The HSE is delighted to recently partner with eMHIC and looks forward to future collaborations and shared initiatives with countries leading and growing their digital mental health supports and innovations.
The HSE is Ireland’s public health service providing health and social care services delivered through a number of National Service Delivery Divisions, which include; acute hospitals, social care, mental health, primary care, health and wellbeing and the national ambulance service.
The HSE Mental Health Division has responsibility for all mental health services, including the promotion of positive mental health, to supporting those experiencing severe and disabling mental health difficulties.
Mental Health Services in the HSE
Mental health services are integrated with primary care, acute hospitals, services for older people, services for people with disabilities and with a wide range of non-health sector partners. Mental health services provide specialised secondary care services for children and adolescents, adults and older persons. The National Office for Suicide Prevention (NOSP) is an integral part of the Mental Health Division and, through its coordinating work delivers on the actions arising from the Connecting for Life, Ireland’s national strategy to reduce suicide 2015-2020, and Implementation Policy Plan 2015-2024.
Specialist secondary care mental health services are provided to respond to an individual’s varied and complex clinical need. The mental health services include Community Health Organisation (CHO) based Mental Health Services which comprise, acute inpatient units, community based mental health teams (Child and Adolescent Mental Health, General Adult, MHID and Psychiatry of Old Age etc), day hospitals, out-patient clinics, continuing care settings and community residential services. There is also the National Forensic Mental Health Service and National Counselling Service. Within the main specialties, certain sub-specialities including rehabilitation and recovery, liaison psychiatry, and perinatal psychiatry are provided. The community-based mental health services are coordinated and delivered through Community Mental Health Teams (CMHTs), which are designed to serve the needs of particular care groups across the lifespan from childhood to later life.
HSE Mental Health Engagement and Recovery (MHER)
The MHER office supports the development and improvement of mental health services in the HSE. A main function of this division is to incorporate lived experience in the design, delivery and evaluation of services and to empower service users, their families and carers in their own recovery.
Digital Mental Health
The HSE Mental Health Operations’ team, led by Mr Derek Chambers, General Manager, Policy Implementation, has pioneered digital mental health in the HSE since 2018, and works closely with funded community and voluntary sector partners, who are largely responsible for the delivery of digital mental health in Ireland. During the COVID-19 pandemic, scaling up of many services, such as video enabled psychology support, free digital cognitive behavioural therapy, occurred at great speed, and many community and voluntary sector partners met large scale public demand for such services.
The HSE’s strategic approach to digital mental health is underpinned by Sharing the Vision’s – A Mental Health Policy For Everyone 2020-2030, and the associated Implementation Plan 2022-2024. The Implementation Plan, specifically recommendations 2 and 31, advocates for the use of digital solutions to promote and support mental health.
Sharing the Vision Recommendations 2 & 31
- Recommendation 2 – Evidence-based digital and social media channels should be used to the maximum to promote mental health and to provide appropriate signposting to services and supports.
- Recommendation 31 – Develop the potential for digital health solutions to enhance service delivery and empower service users
HSE Mental Health Operations established a Digital Mental Health Specialist Group in 2022, to drive and implement recommendations 2 and 31 of Sharing the Vision, which identify digital solutions to promote and support mental health. The main output of this Specialist Group is the development of a HSE Digital Mental Health Action Plan, which identifies actions and priorities for HSE Digital Mental Health over an 18-month period. A more detailed ambitious longer-term digital mental health strategy to cover the period 2024-2030 will follow.
Current digital mental health supports in the HSE
The HSE endorses a layered care model for the provision of digital mental health support (see figure 1), based on individuals’ needs and advocates for the most effective, yet least intensive support first i.e., from level 1 to 3, i.e. health promotion and information, self-help and person-to-person supports (the provision of listening and text services or peer to peer supports), with stepping up to more intensive and specialist services, such as therapy, in level 4 and 5, if required. Individuals can also step back to lower levels; a decision made by them and their clinician. The HSE, along with its funded partners provide information, supports and services across the model of care. While it’s not possible to document the full range of mental health supports and services available in Ireland, an overview and highlights of some services will be provided.
HSE digital initiatives
The HSE provides a range of digital initiatives from online mental health information, promotion and prevention, online person to person supports, to the clinically supported community and primary care health supports providing video enabled consultations. Some of these initiatives include:
Yourmentalhealth.ie
The HSE’s dedicated website yourmentalhealth.ie provides information and resources to support mental health promotion and prevention, mental health difficulties, with signposting to more specialist supports and services. HSE Digital continues to reconfigure the website to enable users to find bespoke content seamlessly on the website.
My Mental Health Plan
The HSE is currently developing an online interactive tool to help support and improve mental health and self-care. My Mental Health Plan will be available on yourmentalhealth.ie in 2024 and will provide more tailored and personalised content on stress, anxiety, low mood and sleep and sign-post to further support, if required.
Online self-directed programmes
The HSE’s online Minding Your Wellbeing programme supports positive mental health and is available through a series of five videos on yourmentalhealth.ie, featuring information on self-care, thoughts, emotions, resilience and building positive relationships.
The HSE is currently developing a Balancing Stress online self-directed programme, which will provide information and practical skills to manage stress and will be freely available to the population from 2024. This replaces the current Stress control programme.
Mental Health Literacy campaign
A public awareness campaign ‘making the connections’ developed to increase population mental health literacy, was launched on World Mental Health Day, October 10th 2022. This iterative campaign aimed at adults 18+, with a multitude of digital promotion, aims to support people to recognise the signs of common mental health difficulties of ongoing stress, anxiety, low mood and sleep problems by directing them to yourmentalhealth.ie
Post campaign awareness research conducted in June 2023 of 1,000 adults in Ireland shows:
- 85% believe it is important to communicate about common mental health difficulties
- 9 in 10 see messages as clear, informative and trustworthy
- GP is the first port of call for help. Just under 1 in 2 would visit yourmentalhealth.ie. The same amount of people said they would deal with the issue themselves.
Online Cognitive Behavioural Therapy
The HSE offers guided digital Cognitive Behavioural Therapy for the treatment of anxiety and depression delivered by SilverCloud by Amwell. Since the pilot programme roll-out in April 2021, and national scale up in April 2023, to date over 13,000 individuals completed guided online programmes . Referrals to this service are from GPs, Primary Care Psychology, National Counselling Service, Community Mental Health Teams and Jigsaw (a funded partner in the voluntary sector, providing a primary care level mental health service to young people aged 12 to 25 years)
A recent report (August 2023) demonstrates:
- 90% of referrals are from GPs
- The most used programmes are, Anxiety Programme (50%), Depression and Anxiety (29%) and Depression (18%).
- The average activation rate is 68%. Counselling in Primary Care and Primary Care Psychology have the highest activation rates at 69% and 68% respectively, with GPs at 67%.
- The majority of users are female (72%), white Irish (86%) and aged between 18-44 years (76%).
- Users spend average 4.9 hours on platform and receive an average of seven supporter views.
- 49% of those in moderate to severe ranges (clinical ranges of depression) show reliable improvement in their depression.
- 59% of those in the moderate to severe ranges (clinical levels of anxiety) show reliable improvement in their anxiety symptoms
The HSE is delighted to receive national recognition for the delivery of this evidence-based guided digital Cognitive Behavioural Programme and has recently been awarded for HealthTech Innovation of the Year, at the Public Sector Digital Transformation Awards and Most Transformative Impact Digital Health at the National Health Tech Innovation Awards.
Peer to peer support in higher education institutions
Togetherall, a clinically moderated 24/7 peer support digital platform for mental health launched 2022 in Ireland, in partnership with the Psychological Counsellors in Higher Education Ireland (PCHEI). The HSE jointly funds the programme, together with the Higher Education Authority. Available in fourteen Higher Education Institutions, this platform provides an online space for safe and anonymous peer support, moderated by mental health professionals and led by an on-duty clinician. An analysis of user feedback in Ireland found 62% of students say Togetherall is their only form of formal support, 35% said they had considered suicide prior to joining and 34% required a 1:1 intervention with a Togetherall clinician.
Working in partnership
The HSE provides funding to community and voluntary sector organisations who provide a broad choice of digital mental health supports to children, young people and adults through online supported counselling, text-based supports, crises help lines, digital self-directed and supported and cognitive behavioural supports. This partnership approach provides supports the layered model of care and allows individuals to choose the best care which is client driven.
In 2018, the HSE partnered with Spun out to develop Text about it , which provides emotional support to anyone experiencing a crisis, through engagement in a text message ‘conversation’ with a trained and supervised volunteer. On average, there are over 4,000 conversations per month.
Jigsaw, a partner in the voluntary sector, provides a primary care level mental health service to young people aged 12 to 25 years, through one-to-one online clinician support, group chats and psychoeducation.
A vision for the future
The HSE through its planned Digital Mental Health Strategy 2024-2030, endeavours to embed and grow digital mental health in HSE mental health, developing services which are client-based and meeting the demands of the population who require such support. Through the HSE Digital Mental Health Specialist Group, a team of clinicians, academics and policy makers is collaborating, sharing knowledge and expertise to ensure standards of care and best operational procedures are met. The HSE MHER office works closely with HSE Mental Health Operations to ensure those with lived experience have a voice in our services and policies.
The HSE plans to collaborate and work closely with eMHIC to gain practical knowledge of new and emerging digital mental innovations to ensure the best mental health outcomes for all.
