Digital Mental Health for Young People: A Scoping Review of Ethical Promises and Challenges

Abstract

Mental health disorders are complex disorders of the nervous system characterized by a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Mental illness is of particular concern for younger people. The WHO estimates that around 20% of the world's children and adolescents have a mental health condition, a rate that is almost double compared to the general population. One approach toward mitigating the medical and socio-economic effects of mental health disorders is leveraging the power of digital health technology to deploy assistive, preventative, and therapeutic solutions for people in need. We define “digital mental health” as any application of digital health technology for mental health assessment, support, prevention, and treatment. However, there is only limited evidence that digital mental health tools can be successfully implemented in clinical settings. Authors have pointed to a lack of technical and medical standards for digital mental health apps, personalized neurotechnology, and assistive cognitive technology as a possible cause of suboptimal adoption and implementation in the clinical setting. Further, ethical concerns have been raised related to insufficient effectiveness, lack of adequate clinical validation, and user-centered design as well as data privacy vulnerabilities of current digital mental health products. The aim of this paper is to report on a scoping review we conducted to capture and synthesize the growing literature on the promises and ethical challenges of digital mental health for young people aged 0–25. This review seeks to survey the scope and focus of the relevant literature, identify major benefits and opportunities of ethical significance (e.g., reducing suffering and improving well-being), and provide a comprehensive mapping of the emerging ethical challenges. Our findings provide a comprehensive synthesis of the current literature and offer a detailed informative basis for any stakeholder involved in the development, deployment, and management of ethically-aligned digital mental health solutions for young people.

Digital Mental Health Amid COVID-19

“…There is a need for rapidly deploying and efficiently integrating effective and evaluated digital solutions for users at individual, organizational, and governmental levels [6,[18][19][20]. However, there are hindering issues in enacting a hybrid model of care e.g., the quality of digital mental health solutions needs to be better discerned and there is a need for more studies with vulnerable and at-risk populations [18].…”

“…There are a range of digital mental health interventions available for various mental health needs and conditions, from substance abuse recovery to suicide prevention [23]. Stronger evidence and new models of care will be necessary for higher accessibility, equity, and successful clinical implementation [5,20,24,25]. Predictive technologies (e.g., real-time machine learning algorithms) are useful for monitoring but should be deployed carefully as decision support tools [20,25,26].…”

“…Stronger evidence and new models of care will be necessary for higher accessibility, equity, and successful clinical implementation [5,20,24,25]. Predictive technologies (e.g., real-time machine learning algorithms) are useful for monitoring but should be deployed carefully as decision support tools [20,25,26]. On an operations level, there is the issue of integrating technology into mental health care delivery for diverse populations.…”

“…The adoption of digital tools has been hindered at the organizational and policy level-user-friendly workflows, decision models and protocols have been offered as solutions [19,28]. Suitable information, training, infrastructure, clinical guidelines, and policies may counter excessive information/workloads, ambiguous policies, mixed implementation, and a struggle to maintain systems [19,20].…”

“…Digital mental health interventions are assisting the facilitation of therapy, prediction, and prevention of mental ill-health [37,38,[42][43][44]. The COVID-19 pandemic heightened the need to counter the medical and socio-economic effects of mental ill-health via deployment of assistive, preventative, and therapeutic solutions (e.g., internet-based data collection tools, digital platforms and apps) [13,20,45,46]. A multimethod study developed a codesigned freely available resource guide that builds on existing evidence on digital mental health tools [46].…”