Digital mental health programs are inexpensive and innovative. But do they work?

Almost half of Australians will experience mental health problems in their lifetime. Recent floods, droughts, cyclones, bushfires and the COVID pandemic have increased distress in the community.

Yet, many people who need mental health services are unable to access them. Cost, stigma and availability of mental health workers are barriers to care. Australia also has a critical shortage of mental health workers. And by 2030, it’s predicted we will be missing 42% of the mental health workforce needed to meet the demand.

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To partially address this gap, the Australian government has committed to investing A$135 million in digital mental health programs if re-elected.

Online mental health programs can be more innovative and less expensive than other types of therapy. But do they actually work? Let’s assess the evidence.

What are digital mental health services?

Digital mental health services vary widely. They include online or app-based mental health information, symptom tracking tools, and learning or skills programs. These tools can be accessed with or without support from a therapist or coach, with some using generative generative artificial intelligence (AI) and machine learning.

The umbrella term “digital mental health services” also includes peer-support networks, phone helplines and human-delivered phone, chat, or video-based telehealth services.

Services such as Mindspot, for example, offer online assessment, feedback and referrals to online treatments that have optional therapist support.

Digital mental health services target a range of mental health problems, such as depression, anxiety, trauma and eating disorders. Some are designed for specific groups of people, including culturally diverse communities, LGBTQIA+ people, new parents and young people.

With so many digital options available, finding the right program can be challenging. The government-funded Medicare Mental Health portal was set up to help Australians find evidence-based services.

Do they work?

A 2020 review of the evidence found almost half of people who used online programs for common mental health conditions benefited.

This review included online programs with self-directed lessons or modules to reduce symptoms of depression or anxiety. These programs were as effective as face-to-face therapy, but face-to-face therapy required on average 7.8 times more therapist time than online programs.

The evidence for other types of digital mental health programs is still developing.

The evidence for smartphone apps targeting mental health symptoms, for example, is mixed. While some studies have reported mental health benefits from the use of such apps, others have reported no differences in symptoms. Researchers suggest these apps should be used with other mental health supports rather than as standalone interventions.

Similarly, while AI chatbots have received recent attention, there is uncertainty about the safety and effectiveness of these tools as a substitute for therapy.

Chatbots, such as the AI “Woebot” for depression, can give users personalised guidance and support to learn therapeutic techniques. But while chatbots may have the potential to improve mental health, the results are largely inconclusive to date. There is also a lack of regulation in this field.

Early studies also show some benefits for digital approaches in treating more complex mental health conditions, such as suicidal thoughts and behaviours, and psychosis. But more research is needed.

Do users like them?

Users have reported many benefits to digital mental health services. People find them convenient, accessible, private and affordable, and are often highly satisfied with them.

Digital services are designed to directly address some of the major barriers to treatment access and have the potential to reach the significant numbers of people who go online for mental health information.

Digital supports can also be used in a “stepped care” approach to treating mental health problems. This means people with less complex or less severe symptoms try a low-intensity digital program first before being “stepped up” to more intensive supports. The United Kingdom’s National Health Service’s Talking Therapies program uses this model.

But some people still prefer face-to-face services. Reasons for this include problems with internet connectivity, a perceived lack of treatment tailoring and personal connection, and concerns about quality of care.

Some Australians face challenges with digital literacy and internet access, making it difficult to engage with online services.

Privacy concerns may also discourage people from using digital platforms, as they worry about how their personal data is stored and shared.

What do clinicians think about them?

Mental health professionals increased their use of digital mental health tools (such as telehealth consultations) markedly during the COVID pandemic. Yet many clinicians struggle to use these tools because they have not received enough training or support.

Even when willing, clinicians face workplace barriers which make it difficult to incorporate them into their practice. These include:

• limited funding and reimbursement
• unclear policies related to liability and risk management, data storage and security
• workflow disruptions, such as integrating these tools into existing systems, training clients to use them, and monitoring their use.

Some clinicians remain sceptical about whether digital services can truly match the quality of in-person therapy, leading to hesitation in recommending them to those who might benefit.

What needs to happen next?

With mental illness and suicide estimated to cost the Australian economy $70 billion per year, there are strong personal, social and financial reasons to support innovative solutions that increase access to mental health services.

But for digital approaches to reach their full potential, we need to upskill the mental health workforce and support organisations to include digital technologies into their practice.

It’s also important to improve awareness of digital mental health programs and reduce the barriers to accessing these services, or we risk leaving behind the very people who need them the most.

For Australians with more complex mental health issues, or those for whom digital mental health treatment hasn’t worked, access to in-person therapy and other mental health treatments should remain available. Digital mental health programs are one part of the mental health care system, and not a replacement for all types of care.

If you or anyone you know needs help or support, you can call Lifeline on 13 11 14.