Addressing the Shift from Traditional to Digital Mental Healthcare Services

How we deliver healthcare is rapidly evolving.

The use of telehealth and mHealth applications in behavioral health interventions and management is one example where technology innovations provide at least partial solutions to critical deficits in our healthcare network.

Here in the United States, we face an urgent behavioral health crisis: marked by an acute shortage of behavioral health providers, including pediatric specialists. Prior to the COVID-19 Pandemic, an estimated 20% of adults had significant mental health needs or experienced a mental health or substance use disorder. That 2019 estimate was conservative then; needless to say, the Pandemic has exacerbated that need, leaving our current provider pipeline unequipped to keep up. Over 150 million Americans live in federally designated mental health provider shortage areas, and future forecasting doesn’t look good, as Dr. Saul Levin, the Medical Director of the American Psychiatric Association, recently stated: “We have a chronic shortage of psychiatrists, and it’s going to keep growing.”

HOW CAN DIGITAL HEALTH INTERVENTIONS AND RESOURCES HELP?

Digital health interventions can help bridge the gap between diagnosis and treatment, especially among underserved communities which are more likely to have barriers to reliable access to behavioral health services. This includes direct delivery of treatment from a provider through telehealth consultations. But mobile health applications (mHealth) also present opportunities to support an individual’s self-management, skill development, monitoring, and the integration of a support network. Digital applications represent another tool in creating an environment to support an individual’s health – something that is all the more important when so many people’s immediate communities lack adequate system infrastructure. 

Simply put, digital health interventions are an essential tool for providing services and can also be an important resource to address health inequities.

WHAT SHOULD HEALTH CARE PROVIDERS CONSIDER WHEN INCORPORATING DIGITAL HEALTH SOLUTIONS IN THEIR PRACTICE?

While Digital health applications for mental and behavioral health present important opportunities, this is not to say that their integration within clinical practice is simple or easy. The Pandemic has provided many practices with an (extended) crash course in the remote delivery of services through telehealth. The lessons of that experience also translate to the integration of mHealth applications as part of care management or for the support or monitoring of treatment for patients.

1. Carefully evaluate digital health applications prior to selecting and integrating them in your practice. Vetting of applications goes beyond reviewing the products’ published use cases or marketing material – you need to pilot test the application to understand how it operates in practice – from both a patient’s perspective and the practice’s perspective. How will it fit within your existing clinical workflows and platforms and what adaptations need to make the integration possible? Are the privacy and security controls and terms of use consistent with your operations and regulatory responsibilities? Is the solution tailored to your patients’ needs and means?
2. Invest the time to negotiate contracts with the digital health provider. The devil is always in the details and when it comes to software as a service there are a lot of consequential elements. You need to understand how data is collected, stored, transmitted, and used (and if those terms of use are acceptable to your own practices, risk profile, and regulatory responsibilities). Contract negotiations often don’t fall on the “fun” or easy side of the ledger and there can be a tendency to just “get it done.” But an ounce of prevention is worth a metric ton of cure so yes, you need to call the Legal Team and rope in your compliance and information security officer(s) for this process.
3. Privacy and Security: Since mental health data is very sensitive information, it is essential to consider what privacy controls you have to keep protected health information safe. Whether those controls need to be updated or an adapted integration of the digital application. This includes the development of policies, procedures, and training for your own staff in the use of these platforms, the transmittal and storage of data
4. Interoperability: Is the digital application directly interoperable with your care management record or EHR? If not – how will data be (securely) collected and integrated into (1) a patient’s record or (2) aggregated performance measures across a cohort?
5. Patient onboarding and support: You can’t assume that your patients will have the technical knowledge, interest, or even the devices and data plans (or consistent access to high-speed internet) to support the continued use of these applications.
6. Management and Support: What internal (and external) resources do you need to support the implementation, maintenance, and evaluation of your digital health initiative? Is the application interoperable with your care management or Electronic Health Record? Does your organization have the infrastructure and internal resources to support implementing a digital health initiative? If not, what additional resources are needed (hint: additional resources and capacity development is always needed).
7. Sustainability and ROI: One of the biggest challenges with digital mental health initiatives is measuring your Return On Investment (ROI). It is crucial to not only utilize applications backed by scientific evidence but also have the necessary mechanisms in place to provide you with data to evaluate program effectiveness and impact.

Finally, recognize that this is an iterative process. Although the shift from the traditional delivery of behavioral health services to a more digital approach is a positive one and will create a more equitable space for individuals to receive care, it may take some time to get used to. Seek to constantly evaluate your performance and identify opportunities for improvement. As technology also continues to change, it is important to stay on top of the current trends and learnings.

Check out the links we compiled below for more information about how you can stay on top of the latest mental health technologies and digital initiative happenings.

Resources

• The World Health Organization. Global Strategy on Digital Health 2020-2025. https://www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf
• Aungst, T. D., & Patel, R. (2020). Integrating Digital Health into the Curriculum-Considerations on the Current Landscape and Future Developments. Journal of medical education and curricular development, 7, 2382120519901275. https://doi.org/10.1177/2382120519901275
• Graham, A. K., Lattie, E. G., Powell, B. J., Lyon, A. R., Smith, J. D., Schueller, S. M., Stadnick, N. A., Brown, C. H., & Mohr, D. C. (2020). Implementation strategies for digital mental health interventions in health care settings. The American psychologist, 75(8), 1080–1092. https://doi.org/10.1037/amp0000686