Mental Wellness Self-care in Singapore with mindline.sg: A Framework for the Development of a Digital Mental Health Platform for Behaviour Change (Preprint)

Abstract

BACKGROUND Singapore, like the rest of Asia, faces persistent challenges to mental health promotion including stigma around unwellness and seeking treatment, low mental health literacy, a lack of trained mental health personnel, and underdevelopment of mental healthcare ecosystems. The COVID-19 pandemic created a surge in mental healthcare needs, giving new impetus to addressing these shortcomings. The pandemic situation also accelerated the acceptance and adoption of digital health solutions, creating a new opportunity for innovative approaches to quickly scale solutions to address mental healthcare needs in the region. OBJECTIVE In June 2020, a subsidiary of the Singaporean government launched mindline.sg, a digital mental health resource website that has grown to include over 500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an AI chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. Carefully selected resources on causative factors (such as financial and employment stress) are also provided. The platform was developed to be anonymous and to contain authoritative and localised content at multiple levels of progressive engagement. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution. METHODS Website utilisation is primarily measured through click-level data analytics captured via Google Analytics and custom APIs, which in turn drive a customised analytics infrastructure based on Metabase. Unique, non-bounced, engaged, and return users are reported. Self-assessments are recorded only if completed, and Wysa AI chatbot usage is only measured if a user lands on Wysa’s platform. RESULTS In the two years following launch (1 July 2020 through 30 June 2022), the website received over 447,000 visitors (about 15% of the target population of three million), 62% of which explore the site or engage with resources, and about 10% of those engaged users return. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.5% and 10.8% of non-bounced visitors, respectively. On mindline at work, the rates of non-bounced visitors who explored the site (i.e., spent 40 seconds or more exploring resources) and who returned were 51.6% and 13.4% over a year, respectively, compared to 35.2% and 11.4%, respectively, on the generic mindline.sg site in the same year. CONCLUSIONS The site has achieved desired reach and has seen a strong growth rate in the number of visitors. Substantial and sustained digital marketing campaigns and strategic outreach partnerships, supported by an appropriate analytics infrastructure, are required to achieve this level of reach for such a platform. The site was careful to preserve anonymity, limiting the detail of analytics. Nevertheless, it was observed that the digital therapeutic exercises delivered by the AI chatbot and the self-assessment tool were among the most popular features of the site and improved user engagement. The customised site for working adults appears to have achieved higher engagement than the site designed for the general population. The good levels of overall adoption encourage us to believe that mild-to-moderate mental health conditions, and the social factors that underly them, are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customisation are widely and globally applicable.

Perceptions of a Digital Mental Health Platform Among Participants With Depressive Disorder, Anxiety Disorder, and Other Clinically Diagnosed Mental Disorders in Singapore: Usability and Acceptability Study

“…In June 2020, the Ministry of Health Office for Healthcare Transformation, a subsidiary of the Ministry of Health, launched mindline.sg [ 7 ], an anonymous, digital mental health platform. This platform was developed to empower users in Singapore with knowledge, tools, and pathways to self-care as well as resources to help individuals seek out professional help when needed [ 8 ]. The website has since rapidly expanded to now include more than 500 curated resources, a self-assessment tool, and an emotionally intelligent artificial intelligence chatbot from Wysa that deploys a suite of interactive digital therapeutic exercises based on cognitive behavioral therapy.…”