The challenges of designing novel digital mental health services for use in community settings

The use of digital interventions is becoming more common throughout industry and the health sector. The implementation of digital services allows for clients to gain access to app-based treatment more flexibly than they would if waiting for traditional in-person sessions, allowing for improvements in preventative services. This allows in-person sessions to be offered to clients needing more intensive care. Despite the clear benefit of increased accessibility and flexibility, digital mental health interventions pose a number of challenges. Interest in digital interventions is increasing due to improvements in awareness; however, many users may find it difficult to engage with these services. Clients from deprived areas may have interest in accessing digital services, but may require additional support. Rural communities are more at risk of digital exclusion due to poor broadband connectivity making core services less accessible. User retention remains a significant issue in this sector. In randomised trials, retention rates for mental health intervention applications remain below 50%, with a reduced rate being observed for web-based solutions. Figures show engagement dropping by 30% within one day of app installation, with this figure dropping to 10% within a week. The efficacy of mental health interventions cannot be assessed from outcome assessment and retention rates alone. Ecological momentary assessments and event logs can provide an additional layer of anonymised user data that illustrates how clients interact with digital services. Engagement rates can vary based on time of day, and type of assessment, including media, tone and content. When designing digital mental health services, user demographics may be considered to ensure maximum engagement with momentary assessments. In turn, this data can be used to refine the application and improve the quality of care being offered.