Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy

Abstract

Background Globally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users’ needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care. Objective Project Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms. Methods Participating health care organizations included the following: Open Arms–Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]); NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads); the Butterfly Foundation’s National Helpline for eating disorders; Kildare Road Medical Centre for enhanced primary care; and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention. Results Despite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted. Conclusions Although the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care.

Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: a mixed-methods approach to understanding clinicians’ perspectives

“…Acknowledging health professionals’ attitudes towards virtual care is important as they are key actors in its successful implementation. Health professionals are more likely to accept changes they are prepared for [ 34 , 35 ], that they value, and that will likely lead to direct patient benefits [ 35 ]. Initial attitudes towards virtual care may be especially important because mental health professionals who endorsed lower perceived quality of online therapeutic relations and had more negative attitudes towards online therapy and its efficacy before having used it also eventually reported more obstacles during its use [ 36 ].…”

Unpeeling the onion: Digital triage and monitoring of general practice, private psychiatry, and psychology

“…As shown in Figure 1, the main elements of the proposed DTM model are as follows: Under the DTM model, patients would initially access a federally funded digital platform and complete a series of routine self-report questionnaires. 4 Algorithms would then triage patients to the following levels of care based on severity: self-management (e.g. apps and e-tools), ambulatory care (e.g.…”

“…public hospital emergency departments). 4 In the DTM model, PHNs would commission NGOs to provide regional coordination services to oversee digital triage (Figure 1). These technology-enabled NGO services would displace GPs from their central roles as patient advocates including relational support and care coordination.…”

“…5 The trial aimed to assess outcomes for patients, health professionals, and regional services. 4,8 The final report on Project Synergy, available under a Freedom of Information request, indicates that only one patient was deemed eligible by the regional NGO to use the Project Synergy digital platform during the 8-month trial. 5 Thus, the recruitment rate was approximately 1/500, 000 in North Coast NSW, so there was no opportunity to assess the outcomes of DTM for patients, health professionals, and regional services.…”

“…Despite these limited real-world outcomes, the technology-enhanced pathway of care developed in the North Coast trial forms the basis for the DTM model. [2][3][4]8,9 In the absence of substantive evidence of better real-world outcomes, the DTM model appears to be reliant on theoretical modelling. There is good reason, however, to doubt the accuracy of this kind of modelling, which forecasts substantial increases in population distress and suicide in Australia during the COVID-19 pandemic that did not eventuate.…”