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A revolutionary moment in the world's history is a time for revolutions, not for patching!

What has been the role of digital tools for mental health during the pandemic thus far, and how might it help health services identify challenges that are still to come?

The COVID-19 pandemic has been associated with a substantial amount of distress experienced by people both with and without a prior mental health diagnosis. However, the necessary restrictions of lockdown have limited physical access to mental health services. A study by Mansfield and colleagues published in The Lancet Digital Healthfound a substantial decrease in the number of primary care contacts for mental health conditions following the introduction of the first UK lockdown in March, 2020. This study highlights the need for alternative means of delivering mental health services.

Many services have risen to the challenge. Indeed, WHO found that, of 130 countries surveyed, 91 (70%) have adopted telemedicine or teletherapy for MHPSS, and evidence suggests these remote consultations have been effective at improving and treating mental health conditions, including anxiety and substance abuse. However, the percentage of adoption varies considerably between countries, being less than 50% in the 15 low-income countries surveyed, because of limited resources. Additionally, patient uptake of remote consultations can differ across sociodemographic factors, being lower in non-White ethnicities and in people aged 65 years and older. This digital divide is also apparent in the use of mobile apps. There are approximately 20 000 consumer-available mobile apps for mental health, and while some are supported by evidence of efficacy, not all are designed to be inclusive. The move to digital services is a promising start, but there is more to do. Now is the time to address the digital divide, ensure equitable access across a diverse population, and identify groups for whom digital services are not preferable or feasible, and who should be prioritised for different models of service delivery.

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