As more mental health and wellbeing services and supports are delivered digitally, Gregor Henderson asks the sector what is being done to safeguard and support people at risk, in crisis or in distress online.



The rise of digital mental health


Digital mental health services are growing in number and complexity. More services and supports are being delivered and commissioned online and the global pandemic has seen digital mental health services come more to the fore as both complements to and alternatives to more traditional face to face mental health services and supports.


There is no doubt that the further development of digital tools and services has been a welcome development not least to help mitigate some of the impact on more traditional service provision caused by the pandemic. Such online tools and services will continue to be needed to meet need 24/7, augment and enhance existing services, support capacity and reach those populations under-served by more traditional service models.


Digital technology does not simply replicate offline service models. While 1-2-1 talking therapies and structured CBT courses have been moving into online spaces via video and chat functionality, a range of digital services such as clinically moderated platforms, online peer community services, mental wellbeing apps and others are now emerging, offering everything from moderated support, peer support, mood tracking, to engaging content and curated self-directed care and support. With this wide range of options, care is needed in choosing an online service and support provider.


Choice is good. Informed choice is critical.


There are benefits to the choice that is starting to become available, especially in terms of population health care and support, early intervention, prevention and promotion of good mental health. Such tools also deliver experiences in a way people have become more accustomed to, and many now actively seek out online support as a first port of call and as a way of augmenting other supports and care they receive and use.


While choice is good, what has always been vital in clinically approved models has been appropriate assessment of individual needs and the delivery of appropriate services to match those needs. We must especially look at the needs of people who are, or may be, at risk, in distress or experiencing a period of crisis while they use a digital platform. This is critical to good, effective and safe online support We go to great lengths to protect personal data online, but we must also go further to protect people who may be or who are vulnerable.


Commitment to and a pursuit of the values of safe and effective care online are needed to ensure the quality, efficacy and safety of what is on offer online. Online services need to provide people with the knowledge and skills to make informed choices about how digital mental health services operate. This needs to include considerations of how they manage risk and crisis online.


Responsibilities for digital mental health service providers


When we look at the services available online, the situation is mixed. There does not appear to be any clear legal requirement on digital mental health providers in respect of their approach to risk escalation and responding to and managing crisis online. This is a gap in current legislation and regulation, and those using digital services are reliant on providers to voluntarily put policies and processes in place. Providers vary in their approach and consistency to this.


This also raises questions about where liability lies when services fall short of an expected response and a person suffers harm or inflicts harm in their distress. This is becoming a central concern for commissioners of digital mental health services. Responsible commissioners work with providers to ensure that any service they commission can assure them that they have policies and processes in place for risk management, crisis and escalation.


Get the discussion paper


To help contribute to this important issue of risk escalation and managing crisis on a digital platform, Togetherall commissioned myself and my colleague Steve Appleton to look into this issue further. We explored the problems and highlight emerging practice in the UK and internationally that attempt to deal with risk and crisis online.

With our discussion paper, we hope to inform the wider digital mental health system, commissioners of digital mental health services, Governments and regulators of the current landscape, its gaps and the opportunities that present themselves to get this right. We aim to stimulate sector-wide discussion and debate on the legal, quality, risk and moral drivers of having risk escalation policies and processes in place for digital mental health services and mental health platforms.


You can get a free digital copy of our paper, by clicking here.



Gregor Henderson is an independent consultant and advisor on mental health and served as Director for Mental Health and Wellbeing for Public Health England from 2013-2021. He is a board member of the eMental Health International Collaborative and an active member of the International Initiative for Mental Health Leadership. He works in an advisory capacity with Togetherall.