My View - empowering mental wellness

VIEW - Anil Thapliyal, executive director, eMental Health International Collaborative

Whenever a new government is voted into power, there is always an element of natural hope and optimism that things will improve in the provision of mental health services. However, as the months roll by, a sense of frustration starts creeping in when no tangible change is experienced by the people who access these services. Lately, news headlines like “Hospitals asked to save a total of $105 million by July, Te Whatu Ora confirms” and “HIRA future uncertain - finishing on 30 June 2024” further erode people’s confidence in the healthcare system.

To provide a broader context on this issue, in my role as the executive director of the eMental Health International Collaborative (eMHIC), I have the privilege of working with the governments of many countries around the world—Australia, New Zealand, Canada, Scotland, Ireland, the USA, Sweden, Denmark, Singapore, the Philippines—and global peak bodies such as UNICEF, WHO, the World Federation of Public Health Associations, and the APEC Digital Hub for Mental Health, to name a few.

Two decades ago, New Zealand was internationally regarded as the epitome of excellence in the digital mental health domain. With initiatives like Whakarongorau, the commissioning of the Digital Mental Health & Addiction Tool (DMHAT) by the Ministry of Health, and brilliant programs like The National Depression Initiative, The Lowdown, Like Minds Like Mine, Groov, Headlight Trust, Auntie Dee, and Just A Thought, New Zealand set a high standard. Even the establishment of Ember Innovations speaks volumes about the enablement of community-led responses.

However, without continued investment in baseline infrastructure and capabilities, there is a risk that all these gains could become a thing of the past.

Adversity <> Opportunity

The entire world has endured so much adversity since 2020, ranging from the COVID pandemic and conflicts around the world to environmental challenges and a burgeoning demand for mental health services with no sign of abating or ending. However, paradoxically, through this period of adversity, the world has also seen incredible investment in and adoption of digital mental health solutions and approaches in all countries, regardless of their socioeconomic status. In certain scenarios, adversity, rather than hindering creative endeavours, has catalysed innovation and imaginative thinking, as has been the case with digital mental health adoption to improve timely access to information, care, support, and treatment.

To me, this dynamically evolving paradigm is less about "digital" per se and more about speaking the "language of today's consumer." We already know how people are accessing and consuming information. In my view, with the right leaders, adversity can spawn the most innovative, cost-effective solutions.

GLOCAL: Think globally, act locally

eMHIC promotes international collaboration as a key method to support the development, implementation, and use of safe and effective digital mental health solutions. eMHIC believes in the local adaptation of international best practices to respond to the specific needs and situations of different community and country contexts, as well as diverse populations. This learning collaborative offers opportunities to "Think Globally and Act Locally (GLOCAL)" by fostering collaboration between policymakers, funders, planners, people with lived experience, academia, the workforce, and industry to inform the effective implementation of scalable digital mental health solutions.

Community engagement and empowerment

The eMental Health International Collaborative (eMHIC) recently convened invitation-only expert Roundtables on Digital Mental Health in Australia and New Zealand, held from April to May 2024, which were a resounding success. As an integral part of its broader global strategic program to engage local champions and leaders, eMHIC collaborated with local and national government entities to lead six roundtable events across Australia and New Zealand. These gatherings brought together local and international experts to explore Digital Mental Health Strategy & Implementation and the role of AI in Mental Health. Discussions at the roundtables encompassed international best practices in designing, developing, and implementing digital mental health strategies, integrating them into broader ecosystems of mental health and psychosocial supports, and ensuring that individuals with lived experience of mental ill health remained central to the discussions.

In addition to local invitees, the events welcomed international experts such as renowned Canadian Professor Andrew Greenshaw and digital mental health champion Katherine Hay, CEO of Kids Help Phone, Canada’s most trusted charity in 2023. Key Australian co-hosts and partners included the Australian Government Department of Health and Aged Care, the National Mental Health Commission of Australia, the Mental Health Commission of South Australia, the Mental Health and Wellbeing Division (Melbourne, Victoria), and the Australian Commission on Safety and Quality in Health Care. New Zealand’s impressive list of co-hosts and partners featured the New Zealand Ministry of Health, Health New Zealand, the Mental Health and Wellbeing Commission, the Hokonui Locality, Gore Health, Whakarongorau, Ember Innovation, and Healthify.

Need for continued investment in innovation in mental health

Lester Levy, in a recent article “Data and digital critical to health” in eHealth News argues in favour of the need for continued investment in innovation.

As eMHIC is an international organisation working across the globe, it brings an informed perspective on how other countries are dealing with budgetary constraints while continuing to drive the innovation agenda. It is also important to recognize that the ability to implement scalable solutions is a significant skill in itself.

A resilient nation

Fortunately, there is no dearth of talent pool. We simply need to create an enabling environment that is not steeped in bureaucracy and long-procurement lifecycles.

By its character, New Zealand is a resilient nation, and I know we can get through this rough patch. Despite the doom and gloom of recession talk, I firmly believe we can get it right by design if we are determined and focused. It is never too late.

Global conversations

It was very poignant and timely that last month I sat down with John Tourous at JMIR's webinar discussing how to optimally harness cross-border collaboration in the digital mental health domain for positive impact and empower global mental wellness. To that end, eMHIC has established strategic collaborations internationally. The entire global community of interest interested in this niche domain is working on uniquely differentiated parts of the big digital mental health jigsaw puzzle.

Limitations of government-led responses alone

Governments alone in any country cannot meet the total demand for mental health services that exist out there. Recent eMHIC roundtables on digital mental health in Australia and New Zealand emphasised the need for community-based responses if we are serious about meeting the ever-increasing demand for mental health services.

We have to engage and harness the power of communities of interest if we are sincere about building a fully optimised mental health ecosystem.

Next Steps:

Leverage AI in mental health

Artificial Intelligence (AI) holds significant promise to revolutionise mental healthcare delivery. AI algorithms can analyse vast amounts of data to provide insights into individual and population-level mental health trends, facilitating personalised interventions.

AI-driven chatbots and virtual assistants can offer immediate support and guidance to individuals experiencing mental health challenges, augmenting the availability of services and providing a continuum of care.

Predictive analytics powered by AI can identify individuals at risk of developing mental health disorders, enabling early intervention and targeted preventative measures. By leveraging AI technologies coupled with best practice safety and privacy protocols, we can enhance the efficiency and effectiveness of mental health services in New Zealand.

Utilise digital mental health to improve access

Digital mental health platforms play a crucial role in improving access to mental health services, particularly for underserved populations and those in rural and remote areas. These platforms offer convenient and confidential avenues for seeking support and reduce the stigma associated with traditional face-to-face consultations.

Mobile apps, online counselling services, and telepsychiatry enable individuals to access mental health support anytime, anywhere, overcoming geographical barriers and increasing service uptake. New Zealand’s Whakarongorau telehealth service (https://whakarongorau.nz/) offers comprehensive, world-leading counselling and referral services and serves as a solid foundation for further expansion. A growing range of New Zealand-developed mental health apps are available; some of which are safe and effective, while many are not.

By investing in user-friendly, culturally appropriate digital mental health apps and platforms, and promoting awareness of available resources, we can facilitate equitable access to mental healthcare for all New Zealanders, regardless of their location or socioeconomic status. New Zealand’s Healthify (https://healthify.nz) is an international exemplar and offers a robust platform to expand upon as a mental health hub with approved mental health apps and services. The Ministry of Health has already made significant investments in Healthify, including the development of the Digital Mental Health Accreditation Tool (DMHAT, now DHAT), which has not yet been implemented—see ‘5. Leverage Existing Investments’ below.

Utilise digital mental health for prevention and early intervention

Prioritising early intervention and prevention strategies is critical to reducing the burden of mental illness and promoting population-wide mental wellbeing. Digital tools can play a vital role in identifying individuals at risk, supporting personal agency, and reducing the burden on the mental health workforce through self-help mental health support and delivering timely and cost-effective interventions at a time and place of people’s choosing.

Examples of international best practice include:
- Screening tools powered by AI algorithms to detect early signs of mental health problems, allowing for prompt referral and intervention.
- Targeted outreach programs and community-based initiatives using digital tools to raise awareness of and de-stigmatise mental illness and promote help-seeking behaviours.
- Mobile apps that provide cognitive-behavioural therapy (CBT) exercises, mindfulness practices, and other therapeutic resources, enabling users to manage their mental health proactively.

Engage and empower the mental health workforce

Engaging and empowering the mental health workforce is essential for the successful integration of digital technologies into practice. This is because well-informed and confident clinicians are more likely to adopt and effectively utilise these tools, ultimately improving patient outcomes.

Currently, there is a significant knowledge gap among clinicians regarding the appropriate use of digital mental health supports. Consequently, there is low trust and confidence in integrating and recommending these digital tools within their practice. Several factors contribute to this gap:

Rapid emergence of technologies: Digital mental health was a fledgling domain until recent times, with no or limited digital mental health services in existence when most of the current workforce received their training.
Lack of formal training: There is a notable absence of digital mental health courses within tertiary psychiatry, clinical psychology, social work, and counselling training programs.
Insufficient workplace training: Clinicians, social workers, and others supporting mental health and wellbeing in the community receive no or limited training on digital mental health tools in their workplaces.

Training tools, such as the Digital Mental Health Academy, can address these issues by providing comprehensive training and resources to bridge the knowledge gap, thereby enhancing the capability and confidence of the mental health workforce in using digital supports.

Leverage existing investments

New Zealand possesses well-established, high-performing digital mental health organisations such as Whakarongorau (established by the National Government in 2015), Healthify (formerly Health Navigator, est. 2008), and Ember Korowai Takatini (formerly Connect Supporting Recovery and Framework Trust, est. early 2000s). These entities represent valuable existing investments upon which further digital mental health support can be developed and/or consolidated.

The Ministry of Health has made a significant investment in the development of the Digital Mental Health Accreditation Tool, now known as the Digital Health Accreditation Tool (DHAT). This tool is fundamental in establishing a framework for the formal assessment and accreditation of digital mental health applications for use in New Zealand. Clinicians and mental health professionals are expressing an urgent need for a comprehensive library of safe and reliable digital mental health tools. Given their demanding schedules, these professionals lack the time to independently verify the safety and efficacy of such tools. Therefore, a centralised national repository of accredited digital mental health tools is essential. This approach not only ensures the availability of trusted resources but also represents the most efficient solution for supporting mental health practitioners across the country.

Moreover, as seen internationally, the establishment of a centralised repository will increase the use of digital mental health services, thereby alleviating pressure on the mental health workforce. By providing easy access to accredited tools, practitioners can more readily integrate digital solutions into their practice, leading to better and more equitable mental health outcomes for all New Zealanders.

Collaborate internationally to get it right by design

Collaboration on an international scale is imperative for designing effective digital mental health strategies and policies. While eMHIC member nations engage in regular and rigorous collaboration to draw on international best practices, it is noteworthy that New Zealand's participation has been comparatively lower over the past six years. This lesser involvement has contributed to New Zealand losing ground, relative to its peers, as a digital mental health innovator. There is a tangible opportunity for New Zealand to enhance its cross-border collaboration efforts, thereby accelerating the transformation of mental health outcomes.

The world’s biggest event in the digital mental health domain is being held in Ottawa, Canada, on 19 and 20 September 2024. It is a perfect opportunity to meet Commissioners of Mental Health Care from around the world, lived experience leaders, academics, clinicians, and industry representatives to learn more about working on the ground in countries around the world in scalable and sustainable ways. This year's 9th Digital Mental Health International Congress has the perfect theme of “Digital Building Capacity: 24/7 Mental Health Support for All.” Come and become part of the solution by becoming an integral part of this niche domain.

For more information about the Congress and to register for either in-person or virtual attendance, please visit the official Congress website. To stay updated with the latest developments, follow us on LinkedIn.


Picture: Anil Thapliyal, executive director, eMental Health International Collaborative

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