This workshop explored how digital mental health is being implemented and scaled-up in two countries in Europe. Presentations covered the barriers and facilitators to implementation based on national/regional strategies.
The webinar is one of EHTEL’s Imagining 2029 work programme series as part of its change management and capacity-building track. The webinar was organised by EHTEL in collaboration with the Digital Health Uptake project.
The session’s main emphasis was on what a healthcare system needs to do to encourage the use of digital mental health services or applications across an entire region or country. An early poll showed that 50% of the respondents believe digital mental health applications to already be used now in their region/country. Later discussions raised example experiences from e.g., Germany around medical devices.
The session results are to be used to inform the Digital Health Uptake policy brief on digital mental health which will be produced before the end of 2024. The session was moderated by EHTEL's Tino Marti and Sara Canella.
What did the speakers say?
The first half of the webinar/workshop consisted of two presentations. They were made on what is being done - in the autonomous region of Catalunya, Spain - and what has been done - in Scotland, United Kingdom - to scale-up the use of digital mental health.
The two speakers were:
Enrique Arroyo, Operative Director of the project eSalut Mental Catalunya & Hospital Universitari Parc TaulĂ
“Strategy and deployment of eSalut Mental Catalunya”
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Dawn Robb, Project manager at Digital Health and Care Scotland
“Digital Mental Health deployment in Scotland”
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Today, the numbers of people in Spain who do not receive satisfactory mental health support are considerable. Enrique Arroyo described an initiative that is at an early stage of development in Catalunya, with a focus on digital mental health. The collaboration is a public-private partnership. It is one of 18 transformation projects in the autonomous region. Its financing is supplied by Europe’s NextGen funds. He examined in detail the digital mental health solution that is being explored at his hospital, with the eventual intention to upscale the solution to other hospitals and the region as a whole. There are three solutions. They include a mobile app based on patient self-assessment, and a data platform that can provide digital therapies for low/medium-risk patients, and “passive monitoring” for high-risk patients. Today, 60 adults and 30 teenagers are testing the digital mental health app. The initiative faces up to five major barriers and challenges. Ultimately, expansion throughout Spain might need e.g., a long-term perspective, legislative or regulatory change, and financing over time. Mr. Arroyo’s concluding remarks: “We have a long way to go … let’s do it together!”
Scotland has put into practice digital mental health at scale, starting from earlier (video) telecare solutions like NearMe. Dawn Robb of Scotland’s National Health Service (NHS) outlined the kinds of areas of work that the country has implemented at scale. This has been achieved by using a “test and learn” approach and a distinct set of procedures, based on an improvement methodology. Eight challenges and several more mitigation approaches were outlined. Furthermore, 13 different enablers were cited. Since Scotland has 14 territorial NHS boards responsible for health and care, there are some variants in their approach to digital and to mental health. Ms Robb remarked that, ultimately, scale-up “takes time ... [and has used] a set-by-step approach.”
Overall, the speakers remarks cast light on the kinds of change management approaches to be taken when handling the digital transformation of mental health in a country/region. In relation to capacity-building, both speakers mentioned the kinds of training that health and care staff members may need in order to adopt the use of digital mental health applications in their work. Examples included guidelines for use, short videos, and easy-to-understand documentation.
What did the question-and-answer session offer?
The second half of the afternoon consisted of a comprehensive and detailed question-and-answer session. Around 15 questions were handled. Some questions were posed to both speakers; others to only one of the presenters. The wide-ranging questions are listed here according to various categories. They are simplified versions of the actual questions posed.
Systems development:
- What was the rationale to go for public procurement rather than in-house development?
- What would be/is your “dream team” of collaborators?
- Are any (future) research and development projects under consideration?
Facilitation:
- What “control knobs” would you activate (e.g., regulation, financing, payment(s), organisation, behavioural change)?
- What can you say more on “implementation knobs”?
- How did you do “rapid evaluation”?
- What were the experiences of e.g., the use of other best/good practices or pilots?
- What would you do/have done differently?
Scale-up:
- What scaling-up strategies were used?
- Can artificial intelligence (AI) help in the scale-up from application of the system/service from a small cohort of patients to a much larger volume of patients?
Use of the apps/solutions for treatment/care:
- What kinds of mental health screening tools are proposed?
- How is “mood monitoring” handled?
- Does the clinician or the app treat the patient?
- What about the use of medical devices to cope with mental health?
- Does the patient’s condition improve as a result of use of the app?
Healthcare professionals’ and carers’ experiences:
- Can more be said about resistance to developments on the part of health care professionals?
- How will clinicians cope when they are flooded by real-world data?
What’s next?
The content of this session will be used by the DigitalHealthUptake project to formulate a policy brief on the use of digital mental health. The brief will be circulated in draft format to session attendees in order to obtain feedback further feedback. The brief should be made public by the end of 2024.
What is the Digital Health Uptake project?
The Digital Health Uptake (DHU) project bridges the gap between virtual and physical health and care tools by coordinating activities between health stakeholders . The intention is to integrate digital solutions along the continuum of health and care.
DHU is facilitating the alignment of policies, strategies, instruments and activities to advance the uptake of digital health solutions and services in Europe.
What does EHTEL do in DigitalHealthUptake?
EHTEL leads DHU’s work on the acceleration of digital health solutions adoption and it co-leads activities on dissemination and communication in collaboration with other DHU partners. It identifies tools and methodologies to provide technical assistance and training so as to offer these to digital solutions’ implementers.
