Building the Digital Mental Health Ecosystem: Opportunities and Challenges for Mobile Health Innovators

Abstract

Digital mental health technologies such as mobile health (mHealth) tools can offer innovative ways to help develop and facilitate mental health care provision, with the COVID-19 pandemic acting as a pivot point for digital health implementation. This viewpoint offers an overview of the opportunities and challenges mHealth innovators must navigate to create an integrated digital ecosystem for mental health care moving forward. Opportunities exist for innovators to develop tools that can collect a vast range of active and passive patient and transdiagnostic symptom data. Moving away from a symptom-count approach to a transdiagnostic view of psychopathology has the potential to facilitate early and accurate diagnosis, and can further enable personalized treatment strategies. However, the uptake of these technologies critically depends on the perceived relevance and engagement of end users. To this end, behavior theories and codesigning approaches offer opportunities to identify behavioral drivers and address barriers to uptake, while ensuring that products meet users’ needs and preferences. The agenda for innovators should also include building strong evidence-based cases for digital mental health, moving away from a one-size-fits-all well-being approach to embrace the development of comprehensive digital diagnostics and validated digital tools. In particular, innovators have the opportunity to make their clinical evaluations more insightful by assessing effectiveness and feasibility in the intended context of use. Finally, innovators should adhere to standardized evaluation frameworks introduced by regulators and health care providers, as this can facilitate transparency and guide health care professionals toward clinically safe and effective technologies. By laying these foundations, digital services can become integrated into clinical practice, thus facilitating deeper technology-enabled changes.

Digital health technologies and major depressive disorder

“…128 Efforts to develop treatment strategies for MDD and other psychiatric indications by combining pharmacologic therapies (eg, ADTs) with digital therapeutics (eg, mobile medical apps, which are medical devices approved/cleared by the FDA or conformed with the Medical Device Regulation (MDR [EU]) 2017/745 129 ) are ongoing, 130,131 and there are opportunities to create integrated digital health ecosystems for the treatment of MDD. 132 Behavior theories such as the health belief model, the behavioral intervention technology model, and the just-in-time adaptive intervention (JITAI) model can help developers evaluate the feasibility of digital mental health services. For example, JITAI is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual's changing internal and contextual state and impact on patient-reported outcomes (PROs).…”

mHealth Solutions for Mental Health Screening and Diagnosis: A Review of App User Perspectives Using Sentiment and Thematic Analysis

“…Thus, screening could also identify patients whose mental health could be managed with self-help strategies and do not require formal treatment ( 23 ). Screening could additionally reduce strain on primary care services ( 24 ) which is vital considering that, as of 2018, General Practitioners (GPs) report that 40% of appointments are related to mental health concerns ( 22 , 25 ). This could be accomplished via signposting to other services following mental health screening, as a case study conducted in a group of GP surgeries demonstrated that active signposting frees up 80 additional appointments per surgery each week ( 26 ).…”

“…Additionally, they can facilitate early identification of mental health disorders and support self-management ( 28 ). mHealth tools are convenient, instant, and scalable ( 24 , 29 ), as well as empowering individuals in managing their mental health ( 28 – 30 ), without the restrictions imposed by traditional mental health services (i.e., lack of access and long waiting times) ( 28 , 29 ). Apps can also aid in engaging typically hard-to-reach patient populations by reducing stigma and increasing help-seeking behaviors ( 30 ).…”

Developing, Co-Designing and Testing a New Approach in Digital Mental Health for Young Adolescents: Match Emoji, a Casual Video Game Adapted for Mental Health and Well-Being

“…As stated in Chapter Two, many DMHIs exist; however, few have been designed using a collaborative approach that includes target user feedback, academics, health professionals and research Spadaro et al, 2021). The lack of collaboration in the development of DMHIs may help explain the disappointing levels of engagement with these tools outside of trial settings.…”