Mental health challenges are rising across Europe, driven by socioeconomic factors and exacerbated by the COVID-19 pandemic. This has highlighted significant gaps in traditional mental health services, creating an urgent need for scalable, cost-effective solutions. Digital mental health tools – such as mobile apps, telemedicine, and AI-based diagnostics – offer innovative ways to improve accessibility, particularly for underserved populations, while reducing the burden on traditional care systems. In response, the European Commission has emphasized mental health as a priority, aligning with the WHO’s recommendations to integrate digital technologies into mental health care.[1] However, the successful implementation of these solutions requires a comprehensive strategy addressing regulatory, financial, and operational challenges.
This policy brief outlines strategic policy domains and recommendations to optimize digital mental health services across the EU. Key policy domains include the standardisation of digital health platforms, public-private partnerships and digital literacy programmes to reduce the digital divide. Recommendations are based on a scoping review and country cases analysed in an executive digest and a stakeholder engagement workshop organised by the project DigitalHealthUptake.
To support the sustainable and effective deployment of digital mental health services, the recommendations are structured around five policy instruments: financing, procurement, organization, regulation, and behaviour change. These recommendations aim to ensure that digital mental health services are accessible, secure, and aligned with the needs of diverse populations. Furthermore, a digital implementation strategy is proposed to guide member states through a phased, scalable approach for the deployment of digital mental health tools, drawing on two successful case studies.
By prioritizing strategic investment, regulatory frameworks, and partnerships, the EU can foster an environment where digital mental health solutions flourish, improving mental health outcomes, promoting equity, and building a resilient healthcare infrastructure across Europe.
Introduction
Mental health, as a fundamental aspect of well-being, is increasingly impacted by socioeconomic challenges, with issues such as anxiety and depression on the rise across Europe. The COVID-19 pandemic has further highlighted gaps in traditional mental health services, prompting an accelerated shift toward digital solutions that can enhance access to care. Digital mental health tools, including mobile apps, telemedicine, and AI-based diagnostics, offer scalable, cost-effective approaches to reach underserved populations and improve health outcomes.
The European Commission’s recent emphasis on mental health, coupled with the World Health Organization (WHO) recommendations for integrating digital health in mental care, underscores the need for a coordinated response. Leveraging digital technologies for mental health promotion, prevention, and treatment can enhance service delivery, but effective implementation requires addressing regulatory, financial, and operational barriers. This policy brief outlines strategic domains to optimize digital mental health care, aiming to advance accessibility, quality, and equity in mental health services across the EU.
Problem description
Mental health is a critical aspect of overall well-being, in line with the WHO definition of health[2] as a state of complete physical, mental, and social well-being. However, mental health conditions are influenced by various socioeconomic factors, requiring a
comprehensive, whole-of-government approach to promotion, prevention, treatment, and recovery. Unfortunately, mental health issues are on the rise across Europe, exacerbated by the COVID-19 pandemic, while access to traditional mental health services remains inconsistent.
Globally, mental health disorders contribute to 13% of the total disease burden and are among the leading causes of disability. With socio-economic impacts projected to grow, and up to 50% of individuals with severe mental illnesses currently going untreated, digitalization presents an opportunity to improve access, quality, and cost-effectiveness. It also enables data-driven, personalized approaches to mental health care, supporting innovative strategies for prevention, diagnosis, and management[3].
Digital mental health services have emerged as a promising solution to these growing challenges. Evidence-based digital tools – including mobile applications, telemedicine, and artificial intelligence (AI) for diagnostics and monitoring – offer scalable and cost-effective ways to expand access to care. The pandemic has accelerated the adoption of telemedicine, leading to greater acceptance among both clinicians and patients. Additionally, many countries have adjusted privacy regulations and reimbursement policies to facilitate digital consultations.
The Mental Health Action Plan 2013–2030 (WHO, 2021)[4] underscores the potential of digital technologies in mental health care, advocating for digital self-help tools, telehealth services, and social media for mental health promotion and prevention. Likewise, the “Benchmark for Mental Health Systems” (OECD, 2021)[5] highlights the value of AI in early detection and monitoring by analysing internet and social media use. Various governmental and non-governmental organizations have launched digital mental health portals and app libraries to improve access to reliable resources.
In 2023, the European Commission introduced a comprehensive mental health strategy[6], addressing mental health challenges caused by COVID-19, economic strain, and social instability. Despite these efforts, access to care remains insufficient, particularly for vulnerable groups facing rising rates of anxiety and depression. Tackling these issues requires a policy shift toward digital health solutions, improved coordination of services, and greater integration across sectors. Digital tools and telemedicine, when incorporated into health systems, could significantly enhance accessibility, improve outcomes, and alleviate social and economic burdens.
Methodological approach
To address the accessibility and quality of mental health services through digital means, this policy brief adopted a multipronged approach. First, a rapid review was conducted to identify key policy domains and recommendations at European level. Second, a review of national and regional experiences in deploying mental health services at large-scale complemented the rapid review and provided implementation insights. Finally, a semi-structured discussion during the stakeholder engagement workshop organised by the DigitalHealthUptake project allowed to refine key scaling aspects.
Policy domains
As Europe faces rising mental health challenges, digital solutions offer a pathway to expand access, improve quality, and reduce costs. To fully realize the benefits of digital mental health care, policymakers must consider strategies that address standardization, collaboration, and accessibility. Below are three complementary and strategic policy domains to optimize the development and adoption of digital mental health tools across the EU:
Domain 1: Framework for Digital Health Platforms
To ensure that digital mental health platforms across Europe adhere to high standards of quality, safety, and regulatory compliance, implementing nationals and EU-wide standards is essential. This approach promotes a consistent framework, enabling seamless data sharing and interoperability between platforms. By fostering trust, standardization can encourage more users to engage with digital mental health solutions, confident in their reliability and security.
However, establishing these standards requires careful coordination to align diverse national regulations. Additionally, rigid standards could potentially stifle innovation, posing challenges for smaller developers who may face high costs related to compliance and certification. Despite these challenges, standardization offers a pathway to a more integrated digital health landscape across Europe.
Domain 1
Objectives
- Enhances trust in digital mental health solutions
- Ensures consistent quality and safety for all users
- Facilitates interoperability and data sharing between platforms
Challenges
- Difficulties in aligning diverse national regulations
- Risk of preventing innovation due to rigid standards
- High costs for compliance and certification, especially for smaller developers
Domain 2: Public-Private Partnerships
Public-private partnerships (PPPs) can accelerate the development and deployment of advanced digital mental health tools. By combining government support with private sector innovation, PPPs can foster the rapid growth of technologies that address pressing mental health needs. This approach not only encourages private investment in public health infrastructure but also expands access to cutting-edge mental health solutions across a broader demographic.
However, such partnerships come with risks. The involvement of private companies may lead to a focus on profit over patient needs, raising concerns about data privacy and security. Policymakers must carefully design these partnerships to align public health objectives with private sector goals, ensuring that patient welfare remains the priority.
Domain 2
Objectives
- Leverages private sector innovation and resources
- Speeds up the development of advanced technologies
- Encourages investment in public health infrastructure
Challenges
- Risk of prioritizing profit over patient needs
- Data privacy and security concerns when private companies are involved
- Possible conflicts of interest between public health goals and corporate strategies
Domain 3: Digital Literacy Programs
To ensure equitable access to digital mental health services, it is vital to address the digital divide. Digital literacy programmes targeting populations at risk of digital exclusion can empower marginalized groups to benefit from digital mental health tools. By building user confidence and fostering familiarity with technology, these programs enhance engagement and enable vulnerable populations to access critical mental health resources.
Implementing digital literacy initiatives requires significant investment in education and outreach. Additionally, there may be resistance from individuals who are uncomfortable with technology, requiring sustained efforts to foster acceptance. A long-term commitment to updating these programs in line with technological advancements is essential to ensure their effectiveness.
Domain 3
Objectives
- Expands access to digital mental health tools for vulnerable and marginalized groups
- Reduces the digital divide, ensuring more equitable care
- Enhances user confidence and engagement with digital tools
Challenges
- Significant investment required in education and outreach
- Possible resistance from those uncomfortable with technology
- Need of long-term (political) commitment and consistent updates to keep pace with technological advances
Recommendations
In the context of European health systems, different authors have studied the barriers and facilitators to the implementation of digital technologies in mental health systems[7] and have provided practical policy recommendations for upscaling digital mental health.[8],[9] These recommendations are intended to guide the digital transformation of mental health services in Europe, ensuring that such initiatives are effective, secure, and accessible to all stakeholders involved. They emphasize a comprehensive, system-wide approach to the implementation of digital mental health technologies and aim to tackle barriers like legal uncertainty, lack of awareness, and insufficient financing, which currently slow the implementation of digital mental health in Europe. The following table summarises their recommendations based on areas for policy development.
Learning from implementers
In the context of DigitalHealthUptake activities, EHTEL worked out an executive brief and organised a “Stakeholder Engagement Workshop” to identify key strategies for large-scale deployment of digital mental health services.[10] [11] [12] Spain and United Kingdom were invited to share their learnings through the experiences of digital mental health rollout plans in Catalonia and implementation in Scotland. Barriers and enablers within their national and regional strategies and effective approaches to encourage the widespread use of digital mental health services across an entire region or country were highlighted.
In Catalonia, an early-stage public-private partnership project called Mental eHealth Programme is part of a broader effort to transform healthcare through one of 18 regional initiatives funded by the EU’s NextGen funds. This project, piloted across several hospitals, includes a mobile app for patient self-assessment, a platform for digital therapies aimed at low to medium-risk patients, and passive monitoring for high-risk individuals. Currently, 90 participants – 60 adults and 30 teenagers – are testing the app. The initiative aims to expand throughout Catalonia and eventually across Spain. It faces several challenges, such as the need for regulatory changes, long-term financing, and a sustained perspective to fully integrate digital mental health solutions.
Scotland has implemented the Digital Mental Health programme at scale throughout the Scottish NHS, starting with early telecare solutions like Near Me[13], a video consultation platform. The NHS followed a “test and learn” approach, underpinned by a distinct improvement methodology, that has enabled widespread adoption across the country. The approach involves iterative testing and refinement, addressing eight main challenges through multiple mitigation strategies and leveraging 13 key enablers. With 14 territorial NHS boards, Scotland has had to navigate regional variations in digital health approaches, but the country’s structured and step-by-step model facilitates scalability.
Adopted policy instruments and implementation strategy
Funding
Assess unmet needs and prioritize investment: conduct targeted studies to identify gaps between mental health demands and available resources. Use these insights to prioritize mental health for digital innovation and transformation, setting a foundation for strategic investment in new technologies.
Ensure long-term funding and policy support: secure sustained investment through multi-year funding commitments, allowing impactful changes in digital mental health services. Nationally approved policies on data security and information governance further support consistent, safe implementation.
Procurement
Build strategic partnerships: collaborate with tech companies through public procurement models to co-develop digital tools that are clinically relevant and user-friendly. Partnerships with technology providers enable the creation and refinement of tailored solutions that align with healthcare needs.
Organisation
Provide training and change management support: equip healthcare professionals with necessary training and change management support to ensure seamless adoption of digital tools. Offering guides, drop-in sessions, and accessible resources is crucial for staff to adapt smoothly.
Address administrative and IT barriers: simplify procurement processes to minimize delays and develop interoperable IT systems that support data sharing across regions. A unified digital health infrastructure is essential for scalable, consistent care delivery.
Engagement
Focus on continuous feedback and engagement: engage stakeholders throughout the testing and implementation phases to gather feedback. This engagement, supported by campaigns and collaborative events, drives acceptance and helps refine technologies based on real-world insights.
Implementation strategy
Implement a structured, phased approach: adopt a standardized “test and learn” approach for digital mental health solutions. This model allows rigorous testing of new technologies before large-scale rollout, minimizing implementation time and enabling a smoother transition across locations.
Integrate digital solutions for enhanced care: introduce self-assessment tools for early identification, digital therapy programmes for structured self-care, and continuous monitoring for high-risk patients. These solutions improve accessibility, care quality, and allow for proactive intervention.
Conclusions
The above recommendations emphasize the importance of leveraging digital tools to expand access, improve care quality, and reduce disparities in mental health services. Together, they allow developing a comprehensive roadmap for advancing digital mental health care across Europe by: (1) establishing a regulatory framework that upholds legal clarity, ethical standards, and data security, member states can foster trust and protect the rights of users; (2) a coordinated approach involving strong governance, sustainable financing, and public-private partnerships will drive innovation and enhance the availability of digital mental health services; (3) prioritizing system integration, interoperability, and workforce training, healthcare systems can ensure that digital solutions are effectively embedded into existing mental health services; (4) securing long-term viability for digital mental health interventions through strategic investments, ensuring equitable access for diverse populations.
Furthermore, initiatives to enhance digital literacy and incentivize provider adoption will build trust and engagement with digital mental health tools, underscoring the importance of inclusivity and tailored care. Through continuous evaluation and research, Europe can count on a digital mental health ecosystem that not only meets high standards of safety and effectiveness but also adapts to evolving healthcare needs.
With targeted actions based on adopted policy instrument and implementation processes, including financing, procurement, organization, regulation, and behavioural strategies, European healthcare systems can advance toward a digitally empowered mental health landscape. Learning from the successful implementation models of Catalonia and Scotland, and engaging stakeholders in a phased, iterative approach, the EU can set a precedent for scalable, inclusive, and efficient digital mental health care. Together, these strategies will create a future where mental health support is accessible, effective, and adaptable to the evolving needs of all Europeans.
References
Berardi C, Antonini M, Jordan Z, Wechtler H, Paolucci F, Hinwood M. Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework. BMC health services research. 2024 Feb 26;24(1):243.
Gaebel W, Lukies R, Kerst A, Stricker J, Zielasek J, Diekmann S, Trost N, Gouzoulis-Mayfrank E, Bonroy B, Cullen K, Desie K. Upscaling e-mental health in Europe: a six-country qualitative analysis and policy recommendations from the eMEN project. European Archives of Psychiatry and Clinical Neuroscience. 2021 Sep;271:1005-16.
Kalman JL, Burkhardt G, Samochowiec J, Gebhard C, Dom G, John M, Kilic O, Kurimay T, Lien L, Schouler-Ocak M, Vidal DP. Digitalising mental health care: Practical recommendations from the European Psychiatric Association. European Psychiatry. 2024 Jan;67(1):e4.
OECD (2021), A New Benchmark for Mental Health Systems: Tackling the Social and Economic Costs of Mental Ill-Health, OECD, Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/4ed890f6-en.
WHO, Comprehensive Mental Health Action Plan 2013–2030, 2021
Footnotes
[1] EU comprehensive approach to mental health: https://health.ec.europa.eu/non-communicable-diseases/mental-health_en ; Mental health (WHO): https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
[2] https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
[3] Kalman JL, Burkhardt G, Samochowiec J, Gebhard C, Dom G, John M, Kilic O, Kurimay T, Lien L, Schouler-Ocak M, Vidal DP. Digitalising mental health care: Practical recommendations from the European Psychiatric Association. European Psychiatry. 2024 Jan;67(1):e4.
[4] WHO, Comprehensive Mental Health Action Plan 2013–2030, 2021
[5] OECD, A New Benchmark for Mental Health Systems: Tackling the Social and Economic Costs of Mental Ill-Health, OECD, Health Policy Studies, OECD Publishing, Paris, 2021, https://doi.org/10.1787/4ed890f6-en.
[6] https://health.ec.europa.eu/non-communicable-diseases/mental-health_en
[7] Berardi C, Antonini M, Jordan Z, Wechtler H, Paolucci F, Hinwood M. Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework. BMC health services research. 2024 Feb 26;24(1):243.
[8] Kalman JL, Burkhardt G, Samochowiec J, Gebhard C, Dom G, John M, Kilic O, Kurimay T, Lien L, Schouler-Ocak M, Vidal DP. Digitalising mental health care: Practical recommendations from the European Psychiatric Association. European Psychiatry. 2024 Jan;67(1):e4.
[9] Gaebel W, Lukies R, Kerst A, Stricker J, Zielasek J, Diekmann S, Trost N, Gouzoulis-Mayfrank E, Bonroy B, Cullen K, Desie K. Upscaling e-mental health in Europe: a six-country qualitative analysis and policy recommendations from the eMEN project. European Archives of Psychiatry and Clinical Neuroscience. 2021 Sep;271:1005-16.
[10] Improving access to mental health services through digital health solutions and policies (August 2024): https://digitalhealthuptake.eu/resource/improving-access-to-mental-health-services-through-digital-health-solutions-and-policies/
[11] Digital mental health large scale-up (3 October 2024): https://ehtel.eu/events/11-events/234-policy-brief-digital-mental-health-large-scale-up.html
[12] Webinar report: https://ehtel.eu/activities/webinars/2024-change-management-capacity-building-digital-mental-health-large-scale-up.html
[13] Near Me https://www.nearme.scot/
DISCLAIMER
Views and opinions expressed are those of the author(s) only and do not necessarily reflect those of DG CONNECT, European Commission. Neither the European Union nor the granting authority can be held responsible for them.