this area since the start of 2020 with the emergence of COVID-19 pandemic (Ben-Zeev, 2020). In Australia, the most recent Productivity Commission report on Mental Health has advocated for more spending in digital supports (Productivity Commission, 2020).

Importantly, in 2020, the COVID-19 pandemic has fundamentally shifted the mental health service model to rapidly incorporate telehealth across the world (Ben-Zeev, 2020). The widespread introduction of social distancing and movement restrictions across the world, in an effort to control the spread of the virus, has significantly restricted access to face-to-face mental health services. At the same time the need for such services has dramatically increased due to the social isolation, and the economic and social consequences of the pandemic, and the resulting infection control measures. This has necessitated rapid uptake of digital mental health services across a broad range of populations and utilising emerging service models.

The use of technology to support one’s mental health is not a recent phenomenon. Mental health support is frequently accessed via websites and smartphone apps, wearables monitor aspects of physical health and wellbeing, and more recently, video and live chat modalities for mental health consultations. There is growing evidence that supports the positive impact of internet-based interventions (Andersson et al., 2019; Fu et al., 2020), smartphone (Linardon & Fuller-Tyszkiewicz, 2020), video conferencing mental health consultation (Thomas et al., 2021), and social peer support networks (Bailey et al., 2020) can have on mental health. In Australia, the past decade has seen growth in a range of empirically supported online mental health services addressing specific mental health disorders (e.g., Mental Health Online, MindSpot, This Way Up), increases in the demand for crisis support (Lifeline), and expanding online support for young people (eHeadspace, Reach Out).

However, despite emerging empirical evidence for the effectiveness of some of these interventions, demand and use of digital mental health have raced ahead of research. Existing research has identified many challenges for digital mental health around its effective implementation, how to promote meaningful client engagement, and in upskilling and training clinicians to confidently integrate a digital toolkit into practice. Importantly, there has been little research in assessing the impact of the potential exclusion of individuals who do not have access to technology due to various reasons (e.g., geography, cost, or digital literacy; Hollis et al., 2018). The potential inequities due to what has been referred to as the “digital divide” have been amplified with the dramatic increase in digital mental health services since 2020, particularly in some of the most vulnerable populations (i.e., socio-economically disadvantaged, individuals with severe mental illness), and as alternative modes of delivery of mental health services were at times unavailable (Spanakis et al., 2021). This highlights the urgency of research into design and implementation of effective and equitable digital mental health services that bridge the technology gap in society. Questions like: “How do we best blend digital services with existing in-person services to maximise mental health service reach?”; “What are the key success factors for clinicians when working online?”; “How can we better incorporate those with lived experience in designing digital mental health interventions, so they fit flexibly into their lives?”, are all important as digital mental health services become a prominent feature of the health delivery landscape.

This special issue of Clinical Psychologist has aimed to publish a collection of papers highlighting the diverse application of digital technologies to mental health support. The articles included focus on a range of psychological targets for intervention across a number of technologies (i.e., web-based intervention, social media, smartphones, video conferencing). It is hoped that this stimulates practitioners and clinical researchers to considering the ways in which digital technologies can be designed and delivered for mental health support. The articles included also provide timely guidance for practitioners to integrate a digital toolkit into practice.

Smartphone interventions (also referred to as MHapps or mHealth) are well suited to supporting users in self managing their mental health, and can deliver goal-focused, reflection-focused, or education-focused content (Bakker et al., 2016). Taking a critical look at goal-focussed approaches for managing addictive behaviours, Staiger and Liknaitzky (2021) introduce the Chronos approach as a time-based method alternative to “count goals” in behavioural intervention. They describe the integration of the Chronos approach to the app ReplaceIt, highlighting how the capabilities of smartphones directly support the user with goal setting and reminders.

Evaluation of MHapps outside of a research environment is important to understand their real-world performance and impact, particularly at a daily level. In the paper by Giraldo‐O’Meara and Doron (2021) the impact of a CBT-based app designed to improve self-esteem was explored. They demonstrate the utility of short daily use of app delivered self-esteem training, and also highlight the factors that are associated with dropout in the real world.

Rice et al. (2021) outline the development of Entourage, an intervention for social anxiety using the Moderated Online Social Therapy model (Rice et al., 2018; Wadley et al., 2013). They describe the multi-disciplinary and co-designed approach to developing a new intervention approach for social anxiety that utilises the strengths of digital media and social networking for moderated peer support. Importantly they explain how elements of the intervention design incorporate the lived experience and addresses key challenges for engaging young people in digital interventions.

There is now a substantial body of literature supporting the effectiveness of video conferencing (VC) for a range of mental health problems (Thomas et al., 2021). Less is known about how well group CBT performs when delivered via VC. Arrow et al. (2021) explore the development of group climate in an online CBT intervention for depression. They highlight the importance of positive group working environments online in maintaining intervention engagement and draw parallels to in-person group treatment.

The special issue is concluded with two papers that focus on the practical integration of digital technologies in the delivery of mental health services.

Australia has a strong history of investment and delivery of high-quality evidence-based Internet CBT (iCBT) programmes (e.g., MindSpot; Mood Gym; eCouch; Mental Health Online). The paper by Newby et al. (2021) provides an overview of the iCBT programs available in Australia, with particular focus in two platforms (THIS WAY UP and MindSpot), and guides practitioners in how iCBT programs can be integrated into routine practice. Importantly, they provide a comprehensive look at the benefits and barriers of using iCBT with clients, explore the common myths, and outline clinical considerations.

In addition to iCBT, the delivery of tele-mental health services has become a fixture of mental health service delivery in Australia during the coronavirus pandemic while movement restrictions are in place. Support for the workforce in transitioning to telehealth has been rapidly implemented. In their paper, Heydon et al. (2021) provide a synthesis of the evidence-base and practical guidance for delivering psychological services via videoconferencing technology. They provide clear stepwise recommendations for practitioners to deliver and enhance the effectiveness of their video consultation practice.

We believe that the collection of papers in this special issue provides practitioners and clinical researchers with a broad overview of the opportunities and practical considerations involved in developing and delivering digital mental health intervention and support. We express our sincere thanks to the authors for their contribution, creativity, and passion for supporting individual’s mental health with digital technologies.

Disclosure statement

No potential conflict of interest was reported by the author(s).