My View: An eMental health framework for New Zealand – a warrant of fitness for the mind

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Picture: eMental Health and Addiction Lead at the Centre for eHealth AUT and HealthTRx CEO Anil Thapliyal

Guest column by Anil Thapliyal

We make sure our cars are fit for use, but the same protection hasn’t been available in the mental health app space.

Would you buy a car for yourself or your children without a warrant of fitness? I certainly wouldn’t.

Before my family gets behind the wheel of any car, I need to be sure that the vehicle is safe.

Today’s vehicles are a complex blend of mechanical and electronic magic that come together to move us from our homes to our places of work and play. That complexity requires specialist expertise in the form of checklists and vehicle assessors to determine whether my vehicle is fit for purpose.

With the ever-increasing uptake of technology in every aspect of healthcare service provision, like vehicles, this complex blend of traditional and digital health services is becoming intrinsic to our care experience. Mental health is no exception.

Massive expansion in development

The mental health sector has seen huge adoption of digital innovation across information provision, patient engagement, non-medicated treatment interventions throughout the stepped care continuum and social support.

Investments in digital mental health in Silicon Valley and across the United States alone are a good litmus test to gauge what’s here and what amazing new developments are just around the corner. In 2019, there were 717 e-Mental health start-ups in the United States alone, with collective funding of more than US$4 billion.

It’s great to see this level of investment. People need help and a greater range of options for receiving that help: one in four global citizens will experience mental ill health or addiction in their lifetime. This burden is more pervasive than any other illness and is now the leading cause of adult disability and death in OECD nations.

As a result of the groundswell following our Prime Minister’s announcement of the world’s first Wellbeing Budget in 2019, New Zealanders now rightfully expect better mental health and addiction support than in years gone by.

Being in the driver’s seat

Robyn Shearer, Ministry of Health deputy-director mental health and addiction, agrees.

“What we are hearing from people, communities and the health sector is that people want a different approach when it comes to mental health and well-being.

“Many people are frustrated with traditional therapies and they want access to an expanded range of choices. They want to feel in control of their own treatment – to feel like they are in the driver's seat. We need to be gearing up a system that includes people across the full range of needing help, from needing one-off advice right through to specialist treatments,” she says.

“Digital services are at the heart of the change that is taking place and will play an increasingly important role in the health landscape.

“There is significant potential for emerging digital technologies (for example, e-coaching, e-screening, e-therapy, e-navigation and other e-mental health programmes). But I also note that this potential is yet to be fully realised, despite a growing body of evidence suggesting their effectiveness.”

A framework for safety and quality

This brings me back to the warrant of fitness. We need an e-Mental health warrant of fitness – a framework to provide guidance on the use and development of e-Mental health from current providers who design and deliver telehealth, apps and web-based programmes, to practitioners who may be prescribing e-services, through to people who are seeking apps and other online options to support themselves and those around them.

“Internationally, best practice and evidence suggests the need to monitor e-therapies to ensure they are clinically, digitally and culturally safe for users” confirms Shearer.

“One of the challenges will be moving fast enough to get in front of this. Every month there are more and more tools that are developed and available online”.

With more than 10,000 mental health and wellbeing apps out there, and more released every day, an eMental health framework can’t come soon enough.

Ensuring the safety and quality of our vehicles on the road is never in doubt. Ensuring the safety and quality of mental health and addiction apps and other digital tools that are used by New Zealanders must also be a given.

The Ministry of Health has committed to this important work for New Zealand. I applaud Robyn Shearer and her team for taking up the baton last year.

Shearer is drawing on local and international expertise to fast-track an effective approach for the New Zealand context.

“The Ministry of Health has work underway to develop this framework. We are connecting into the experience of other countries via an e-Mental health international collaborative – eMHIC. Through this we are sharing and learning to improve what we are all doing.”  

At its heart, an eMental health framework will provide a warrant of fitness for e-mental health tools, apps and services. But the benefits extend well beyond a pass/fail safety assessment.

An opportunity to reduce inequity

A good framework will offer structures and processes for assessing e-tools against criteria to ensure safety.

A great framework will incentivise best practice, encourage integration of these tools within clinical care pathways across the stepped care continuum and drive integration and interoperability across the health system.

My personal hope is for a framework that enables us to truly reach people who are currently not accessing traditional mental health services and make a serious impact on reducing inequities.

Shearer shares this ambition.

“We need to adapt our service and mental health landscape to how people move and act in the world today – that means online, anywhere and anytime. I look forward to sharing New Zealand's progress with this work in months to come.”

Anil Thapliyal, is the eMental health and addiction lead at the Centre for eHealth, Auckland University of Technology, and HealthTRx CEO.

If you want to contact eHealthNews.nz regarding this View, please email the editor Rebecca McBeth.

Read more views/CIO Interviews:

Kate Reid: Industry View: Technology – a blessing or curse for the wellbeing of our healthcare workforce?

Simon Ross: Data & Digital Futures – MoH View

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