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The future of digital mental health in the post-pandemic world: Evidence-based, blended, responsive and implementable

Australian & New Zealand Journal of Psychiatry, 56(2) Much has been written about the challenges and opportunities for digital mental health brought about by COVID-19. Indeed, the pandemic has led to one of the biggest surges in uptake of digital health interventions, although not always by choice. Yet, this has also been a time of anxiety and there is an undeniable desire to return to our old lives and old ways of working. Hence, it may be an opportune moment to examine the role of digital health interventions in the near future. Overall, the dramatic changes in how we have delivered care over the last 2 years has increased comfort with technology for many clinicians and patients, at least with telehealth. However, digital interventions are far more than the use of telehealth and recommendations of online information sources. For many mental health clinicians in Australia and New Zealand, digital health care already includes online psychological therapies, apps for tracking mood, shared decision-making tools and ‘smart’ medical record systems that prompt guideline concordance. The World Health Organization classifies the broad array of Digital Interventions for Health into those for clients, healthcare providers, health system managers and data services (World Health Organization, 2018). Here, we primarily examine digital health services in reference to those used for, or with clients, although the other aspects of digital interventions are equally important in implementing and maintaining client-facing interventions. Digital intervention tools are already commonplace in the self-management of general mental health, and in the clinical care for people with both chronic physical and mental ill-health. This is not surprising given the ubiquitous permeation of digital technologies in most people’s lives in the developed world today. Policy makers have also recognised the need to leverage digital technologies as highlighted by the 2021 Australian Parliamentary report into Mental Health and Suicide Prevention and the 2019 New Zealand Digital Health Strategic Framework. This is at least partly because of the immense workforce shortages in mental health across Australia and New Zealand. When effective, the interventions can decrease the time required of clinicians to deliver care. Highly skilled clinicians can spend their valuable time delivering care that is reliant on the human interaction, rather than routine tasks which do not do justice to their training and experience. Technology in this instance can be an effective ally rather than a feared foe from a dystopian future. In the future, digital interventions may play an even greater role as technology evolves along with our understanding of mental disorders. Engaging new mechanisms of brain function, cognitive mechanisms and behavioural change through contemporaneous interactions with technologies hold promise for several mental health conditions. For example, core mechanisms such as ruminations can be engaged in real time with promotion of behavioural strategies to counter them. This could be combined with the data gathering ability of commercial wearable devices to deliver interventions concurrently. More nuanced phenotyping made possible by such devices could also tailor or even personalise interventions by targeting subgroups where interventions are effective. These mechanisms are impossible without digital technologies due to the pragmatic limitations of the current clinician-patient interaction. Advances in artificial intelligence (AI) and improved access to technologies could also lead to greater use of virtual reality, chatbots and other emerging applications. Against these possibilities, we propose some principles for adopting digital interventions in the immediate future beyond telehealth and COVID19. We propose that