Integrating digital technologies with clinical practice promises to improve access and enhance care in the context of high service demand and constrained capacity.
Method
We outline the emerging research in the integration of digital tools in clinical care, known as blended care, and provide case examples of mental health technology platforms currently in use, summarise findings regarding novel technologies such as virtual reality, and outline real-world implementation challenges and potential solutions.
Results
Recent evidence shows that blended care approaches are clinically effective and improve service efficiency. Youth-specific technologies such as moderated online social therapy (MOST) are achieving a range of positive clinical and functional outcomes, while emerging technologies like virtual reality have strong evidence in anxiety disorder, and accumulating evidence in psychotic conditions. Implementation science frameworks show promise in helping overcome the common challenges faced in real-world adoption and ongoing use.
Conclusion
The integrated, blended use of digital mental health technologies with face-to-face clinical care has the potential to improve care quality for young people while helping overcome the growing challenges faced by youth mental health service providers.
McGorryPDMeiCChanenA, et al.Designing and scaling up integrated youth mental health care. World Psychiatry2022; 21: 61–76.
2.
GleesonJFRiperHAlvarez-JimenezM. Transforming youth mental health treatment through digital technology. Front Psychiatry2020; 11: 606433.
3.
NicholasJBellIHThompsonA, et al.Implementation lessons from the transition to telehealth during COVID-19: a survey of clinicians and young people from youth mental health services. Psychiatry Res2021; 299: 113848.
4.
BellIHThompsonAValentineL, et al.Ownership, use of, and interest in digital mental health technologies among clinicians and young people across a spectrum of clinical care needs: cross-sectional survey. JMIR Ment Health2022; 9: e30716.
5.
WentzelJvan der VaartRBohlmeijerET, et al.Mixing online and face-to-face therapy: how to benefit from blended care in mental health care. JMIR Ment Health2016; 3: e9.
6.
ErbeDEichertH-CRiperH, et al.Blending face-to-face and internet-based interventions for the treatment of mental disorders in adults: systematic review. J Med Internet Res2017; 19: e306.
7.
NewbyJMasonEKladnistkiN, et al.Integrating internet CBT into clinical practice: a practical guide for clinicians. Clin Psychol2021; 25: 164–178.
8.
RasingSPAStikkelbroekYAJDen HollanderW, et al.Pragmatic quasi-experimental controlled trial evaluating the outcomes of blended CBT compared to face-to-face CBT and treatment as usual for adolescents with depressive disorders. Int J Environ Res Public Health2021; 18: 3102.
9.
Alvarez‐JimenezMKovalPSchmaalL, et al.The Horyzons project: a randomized controlled trial of a novel online social therapy to maintain treatment effects from specialist first‐episode psychosis services. World Psychiatry2021; 20: 233–243.
10.
Alvarez-JimenezMGleesonJFBendallS, et al.Enhancing social functioning in young people at ultra high risk (UHR) for psychosis: a pilot study of a novel strengths and mindfulness-based online social therapy. Schizophr Res2018; 202: 369–377.
11.
RiceSGleesonJDaveyC, et al.Moderated online social therapy for depression relapse prevention in young people: pilot study of a ‘next generation’online intervention. Early Interv Psychiatry2018; 12: 613–625.
12.
Alvarez-JimenezMRiceSD'AlfonsoS, et al.A novel multimodal digital service (moderated online social therapy+) for help-seeking young people experiencing mental ill-health: pilot evaluation within a national youth e-mental health service. J Med Internet Res2020; 22: e17155.
13.
GleesonJLedermanRKovalP, et al.Moderated online social therapy: a model for reducing stress in carers of young people diagnosed with mental health disorders. Front Psychol2017; 8: 485.
14.
BellIHNicholasJAlvarez-JimenezM, et al.Virtual reality as a clinical tool in mental health research and practice. Dialogues Clin Neurosci2022; 22: 169–177.
15.
JahnFSSkovbyeMObenhausenK, et al.Cognitive training with fully immersive virtual reality in patients with neurological and psychiatric disorders: a systematic review of randomized controlled trials. Psychiatry Res2021; 300: 113928.
16.
Rus-CalafellMGaretyPSasonE, et al.Virtual reality in the assessment and treatment of psychosis: a systematic review of its utility, acceptability and effectiveness. Psychol Med2018; 48: 362–391.
17.
ThompsonAElahiFRealpeA, et al.A feasibility and acceptability trial of social cognitive therapy in early psychosis delivered through a virtual world: the VEEP study. Front Psychiatry2020; 11: 219.
18.
FisherAJBoswellJF. Enhancing the personalization of psychotherapy with dynamic assessment and modeling. Assessment2016; 23: 496–506.
19.
BellIHRossellSLFarhallJ, et al.Pilot randomised controlled trial of a brief coping-focused intervention for hearing voices blended with smartphone-based ecological momentary assessment and intervention (SAVVy): feasibility, acceptability and preliminary clinical outcomes. Schizophr Res2020; 216: 479–487.
20.
BickmanL. Improving mental health services: a 50-year journey from randomized experiments to artificial intelligence and precision mental health. Adm Policy Ment Health2020; 47: 795–843. DOI: 10.1007/s10488-020-01065-8.
21.
CrossSPiperSDMiltonA, et al.Implementation and evaluation of a prototypic mental health e-clinic in youth mental health services and its impact on service quality. Med J Aust2019; 211: S30–S36.
22.
GrahamAKLattieEGPowellBJ, et al.Implementation strategies for digital mental health interventions in health care settings. Am Psychol2020; 75: 1080–1092.
23.
TaylorMJMcNicholasCNicolayC, et al.Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Qual Saf2014; 23: 290–298.
24.
DamschroderLJReardonCMWiderquistMAO, et al.The updated consolidated framework for implementation research based on user feedback. Implement Sci2022; 17: 1–16.
25.
TeixeiraPJMarquesMMSilvaMN, et al.A classification of motivation and behavior change techniques used in self-determination theory-based interventions in health contexts. Motiv Sci2020; 6: 438–455.
