Understanding Mental Health Professionals’ Perspectives and Practices Regarding the Implementation of Digital Mental Health: Qualitative Study

Key Messages:

Background

• Across the globe, various studies have been conducted to identify potential drivers of and barriers to digital mental health adoption (ie, acceptance, uptake, and use) and investigate mental health professionals’ attitudes toward such an approach. In general, findings suggest that professionals’ attitudes range from neutral to generally positive, and there are several factors affecting adoption.
• Although previous research provides valuable insight into the factors influencing the adoption of digital mental health by professionals, adoption predictors, and their interrelationships are largely unknown.

Study aim

• The aims of this study are (1) to characterize in depth the perspectives of mental health professionals regarding digital mental health, (2) to characterize in depth the practices of mental health professionals regarding the implementation of digital mental health, and (3) to explore the factors influencing such perspectives and practices in the context of Portugal.
• This qualitative study used in-depth semi-structured interviews to characterize the perspectives and practices of Portuguese mental health professionals regarding the implementation of digital mental health and explore the factors influencing such perspectives and practices.
• A … sample of Portuguese mental health professionals—psychologists and psychiatrists—was planned to capture variation and ensure the inclusion of participants in different age groups and work contexts; with different academic degrees and theoretical orientations; and reporting different levels of work experience, knowledge, and use of digital mental health.

Results

• Digital mental health is not addressed at Portuguese universities, being poorly disseminated in health care institutions and frequently limited to private practice and research organizations. As a result, the participants’ understanding of and experience in the field were dissimilar, ranging from sparse to significant and focalized to comprehensive
• After hearing about digital mental health from a peer, a conference presentation, or a client requesting to be followed remotely, most participants reacted to digital mental health with disquietude. Having received no formal training on digital mental health, participants presented ambivalent predispositions toward this practice.
• According to the participants, the delivery of digital mental health interventions should not be a simple transposition of the face-to-face model to the digital format. Appropriate implementations of digital mental health should comply with specific procedural and relational rules that should be clarified and negotiated with clients’ ad initium.
• In general, interviewees considered the administration of psychological instruments (standardized questionnaires, projective tests, etc) and clinical interviews digitally approachable. Nevertheless, they had reservations about the potential of remote observation and the possibility of performing an accurate and comprehensive psychological assessment using digital mediums.
• During the interviews, the “absence of evidence-based ready to use interventions” (P4) and the lack of accessible, secure, and comprehensive assessment and treatment tools were identified as the major factors affecting treatment delivery…Various participants recognized the lack of usability of existing tools and programs as an important implementation obstacle. Interventions’ “high complexity…” as well as the use of non-inclusive design approaches, were considered problematic because of the deleterious impact they could have on treatment adherence, outcome, and rapport.
• According to the participants, fostering the therapeutic alliance on the web required close monitoring of both the relational and technological dimensions of the therapeutic process.

Conclusions

• This study suggests that mental health professionals deemed important or engaged in the following practices while implementing digital mental health interventions: (1) indication evaluation, (2) therapeutic contract negotiation, (3) digital psychological assessment, (4) technology setup and management, and (5) intervention delivery and follow-up. Although these practices tend to unfold subsequently, they could also co-occur, overlap, be omitted, or assume a recursive nature depending on the purpose of the intervention, the selected treatment modality, and the drivers and barriers encountered along the implementation process.
• Digital mental health’s low-threshold accessibility and professionals’ perceived duty to provide support to their clients were identified as the main drivers facilitating implementation. Conversely, the lack of structured intervention frameworks; the unavailability of usable, validated, and affordable technology; and the absence of structured training programs negatively affected implemention
• To overcome the abovementioned barriers and expedite professionals’ adoption of digital mental health, the publication of legal, regulatory, and practice frameworks that can be easily transferred to practice seems necessary.
• Finally, to guarantee proper implementation of digital mental health, the design of training programs that are structured according to professionals’ most pressing needs and that are assessed, certified, and made widely available to professionals seems of high importance. To incentivize adoption, professionals must be trained in the implementation of digital mental health interventions and in managing the main barriers affecting it.