Table 1 Policy recommendations to facilitate systemic implementation of digital technologies in mental healthcare system

Cognitive /Behavioural, Attitudinal, and Emotional

• De-stigmatization around mental healthcare and legitimation of digital technologies via policies targeted to specific population groups, particularly those most likely to experience negative attitude and beliefs e.g., men, young people

• Active promotion of digital technologies by trusted sources and guidance form health professionals

• Policies which promote clinicians’ attitudinal and behavioral shift toward accepting and providing digital mental healthcare

• Education, training, and resources targeted to specific provider groups according to degree of digital skills e.g., older workers, to improve digital literacy of mental health professionals

-

-

Patient

• Digital health interventions should account for population diversity in terms of gender, religious and cultural identities

• Consider the interplay between characteristics such as social, economic, and gender factors, and digital literacy as determinants of health to improve access to digital technologies in mental healthcare

• Balance trade-offs between improved choice in digital mental care options, efficiency gains in integrating digital technologies, and equitable access for vulnerable groups e.g., providing free access to digital tools for certain population groups

• Limiting choice on the market to a set of high quality and safe options of technologies to avoid excessive choice burden and infodemic

-

-

-

Professional and Interpersonal Domain

-

• Guidelines and training to build digital patient-provider relationship based on trust, transparent communication, and professional boundaries

• Digital technologies as transitional, complementary object rather than a substitute to traditional care through guided use of technology under professional supervision

• Balance patients’ empowerment through involvement in self-care and clinical expertise to guide safe use of technologies and avoid excessive burden of self-care on patients

-

-

Guidelines and Evidence

• Ease of use and perceived usefulness are drivers and need to be assessed case-by-case basis for tailored interventions according to demographics, epidemiological profile, and sensory ability or skills e.g., severity of illness

• Co-design process of digital technologies and implementation to adopt person-centered view

• Digital health interventions should be based on guidelines, protocol, informed by evidence-based outcomes

• Establishment of safety protocol to use with remote digital mental health interventions in case of self-harm

• Digital technologies should provide safe, appropriate, and flexible content, on portable devices

-

-

Support and resources

• Supporting patients’ and tackling their difficulties in time-management and self-care burden in case of unguided use of technologies

• Rewarding additional clinical and administrative burden shifted on clinicians due to integration of technologies with economic and non-economic incentives and flexible work arrangements, to avoid burn-out

• Provide adequate conditions for healthcare organizations to innovate, such as adequate financing through grants for innovation, risk management to reduce risk related to innovation (e.g., reducing fragmentation and pooling financial risk)

• Provide adequate digital work environment and technical assistance to clinicians that experience technical problems with technologies

• Digital technologies should contribute to achievement of SDGs 3: health and well-being, including universal mental health coverage tackling population, services and costs covered; implementation policies should (directly or indirectly) support these aims

System and Process

-

• Establishing guided implementation pathways for digital mental healthcare interventions into existing workflow and practices to ensure continuity of care

• Enthusiastic and accountable leaders and managers

• Organization-based multidisciplinary facilitation teams: clinical, administrative, and technical skills

• Teamwork and staff development pathways

• Stepped-care approach to integrate digital technologies

• Reforms to bring political and policy awareness, adequate economic models, and updated regulation for digital technologies to expand access to mental healthcare

• Transparency of IT privacy policies to ensure confidentiality of personal information and anonymity for patients

• Systemic digitalization of healthcare system to improve systems inter-operability

• Involvement of public, private sectors, and patients in participatory policy decision-making

• Pursuing public-private partnership to innovate, balancing public interest and private profit, and sharing risks and rewards