Evaluating the promise of health IT to enhance/expand the reach of mental health services

“The concept of “reach” as described in the RE-AIM framework [1] refers to the proportion of diverse consumer groups who receive adequate, appropriate and timely mental health (MH) services.”

“Access to quality MH care is limited for nearly all populations but is particularly limited for vulnerable populations such as the oldest and youngest persons, racial/ethnic minorities, the socioeconomically disadvantaged and rural populations [2–10].”

“A recent analysis of the unmet need for psychological services [43] recommends capitalizing on advances in technology to reduce the burden of mental illness.”

“Even if HIT interventions are found to have lower potency, they may still have a role to play in a progression of interventions such as a stepped-care sequence of treatments from least to most intensive/ costly [56–58].”

“Providerlevel barriers can include bias and stigmatizing beliefs [13], discomfort with assessing and treating MH conditions [14], beliefs about treatment (in)effectiveness, resource and time constraints, and burnout [15].”

“Health information technologies (HITs) such as smart phones, apps or desktop software, and the Internet hold enormous promise for significantly expanding the reach of quality MH care [22] by addressing several of these barriers.”

“Even if HIT interventions are found to have lower potency, they may still have a role to play in a progression of interventions such as a stepped-care sequence of treatments from least to most intensive/ costly [56–58].”

“in rural and low-income counties [12].”

“Providerlevel barriers can include bias and stigmatizing beliefs [13], discomfort with assessing and treating MH conditions [14], beliefs about treatment (in)effectiveness, resource and time constraints, and burnout [15].”

“Access to quality MH care is limited for nearly all populations but is particularly limited for vulnerable populations such as the oldest and youngest persons, racial/ethnic minorities, the socioeconomically disadvantaged and rural populations [2–10].”

“limited capacity while offering greater efficiencies and catering to the desires of some consumers to minimize travel and/or receive services at times other than usual office hours [24,25,27].”

“Access to quality MH care is limited for nearly all populations but is particularly limited for vulnerable populations such as the oldest and youngest persons, racial/ethnic minorities, the socioeconomically disadvantaged and rural populations [2–10].”

“limited capacity while offering greater efficiencies and catering to the desires of some consumers to minimize travel and/or receive services at times other than usual office hours [24,25,27].”

“Patient-level barriers include cost [16], health-insurance coverage, distance to MH providers [8,17,18], lack of English proficiency [19], stigma [20] and consumer discomfort with disclosure [21].”

“Telepsychiatrydelivered therapy appears to yield clinical benefits equivalent to face-to-face therapy [59–61], and several studies have found greater cost savings or cost efficiency relative to usual care, face-to-face”

“While a few trials currently under way compare HIT-enabled interventions to traditional treatments [53] and/or include economic analyses [54,55], much more research is needed in this area of study.”

“Telepsychiatrydelivered therapy appears to yield clinical benefits equivalent to face-to-face therapy [59–61], and several studies have found greater cost savings or cost efficiency relative to usual care, face-to-face”

“Many individuals who might otherwise benefit from MH treatments are reluctant to initiate care because of stigma [20]; discomfort with disclosure or with talking about private topics with an unfamiliar person [21]; fear of loss of confidentiality; or, in the case of pharmacotherapy, ambivalence about medications and/o…”

“Many individuals who might otherwise benefit from MH treatments are reluctant to initiate care because of stigma [20]; discomfort with disclosure or with talking about private topics with an unfamiliar person [21]; fear of loss of confidentiality; or, in the case of pharmacotherapy, ambivalence about medications and/o…”

“While a few trials currently under way compare HIT-enabled interventions to traditional treatments [53] and/or include economic analyses [54,55], much more research is needed in this area of study.”

“Access to quality MH care is limited for nearly all populations but is particularly limited for vulnerable populations such as the oldest and youngest persons, racial/ethnic minorities, the socioeconomically disadvantaged and rural populations [2–10].”

“Patient-level barriers include cost [16], health-insurance coverage, distance to MH providers [8,17,18], lack of English proficiency [19], stigma [20] and consumer discomfort with disclosure [21].”

“Patient-level barriers include cost [16], health-insurance coverage, distance to MH providers [8,17,18], lack of English proficiency [19], stigma [20] and consumer discomfort with disclosure [21].”

“Many individuals who might otherwise benefit from MH treatments are reluctant to initiate care because of stigma [20]; discomfort with disclosure or with talking about private topics with an unfamiliar person [21]; fear of loss of confidentiality; or, in the case of pharmacotherapy, ambivalence about medications and/o…”

“This is in recognition that not all consumers need or desire the most intensive of interventions and that lower-cost (and potentially lower-benefit) HIT-enabled interventions may be sufficient for a significant proportion of persons with less severe conditions [58].”

“The recent passage of MH parity legislation [41] and the possible”

“Some trials have evaluated HIT prevention programs, most with positive benefits [47–52].”

“Patient-level barriers include cost [16], health-insurance coverage, distance to MH providers [8,17,18], lack of English proficiency [19], stigma [20] and consumer discomfort with disclosure [21].”

“services in both observational samples and randomized clinical trials [62–64].”

“Many individuals who might otherwise benefit from MH treatments are reluctant to initiate care because of stigma [20]; discomfort with disclosure or with talking about private topics with an unfamiliar person [21]; fear of loss of confidentiality; or, in the case of pharmacotherapy, ambivalence about medications and/o…”

“Telepsychiatrydelivered therapy appears to yield clinical benefits equivalent to face-to-face therapy [59–61], and several studies have found greater cost savings or cost efficiency relative to usual care, face-to-face”

“Providerlevel barriers can include bias and stigmatizing beliefs [13], discomfort with assessing and treating MH conditions [14], beliefs about treatment (in)effectiveness, resource and time constraints, and burnout [15].”

“Several trials have tested Internet or other HIT-enabled therapist training programs [32–40].”

“Early examples include self-assessment Internet sites to assist victims of the 2004 Indian Ocean Tsunami with evaluating whether they needed help for posttraumatic stress disorder or other MH difficulties [28]; Internet monitoring of MH outcomes following Hurricane Katrina [29]; a feasibility pilot of an Internet-deli…”

“telepsychiatry than for traditional face-to-face services [65], especially as expensive new equipment is first put into place and large”

“limited capacity while offering greater efficiencies and catering to the desires of some consumers to minimize travel and/or receive services at times other than usual office hours [24,25,27].”

“consumer willingness to seek subsequent traditional MH treatment, although at least one study failed to find such a result [46].”

“Some trials have evaluated HIT prevention programs, most with positive benefits [47–52].”

“Several trials have tested Internet or other HIT-enabled therapist training programs [32–40].”

“services in both observational samples and randomized clinical trials [62–64].”

“Access to quality MH care is limited for nearly all populations but is particularly limited for vulnerable populations such as the oldest and youngest persons, racial/ethnic minorities, the socioeconomically disadvantaged and rural populations [2–10].”

“services in both observational samples and randomized clinical trials [62–64].”

“Several trials have tested Internet or other HIT-enabled therapist training programs [32–40].”

“Access to quality MH care is limited for nearly all populations but is particularly limited for vulnerable populations such as the oldest and youngest persons, racial/ethnic minorities, the socioeconomically disadvantaged and rural populations [2–10].”

“up-front costs have yet to be spread across a higher patient volume [66].”

“Several trials have tested Internet or other HIT-enabled therapist training programs [32–40].”

“efforts to develop telepsychiatry (virtual consultation), clinical decision support tools and online treatment algorithms [24–27].”

“try, there are still barriers to more widespread adoption — one being the difficulty in obtaining reimbursement for such services [67]”

“Early examples include self-assessment Internet sites to assist victims of the 2004 Indian Ocean Tsunami with evaluating whether they needed help for posttraumatic stress disorder or other MH difficulties [28]; Internet monitoring of MH outcomes following Hurricane Katrina [29]; a feasibility pilot of an Internet-deli…”

“HIT interventions have potential to reach a wide geographic area via remote delivery of care [23]; to decrease the costs in delivering self-help and/or social networking”

“Some trials have evaluated HIT prevention programs, most with positive benefits [47–52].”

“Several trials have tested Internet or other HIT-enabled therapist training programs [32–40].”

“Patient-level barriers include cost [16], health-insurance coverage, distance to MH providers [8,17,18], lack of English proficiency [19], stigma [20] and consumer discomfort with disclosure [21].”

“Several trials have tested Internet or other HIT-enabled therapist training programs [32–40].”

“Early examples include self-assessment Internet sites to assist victims of the 2004 Indian Ocean Tsunami with evaluating whether they needed help for posttraumatic stress disorder or other MH difficulties [28]; Internet monitoring of MH outcomes following Hurricane Katrina [29]; a feasibility pilot of an Internet-deli…”

“Early examples include self-assessment Internet sites to assist victims of the 2004 Indian Ocean Tsunami with evaluating whether they needed help for posttraumatic stress disorder or other MH difficulties [28]; Internet monitoring of MH outcomes following Hurricane Katrina [29]; a feasibility pilot of an Internet-deli…”

“TMH Like telemedicine/telehealth,(16) TMH is a broad term referring to the provision of mental healthcare at a distance.(17)”

“Chatbots lack the ability to understand and respond to complex human emotions (Clarke and Yarborough, 2013).”

“Clarke and Yarborough described this effect as a lowering of threshold of entry-level mental health services so that it extends the reach of care to people who do not seek traditional treatment for depression [5].”

“Other investment-related barriers include lack of budget for digital care [44, 71, 102, 110, 116], the high cost of technology maintenance [92].”

“19–21 DHTs have created opportunities to develop a better understanding of MI and potentially improve the outcomes for patients with chronic mental health conditions in a variety of ways.”

“5 Although studies show the potential benefits and utility of such applications (apps) in mental health, 6,7 translating these ideas and early research into clinical tools in the hands—and on the mobile devices—of patients has received less attention.”

“[32,33] In this context, tele‐psychiatry increases both accessibility and availability of behavioral health services while reducing the overall cost and the burden on practitioners who can the better focus on providing care for the more severely affected patients.[34,35] In addition to fulfilling the critical role as…”

“The traditional models of counseling and appointment management may no longer be adequate for some college students, who may prefer readily available, constantly accessible tools (17).”

“Access to adequate-quality mental health care is also limited for many populations but is particularly limited for vulnerable groups such as the elderly and youth populations, racial and ethnic minorities, the socioeconomically disadvantaged, and rural populations [2].”

“such as geriatric mental health, necessitate more trials with PST tele-health modalities.(40)”

“Access to quality care is especially difficult for disadvantaged and vulnerable populations, including children; Aboriginal and Torres Strait Islander young peoples; young people from culturally and linguistically diverse backgrounds; and young people living in regional, rural, and remote areas [14,15].”

“However, access to treatment is problematic [4] given the acknowledged barriers such as high treatment cost, time constraints [4], geographical location [5], and stigma [4-7].”

“Numerous studies have discussed the barriers to tele-medicine (Brooks et al., 2013; Clarke & Yarborough, 2013; Lauckner & Whitten, 2015; Weinstein et al., 2014), the best practices for setting up telepsychiatry practice, and the effectiveness of telepsychiatry (Di Cerbo et al., 2015; Lilly et al.,…”

“Healthcare Information Technology solutions have the potential to address many of these issues [15].”

“26,28 However, the evidence base now also suggests that integrating online health information technologies with face- to-face services can: • promote universal access to services, regardless of location, vulnerability or socio-economic status; 29,30 • increase disclosure to facilitate a stepped…”

“It is possible that efforts and initiatives to expand phone and internet access to bigger segments of the population could particularly benefit rural residents (Clark & Yarborough, 2013).”

“Utilizing such technologies can help solve the access problem and enable us to extend our clinical reach into underserved populations without significantly expanding our workforce [7].”

“Digital technologies are growing rapidly and have the potential to shape the quality, scale, and method of depression care delivery (Clarke & Yarborough, 2013; Mohr, Burns, Schueller, Clarke, & Klinkman, 2013).”

“They are especially useful for reaching users who are less likely to seek professional support offline due to common barriers [89] such as high treatment cost, time constraints [71], geographical location [17], and stigma [71] [17] [110].”

“Indeed, researchers feel that additional research is required on the use of digital methods and applications, obstacles to implementation and their cost effects (Clarke & Yarborough, 2013; Hopia, Punna, Laitinen, & Latvala, 2015).”

“The introduction of smart technology into mental health treatment for youth is a natural next step toward a more sustainable and innovative mental health care system [43, 44].”

“Further, technology-based interventions have the ability to refer at-risk individuals to inperson treatment (Clarke and Yarborough 2013).”

“A recent review of health information technologies such as smartphones, apps or desktop software, and the Internet emphasized the promise of utilizing these technologies to increase reach, especially in rural and low-income regions.(79) However, the authors also highlight the limited evidence in support of these appro…”

“The convergence of sensor, global positioning, vocal pattern, and other data associated with mobile technologies can be overwhelming to many clinicians, though the effect of such data on the therapeutic relationship is also under-researched (Clarke and Yarborough, 2014).”

“…messaging has previously been shown to be a useful and efficient means of educating patients on sensitive health-related issues that require confidentiality and security, such as HIV prevention [19], mental health [20], sexually transmitted infection management [21], and smoking cessation [22-24].”

“TMH is the use of remote technologies such as video-conferencing systems to deliver MH care [6].”

“More and more, interventions are being designed to provide information directly to the consumer and to capitalize on technological advances (Clarke & Yarborough, 2013).”

“Psychosocial dynamics influence low-income Hispanic diabetes and depression treatment experiences and preference, calling for use of patient-centered approaches [54,55].”

“Residentially vulnerable populations, such as residents of rural areas, medically underserved areas (MUAs), and critical mental health provider shortage areas (MHPSAs), are particularly limited in their access to effective mental health treatment [5].”

“Strong stigmatizing attitudes and beliefs toward mental health disorders are other key factors that have resulted in a wide treatment gap and reluctance in the help-seeking process across the globe (Clarke & Yarborough, 2013; Corrigan, 2004; Henderson, Evans-Lacko, & Thornicroft, 2013).”

“Previous reviews in this field have focused on: (i) the effectiveness of digital technologies for the treatment of mental health disorders [7–11]; (ii) health or mental health systems’ needs, challenges and barriers, without including digital technologies [45, 46]; (iii) financial and health resource benefits that dig…”

“However, these treatments are predominantly delivered via individual or group psychotherapy and thus have limited reach [15-18].”

“For some patients living in social isolation those services may be an incentive to seek help online (Clarke & Yarborough, 2013); for instance, patients suffering from social phobia (Löhr, Rosenvinge, & Wynn, 2011).”

“Technologyassisted therapy provides a promising solution to support student counselling, but the feasibility and effectiveness of doing so are unknown [3, 4].”

“001) so that the anxiety decreased in study group.[27] Burns et al.”

“However, certain benefits of an online mode of psychoeducation include cost-saving, convenience [64, 65], and flexibility in terms of scheduling, and thus can be structured around participants’ availability.”

“Technologybased interventions have offered the opportunity to increase access, improve engagement, and expand the availability of resources for individuals with depression and anxiety (Ahmedani, Crotty, Abdulhak, & Ondersma, 2015; Clarke & Yarborough, 2013).”

“Developments in telepsychiatry hold some utility in extending the reach of psychiatrists and facilitating collaborative care.(36,37) However, substituting in-person psychiatrist-patient interaction with telecommunications is not without concern regarding community integration, mentoring, and interpersonal exchanges of…”

“measures that should be addressed ([3, 4, 12, 13]).”

“Thus, there is a significant need for psychosocial and biopsychosocial HIT research (Clarke & Yarborough, 2013; Druss & Dimitropoulos, 2013; Haberer, Trabin, & Klinkman, 2013; Mohr, Burns, Schueller, Clarke, & Klinkman, 2013; Pagoto & Bennett, 2013; Schickedanz et al., 2013).”

“Email: ell@usc.edu clinicians’ practices, and hence, organizational leaders are calling for health information technology research (Clarke & Yarborough, 2013; Druss & Dimitropoulos, 2013; Haberer, Trabin, & Klinkman, 2013; Lyles et al., 2013; Mohr, Burns, Schueller, Clarke, & Klinkman, 2013;…”

“Interactive mobile health (mHealth) apps and websites themselves have great potential for enhancing wellness and decreasing the cost of care while extending resources to un-derserved populations (Clarke and Yarborough 2013).”

“…lives of young people [16,17], the Internet has demonstrated its potential to overcome many of the barriers to accessing mental health services [18], evolving as a popular, efficient, and clinically effective means of delivering empirically supported psychological interventions to the public,…”

“The concept of reach in implementation science is often defined as the proportion of individuals who are willing to participate in services or who receive timely and adequate services [4–6].”

“…for the treatment and rehabilitation of patients – these are just a few of the organizational changes which are increasingly being used in psychiatry in various countries (Carroll & Rounsaville, 2010; Clarke & Yarborough, 2013; Kraus et al., 2010; Larsen et al., 2016; Wright & Wright, 1997).”