The importance of promoting mental health and providing timely evidence-based care for people suffering from mental health conditions has perhaps never been so well recognized. Along with its many unprecedented challenges, the emotional toll of the COVID-19 pandemic has raised awareness about psychological distress and has catalyzed open discussions about mental health and well-being globally. The pandemic has also accelerated the use of e-mental health technologies for mental health promotion, prevention, screening, treatment and support. The potential for e-mental health to improve the availability and accessibility of mental health supports is increasingly recognized. At the same time, the risk of exacerbating inequities in mental health care access among the most vulnerable populations due to persistent digital technology barriers cannot be ignored.
Collaboration across sectors and jurisdictions is essential to promote equitable access to evidence-based and appropriate DMH supports. The APEC Digital Hub for Mental Health (‘the Digital Hub’) has been working collaboratively with diverse stakeholders- including researchers, policy makers, clinicians and people with lived and living experience of mental health conditions (PWLE)- to support improved mental health and well-being of populations across the Asia Pacific region since 2017. In the wake of the COVID-19 pandemic, the Digital Hub is particularly committed to collaborative research and knowledge exchange initiatives that explicitly promote equitable access to DMH supports among the most vulnerable populations in the region.
The APEC Digital Hub for Mental Health-Who are we and what do we do?
The Digital Hub acts as the coordinating centre for mental health in the Asia Pacific Economic Cooperation (APEC) region. APEC is a multilateral forum made up of 21 ‘member economies’, which promotes sustainable economic growth across the Asia Pacific region. APEC recognizes that mental health and well-being are essential for economic prosperity, and endorsed a 2014-2020 APEC Roadmap to Promote Mental Wellness in a Healthy Asia Pacific which laid out goals and objectives that aligned with the World Health Organization’s 2013-2020 Mental Health Action Plan.
The 2014-2020 Roadmap included as a goal the creation of a digital platform that would act as the administrative hub for APEC’s mental health initiatives, leading to the creation the Digital Hub. We are hosted in Canada at the University of British Columbia (UBC) in partnership with the University of Alberta (UofA) and the Canadian Network of Mood and Anxiety Treatments (CANMAT), with core partners in twelve APEC economies. The Digital Hub is a network of stakeholders representing researchers, healthcare providers, policy makers and PWLE from across the region with the goal of “strengthen[ing] the mental health and wellbeing of individuals and communities across the Asia Pacific region in support of economic growth”.
Since its inception, the Digital Hub has led initiatives, in collaboration with partners across the region, on priority areas including: the integration of mental health into primary care and community-based settings; workplace mental health and well-being; and data collection and standardization. We also drafted, in partnership with representatives of APEC member economies, the 2021-2030 Roadmap to Promote Mental Wellbeing in a Healthy Asia Pacific, which was endorsed by APEC fora in 2021.
Collaborative Research to Promote Equitable e-Mental Health Access in the Asia Pacific
Collaborative research to inform evidence-based mental health policy and practice is a key priority of the Digital Hub. In recent years we have been undertaking research related to two broad challenges in the field of e-mental health. The first is equitable access to e-mental health technologies in the context of the pandemic. We recognize the substantial opportunities that e-mental health technologies offer for improving availability and access to evidence-based mental health supports that do not rely on face-to-face interactions. They hold great promise to help overcome barriers related to geographic proximity to mental health services, insufficient availability of mental health human resources, and long wait times, to name only a few. But we also recognize that e-mental health may also present barriers, particularly for people who are vulnerable or experience marginalization. The digital divide means that not everyone has ready access to digital devices or reliable Internet connections. People living in rural or remote locations, houseless people and people with low socioeconomic status, for example, may be excluded from e-mental health interventions. Digital literacy may also be a barrier for some populations including seniors. E-mental health may not offer appropriate care for ethnocultural minorities, Indigenous populations or other groups that experience marginalization like LGBTQ+ communities. People with disabilities may face barriers if e-mental health technologies are not designed to be accessible.
With the pandemic as a catalyst, we have been undertaking research to understand barriers to equitable e-mental health access and to generate recommendations to promote equity as e-mental health becomes more widespread across health systems. In 2020-2021 we undertook a research study to understand, based on the perspectives of policy makers, PWLE, clinicians and others from across the Asia Pacific, priorities related to equitable e-mental health access. Results will be published later this year.
We’re also leading knowledge exchange activities to raise awareness among the general public about this topic. As part of our Research for Equitable Mental Health in the Asia Pacific-Digital (REMAP-D) research initiative, we are developing, in collaboration with an International Lived Experience Advisory Panel (I-LEAP), a series of interactive online learning modules, hosted on UBC’s innovative Tapestry platform, that present high-level overviews about topics like Global Mental Health, Digital Mental Health Equity, and the Mental Health Impact of COVID-19. Stay tuned for the launch of these modules in late summer 2023.
Our second priority research area is Implementation Science to improve uptake and availability of evidence-based e-mental health interventions. Making sure that research evidence is actually applied in real world settings by policy makers, clinicians and others is a longstanding challenge in health research. Implementation Science is a discipline that studies the processes that lead to uptake and sustainability of evidence-based policy and practice, with an ultimate goal of improving health outcomes. The Digital Hub is leading two Implementation Science studies that aim to improve access to evidence-based e-mental health supports in Asian countries. The first, Enhanced Measurement-based Care Effectiveness for Depression (EMBED) is a partnership between Canada and China. In EMBED, we are testing the implementation of a technology enhanced measurement-based care depression intervention in mental health centres in Shanghai. Measurement-based care for depression is evidence-based but is rarely used in clinical settings. It involves routine use of outcome measures by patients and their doctors to assess changes in depression symptoms as well as functional impairment, quality of life and medication side effects. EMBED is testing whether using e-mental health via WeChat (instead of paper and pencil measures) will help promote the implementation of eMBC. The EMBED study is currently taking place and we expect to have results in 2024.
A second Implementation Science study is Youth Promotion of Resilience Involving e-Health (Y-PRIME). Y-PRIME is a new study, launching in the summer 2023, which involves co-designing with youth in Vietnam an app to promote mental health and well-being among secondary school students. This app will help to fill an urgent gap in mental health promotion, prevention and support for youth mental health in Vietnam, where youth have a high risk of poor mental health with very few available resources. A key feature of Y-PRIME is working with a Youth Advisory Council made up of Vietnamese youth who will collaborate on the content and design of the app and will help make sure that the intervention responds to the specific needs of young people in Vietnam. The study will test the implementation of this app with a view to scaling it up throughout Vietnam.
Collaboration is Essential for Impact
The Digital Hub, at its core, is about collaboration. Addressing complex challenges requires the perspectives and buy-in of diverse stakeholders. For example, we took a collaborative approach to the development of the 2021-2030 Roadmap which began with a Roundtable conference hosted by our partners at Singapore’s Institute of Mental Health in 2019. This provided an opportunity for Digital Hub members from across the region- representing government, research, clinical practice and communities- to come together to develop a vision for the next decade of the Digital Hub’s work. The results of this collaborative consultation directly informed the 2021-2030 Roadmap.
We also recognize that it is essential to engage with PWLE in all aspects of our work. The perspectives of PWLE are fundamental to ensuring that e-mental health research and policy are responsive to the needs of the people who ultimately should benefit from them. As mentioned above, under our REMAP-D initiative, we convened an International Lived Experience Advisory Panel (I-LEAP) which collaborates on all of our activities, including co-designing our upcoming learning modules. The Y-PRIME study will also engage youth through all stages of the project. When working towards equity in the e-mental health space, it is also essential that diversity be prioritized in the engagement of PWLE. Representatives from ethnocultural minority communities and other communities that experience marginalization are frequently not included in research and design for e-mental health. Specific efforts to ensure that diverse PWLE are able to fully participate in a way that promotes their safety, fairly compensates them for their participation, and truly values their perspectives are essential in all efforts to advance e-mental health policy and practice.
Finally, equitable e-mental health access will not be advanced without innovative governance structures that support the implementation of best practice for e-mental health within health systems. The Digital Hub works with policy makers across the region who are leading efforts to strengthen mental health systems, including through e-mental health initiatives. Engaging policy makers and identifying champions within health systems can help to advance e-mental health infrastructure. The lessons learned from the pandemic have created a substantial window of opportunity to advance equitable access to e-mental health, and e-mental health policy initiatives- including the development and implementation of guidelines and frameworks- must consider the promotion of equitable access as a core principle.
What’s Next?
Along with the initiatives described above, the Digital Hub will be hosting an online forum on e-mental health equity in the Asia Pacific in the fall of 2023. This forum will include researchers, policy makers, PWLE, students and others from across the Asia Pacific region who will share initiatives and lessons learned related to a broad range of e-mental health and equity initiatives.
Keep an eye out for more information in the coming weeks by following us on Twitter at: @APEC_MHHub.
To learn more about the Digital Hub and to get involved, contact Dr. Jill Murphy at jill.murphy@ubc.ca.
