Navigating the landscape of digital mental health care: Co-creation and human rights as guiding principles

Digital technologies have emerged as a promising solution to transform mental health systems and meet our populations’ increasing mental health needs. Francesca Centola, Policy and Knowledge Officer at Mental Health Europe, outlines the principles that should guide such a digital transformation

Within the global healthcare landscape, we encounter a considerable gap in mental health care, leaving a significant portion of needs unmet. Even before the COVID-19 pandemic, two out of three individuals seeking mental health support reported difficulties in getting it (OECD, 2021). Emerging digital technologies promise to offer solutions for transforming mental health systems and meeting the growing needs of populations, but we must reflect on what principles should guide such a digital transformation.

The digital revolution

The pandemic accelerated the integration of digital technologies into mental health systems, prompting a dramatic shift towards ‘innovative solutions’. The flood of new digital tools for mental health assessment, support, prevention, and care has been extraordinary.

Digitalisation in the mental health care field can take different forms: telehealth (remote therapy), digital mental health apps, wearables, virtual reality (VR), serious games, data sharing via apps/chats/platforms, Digital Support Groups, Extended Reality (XR) and more. Artificial intelligence (AI) further extends possibilities, from substituting human beings in therapeutic sessions – with ‘chatbots’ supported by sophisticated AI – to (claims to) predict mental health outcomes based on real-time personal data.

Various digital tools have emerged due to developments by researchers, companies, and consumers. This digital revolution has opened the door to business models driven by profit rather than a commitment to public wellbeing. This raises concerns, especially in a field that needs to be properly regulated. The global mental health apps market size was estimated at $5.19 billion in 2022 and is expected to reach around $26.36 billion by 2032. The landscape is evolving rapidly.

Opportunities and risks

Digitalisation presents numerous opportunities, including broader access to support, the provision of care anonymously, and flexibility in delivery. Additionally, the digital realm holds promise for adolescents and young adults, a critical stage where intervention can prevent serious, lifelong mental health problems. At Mental Health Europe, we recognise the opportunities and highlight the risks.

One of our main concerns is the quality of digital mental health interventions. As pointed out by research, there is a contrast between academically driven innovations (not funded by specific industries), supported by rigorous evidence in trials but often lacking real-world impact, and commercially driven innovations, marked by high engagement but minimal integration with formal health systems and weak evidence of effectiveness.

When quality is compromised, the consequences can be harmful. Another concern is equity, as only some have equal access to digital equipment or possess the necessary digital skills. Furthermore, privacy and data security concerns are particularly pronounced in mental health, given the widespread stigma and the desire for anonymity among users. Leaked data can be weaponised to discriminate against individuals in insurance, employment, housing, and credit ratings.

Human rights pitfalls

During an expert meeting co-hosted by Mental Health Europe, service users highlighted the potential of digital technologies to amplify existing human rights pitfalls in the mental health field to a whole new level. In particular, concerns were shared around the extreme application of digital technologies, known as biometric monitoring: the assessment of behaviour, mood and cognition through biometric data generated by devices (e.g., how you use your smartphone—typing, swiping, scrolling—is a way to measure stress levels and even make a diagnosis of mental health problems). This approach was flagged as highly troubling, as it reduces complex inner worlds to simplistic proxy measurements of behaviour. This could result in the creation of a surveillance market that perpetuates and extends existing power imbalances, inequities, and harms ingrained in current mental health practices.

Co-creation and human rights as guiding principles

To counter the inherent risks of digital technologies, a strategic shift is proposed – moving from a technology- centric focus to questions like ‘who benefits from it?’ and, crucially, ‘who stands to lose?’ Rather than adopting digital technologies solely for their feasibility and profitability, the emphasis should be on whether they genuinely meet the needs of the people they aim to assist.

At Mental Health Europe, we believe that digital technologies should not be considered an end in themselves but as a means to an end. We advocate for a co-creation approach and a human rights framework to be the compass for any developments in digital mental health.

Co-creation involves a collaborative approach, bringing together all relevant stakeholders – policymakers, tech companies, providers, users of care services, and the general public – to share decision-making power. Only with this collaborative approach – in every step of the process, from design to evaluation – can digital technologies align with real needs and work towards realising a vision of a society where everybody can fully enjoy their human rights and thrive.

Concrete actions to ensure quality, equity, and privacy

Concerning concrete actions, governments and healthcare providers need to shape the market towards the outcomes they most want and the standard of evidence they need. This could be achieved by funding digital mental health technologies based on strict evidence of safety and efficacy. The Digital Health Act (DIGA) in Germany is highlighted as an exemplary legislative reform, enabling doctors to prescribe digital mental health apps and allowing insurance companies to reimburse associated costs.

In addressing equity concerns, governments should consider subsidising the purchase of equipment, supporting internet access, and providing education to enhance digital literacy. Service users’ privacy should be protected via technical solutions and normative interventions. Companies must provide evidence of their apps’ safety and efficacy before receiving government reimbursement via medical insurers.

Avoiding techno-solutionism

Digital technologies, and in general practices considered innovative in the mental health field, often focus on the individual, viewing them as needing to be ‘fixed’. This poses a risk of diverting attention and public resources from the necessary structural actions that are needed to promote mental health, prevent mental health problems, and allow for recovery.

A critical warning is sounded against succumbing to techno-solutionism – the flawed belief that every complex social problem has a technological fix. Governments are urged to resist seeking simplistic technological solutions for inherently intricate social issues.

Mental Health Europe advocates for a psychosocial approach to innovation, emphasising that mental health is not solely an individual concern but a societal one. Policymakers must recognise that mental health is influenced by socioeconomic, relational, and environmental factors, necessitating structural actions alongside technological solutions.

Social innovation

In the quest to meet the escalating mental health needs, we at Mental Health Europe suggest that real innovation lies not just in technological advancements but in the way we approach mental health care in our communities.

This collaborative approach is seen as the key to realising a vision of better mental health for all, where individuals flourish and fully enjoy their human rights.