Relevance of this topic to Digital Health
Mental health is not only the absence of mental disorders; it is a state of mental well-being that allows people to live fulfilling lives. Mental health problems can be influenced by different determinants related to emotional skills, substance use, and genetics. Furthermore, the socio-economic, geopolitical and environmental context can contribute to the risk of developing mental health problems.
Before the COVID-19 pandemic, mental health affected around 84 million people in the EU (in 2019, over 7% of the EU population suffered from depression, and 13% experienced frequent loneliness) with an estimated cost of around EUR 600 billion annually. The pandemic has worsened this situation, with 27% of workers affected by work-related stress, depression, or anxiety and consequently an increase of absenteeism. The negative impact has been significant on both individuals and businesses, thus the rising cost of inaction on mental health necessitates the adoption of innovative approaches to mitigate these issues.
Mental health conditions cost approximately US$2.5 trillion in 2010, with an expected rise to US$6.0 trillion by 2030. The World Health Organization (WHO) aims at ensuring a world where mental health is prevented, promoted and protected. For that reason, it is important to guarantee the both the accessibility and affordability of mental health services and find the right resources or tools to face the rising costs. (). In the EU, the need of comprehensive reforms in mental health is urgent, to ensure de-stigmatization, prevention, treatment, and reintegration of people experimenting these problems.
Digital health solutions can be helpful to ensure the accessibility of mental health service delivery and their scalability, coping with the lack of health professionals and the increased demand of mental health care. In a nutshell, digital technologies can represent a concrete solution to ensure service delivery. A survey by the World Economic Forum and Harvard T.H. Chan School of Public Health revealed that 83% of respondents believe in the importance of digital solutions for enhancing mental health services. This belief is fuelling significant investment and innovation in digital mental health tools.
Digital mental health interventions (DMHIs) can improve access to mental health care through services offered in both self-guided and guided formats. Actually, DMHIs have already been integrated in different health systems like in Germany and UK. In Germany, all individuals are covered by public health insurance to be reimbursed for the use of certain digital mental health applications. In the UK, the National Health Service (NHS) provides computerized cognitive behavioural therapy (cCBT) and Internet-based cognitive behavioural therapy (iCBT) free of charge as a low-intensity treatment for depression and anxiety disorders.
This executive digest delves on two country cases, Denmark and Scotland, to find out technology and policy insights on how to adopt and deploy digital mental health services at a large scale to improving accessibility and sustainability.
Current focus of policy, legislation, standards, emerging practices in this landscape
Two system-wide good practices (Scotland and Denmark) are presented in this executive digest and analysed how digital health solutions and national/regional policy help to improve access and to mental health services.
Scotland has successfully integrated various digital technologies into their clinical service structures, enhancing and delivering a wide range of specific treatments (iCBT, video-enabled therapy, and self-help resources). One-third of all mental health referrals are to digital services, predicting it to become the largest mental health service in the country soon. Digital services are extensively used, particularly in remote and dispersed populations areas, overcoming geographical barriers. Furthermore, patients wait no longer than 5 working days to access these services and patient satisfaction rate is 91%. Policy strategies like the establishment of a national advisor to bridge digital and mental health services, the integration of digital mental health into the national mental health and digital strategies or embedding digital mental health governance within senior government structures have facilitated progress and achievement.
In the Region of Southern Denmark, the Centre for Digital Psychiatry leads innovative projects with iCBT and virtual reality therapy for scalable and effective mental health treatments (depression, anxiety) regardless of location. National standards ensuring interoperability and reliability across digital health services support data exchange and secure access to health information. Government-backed initiatives and digital strategies integrate digital solutions into the healthcare system, ensuring sustainability and widespread adoption.
Implications for digital health uptake
Developers
- Developers can collaborate with clinical service providers, public entities, and private companies, leveraging public-private partnerships to innovate and implement effective digital mental health solutions.
- Collaborative projects between public entities and private companies could facilitate the procurement of innovative digital health solutions, enhancing the effectiveness and reach of mental health services.
Enablers
- Establishing national advisor roles and embedding digital mental health governance within senior government structures ensure high visibility and alignment with broader health strategies.
- National advisors and integrated policies provide clear pathways for aligning digital tools with national mental health and digital strategies, helping developers to meet regulatory and clinical requirements.
- National/regional competence Centres support standardization, data exchange, and secure access to health information, crucial for enabling digital mental services.
- National innovation clusters and research centres could provide platforms for developing and testing new technologies, including internet-based CBT and VR therapy.
Payers and procurers
- Government-backed initiatives and integration of digital mental health into national strategies provide a stable environment for procurement and funding decisions, ensuring balanced development alongside traditional services.
- A structured evaluation framework ensures that all digital mental services adhere to evidence-based standards, such as randomized control trials or national clinical guidance.
Users
- A wide range of self-managed digital treatments, including internet CBT, video-enabled therapy, and AI-tailored interventions, empower users to take control of their mental health and receive personalized care.
- High satisfaction rates indicate positive user experiences and acceptance of digital mental health services, reflecting the effectiveness and user-centric design of these solutions.
- Digital services are designed to overcome geographical barriers and reduce waiting time, ensuring wide accessibility, particularly for remote and dispersed populations.
Remaining gaps and issues
These are the key gaps and issues classified by the perspective of the supply, enabler and demand sides.
Supply side
- Need for training and skills development to stay current with technological advancements and best practices in digital mental health.
- Definition of pathways for commercialization, market access strategies, or support for scaling solutions beyond the initial development and testing phase.
Enabler side
- Specific strategies for ensuring long-term sustainability and scalability of digital mental health solutions.
- Readiness and capacity of the existing digital infrastructure to support new technologies.
- Interoperability with existing healthcare systems, electronic health records (EHRs) and workflows, ensuring a seamless experience for both providers and patients.
- Evaluation of the cost-effectiveness of digital mental health solutions compared to traditional services and their accessibility limitations.
- Potential technology failures, cybersecurity threats, or user data breaches.
Demand side
- Improve digital literacy among users, including healthcare providers, to ensure they can effectively use and benefit from digital mental health services.
- Potential equity issues, such as ensuring access for underserved populations, individuals with disabilities, or those with low digital or health literacy.
Legislative, regulatory, policy or standardisation instrument, or good practice
Scaling up Digital Mental Health in Scotland: Leadership and Transformation
Instrument status:
Published
Publisher or source:
Speaker: Chris Wright, National Advisor and Lead
for Digital Mental Health, Scottish Government
Publisher: EHTEL
Summary of the instrument
Scotland has made significant advancements in integrating digital solutions into its mental health services through a comprehensive approach that combines solution-level innovations and supportive legislative frameworks.1
The country offers a wide range of digital offerings, including 29 self-managed treatments such as computerised cognitive behavioural therapy (cCBT) that satisfy diverse conditions and demographic groups2. Therapy sessions are available via video consultations and web chats, ensuring accessibility and flexibility for patients, and extensive online self-help and self-management resources are accessed by thousands of users monthly (over 71,000 referrals/self-referrals in 2022).
Digital services significantly reduce waiting times, with patients waiting no longer than five working days to access these services, and they are particularly beneficial in remote and rural areas, addressing geographic barriers to mental health care.
High patient satisfaction rates, with 91% of users expressing positive feedback with the services, highlight the effectiveness and acceptance of digital mental health solutions. These interventions are backed by rigorous data and research, aligning with national clinical guidance to ensure evidence-based practices.
Scotland has implemented robust regulations and standards to ensure the quality and safety of digital mental health services, integrating these solutions with the NHS for a cohesive approach to mental health care. Government initiatives and funding programs support the development and scaling up of digital mental health services, promoting innovation and accessibility.
Leadership roles within the government, such as the national adviser for policy and implementation lead for digital mental health, facilitate the integration of digital solutions into policy and practice. Strong data privacy laws ensure that personal information collected through digital platforms is securely managed, maintaining patient trust and compliance with legal standards.
The development of national policies and strategies, such as the mental health strategy3 and digital health strategy4, ensures that digital mental health services are an integral part of the overall healthcare system.
Collaboration between public and private sectors fosters innovation and effective implementation of digital health solutions. Scotland’s comprehensive and strategic approach to digital mental health services showcases its commitment to accessibility, efficiency, and patient-centred care, supported by a robust legislative framework and strong government backing.
1 Digital Health and Care Scotland. Digital Mental Health
2 Digital Health and Care Scotland. Digital therapies
3 Scottish Government. Mental Health and Wellbeing Strategy
4 Scottish Government. Digital Health and Care Strategy
A behind-the-scenes look into the Danish health IT market: Mental health and psychiatric services in the Region of Southern Denmark
Instrument status:
Published
Publisher or source:
Speakers: Janne Rasmussen, Chief Consultant,
MedCom; Claus Duedal Pedersen, Head of Unit, sundhed.dk;
Thomas Lambertsen Binzer, Head of Development &
Implementation, Centre for Digital Psychiatry
Publisher: EHTEL
Summary of the instrument
Denmark has been at the forefront of integrating digital solutions into its healthcare system, particularly in mental health services. These developments can be analysed at both solution and legislative levels.
At the solution level, Denmark has introduced several innovative mental health projects and services.
- Internetpsykiatrien is an online clinic offering internet-based cognitive behavioural therapy (iCBT) for mild to moderate depression and anxiety, providing free and accessible mental health care across the country.
- Mindhelper is a significant online resource providing mental health information to young people, covering various topics from loneliness to severe mental health issues.
- The VR8 Project uses virtual reality for exposure therapy to treat anxiety disorders, showcasing Denmark’s commitment to leveraging advanced technologies in mental health care.
- Additionally, the PERSONA Project focuses on AI-guided depression treatment, employing a stepped care model to optimize resource distribution and provide tailored treatments.
Continuous research on digital interventions ensures their effectiveness and suitability for various patient groups, with the Centre for Digital Psychiatry actively engaging in developing and testing new digital solutions to ensure they are backed by robust evidence before being implemented into routine care.
Patient engagement and accessibility are high in Denmark due to the widespread trust in public healthcare systems and the use of digital signatures and secure login methods, which facilitate smooth access to digital health services. Public campaigns, such as those during the COVID-19 pandemic, have significantly boosted the adoption of digital health tools, making them integral to everyday healthcare access.
At the legislative level, Denmark’s health IT infrastructure is built on national standards ensuring interoperability and consistent data exchange across various health sectors. Organizations like MedCom and the Danish Health Data Authority play crucial roles in standardizing, testing, and certifying digital mental health solutions to ensure they meet national requirements. Collaborative projects between public entities and private companies enhance innovation and the implementation of digital health solutions, ensuring they are effectively integrated into the healthcare system.
Government-backed initiatives, such as the national digitalization strategy, provide a clear framework and support for integrating digital solutions into healthcare.5 Regular bilateral agreements between municipalities, regions, and the state define budgets and priorities, ensuring that digital mental health projects are adequately funded and aligned with national health objectives. Denmark emphasizes building sustainable digital health services with a long-term impact, supported by strong infrastructure and national programs. Denmark’s approach to developing digital mental health services is thus characterized by innovation, evidence-based practices, and strong legislative support, making it a model for integrating digital solutions into mental health care.6
5 Healthcare Denmark. Digitalisation in Danish Healthcare
6 Healthcare Denmark. The Danish approach to Mental Health