Analysis of the Recomposition of Norms and Representations in the Field of Psychiatry and Mental Health in the Age of Electronic Mental Health: Qualitative Study

Abstract

BackgroundFor the World Health Organization, electronic health (eHealth) is seen as an effective way to improve therapeutic practices and disease prevention in health. Digital tools lead to major changes in the field of mental medicine, but specific analyses are required to understand and accompany these changes.ObjectiveOur objective was to highlight the positions of the different stakeholders of the mental health care system on eHealth services and tools, as well as to establish professional and user group profiles of these positions and the uses of these services.MethodsIn order to acquire the opinions and expectations of different categories of people, we carried out a qualitative study based on 10 focus groups (n=70, from 3-12 people per group) composed of: general practitioners, psychiatrists, psychologists, social workers, occupational therapists, nurses, caregivers, mental health services users, user representatives, and the general public. The analyses of focus group discussions were performed independently by four investigators through a common analysis grid. The constant comparative method was adopted within this framework.ResultsThe interviewees expressed different problems that new technologies engender in the field of mental health. What was previously strictly under the jurisdiction of physicians now tends to be fragmented and distributed over different groups and locations. New technologies reposition care in the field of domestic, rather than therapeutic, activities, and thus the conception of care as an autonomous activity in the subject’s life is questioned. The ideal of social autonomy through technology is part of the new logic of health democracy and empowerment, which is linked to a strong, contemporary aspiration to perform. Participants emphasized that there was the potential risk of a decrease in autonomy for the digitally engaged patient, while personal empowerment could become a set of obligations.ConclusionsThis qualitative research highlights the heterogeneity of opinions among the groups and within each group. It suggests that opinions on electronic mental health devices are still far from being stabilized, and that a change management process should be set up to both regulate the development and facilitate the use of these tools.

Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework

“…Engagement with digital technologies was influenced by emotional barriers such as feeling scrutinised [ 76 ], the perception of technologies as rigid and artificial [ 43 , 76 , 80 , 95 ], an unwillingness to spend additional time on technology after work [ 47 , 49 , 60 , 105 ], or feeling overwhelmed by the number of digital interventions available [ 41 , 55 , 58 , 101 , 104 ]. Improved access to care was broadly shown to facilitate implementation [ 41 , 50 , 56 ], with the most highly cited specific accessibility measures including flexibility and availability of digital technologies and resources when needed [ 39 , 40 , 46 , 47 , 49 , 54 , 56 , 60 , 75 , 78 , 85 , 88 , 97 , 98 , 100 , 103 ], and ease of integration into routine activities and places such as home or office [ 47 , 49 , 60 , 85 , 89 ]. Other facilitators included the ability to review materials and resources at a convenient time [ 49 ], reduced waiting times [ 37 , 54 , 74 , 94 ], reduced costs [ 61 , 84 ], enhanced choice of treatment delivery modalities [ 51 , 54 ], and providing an option for those who may not seek traditional face-to-face mental health care [ 74 ].…”

“…Absence of human interaction and non-verbal language, empathy, and impersonality has been cited as a barrier by both patients and providers [ 37 , 39 – 44 , 46 , 48 , 49 , 51 , 53 , 54 , 56 , 61 , 63 , 64 , 68 , 69 , 71 , 73 , 74 , 76 , 81 , 86 , 88 , 93 , 94 , 96 , 103 , 106 – 108 ]. As technology cannot fully replace human interactions for mental health care [ 40 , 49 , 90 , 97 ], some clinicians suggested that the most favourable place in therapy for digital interventions may be to complement and supplement face to face sessions [ 40 , 45 , 54 , 56 , 66 , 72 , 75 , 76 , 81 , 90 , 97 , 103 , 104 , 109 , 110 ], or to provide end of therapy support [ 67 , 100 ], rather than to substitute completely for traditional care.…”

Social Representations of e-Mental Health Among the Actors of the Health Care System: Free-Association Study

“…Data from the free-association task suggest a relative openness or at least a lack of aversion to the mental health of participants. The subsequent focus group discussions also point in this direction, but nevertheless highlighted fears linked to “dehumanization” or the replacement of humans by technological tools [ 17 ]. The peripheral elements are linked to the structural and organizational dimensions of e-mental health (ie, “structure of care,” “organization”).…”

“…The first part of the study, based on data collected in focus groups, revealed a heterogeneous and unstable definition of e-mental health with regard to the different groups of actors concerned as well as within each group [ 17 ]. The second part of the study, presented here, is based on the free-association task method.…”

“…Participants were recruited through announcements to various professional networks, peer support groups, user and carer representatives (mainly posted on their respective websites), and by word of mouth. The inclusion criteria were as follows: (1) belong to one of these 10 categories of actors, (2) speak the French language, (3) be of legal age, (4) The first part of the study, based on data collected in focus groups, revealed a heterogeneous and unstable definition of e-mental health with regard to the different groups of actors concerned as well as within each group [17]. The second part of the study, presented here, is based on the free-association task method.…”