Resources to help you integrate digital tools into your mental health practice
This page collects and shares resources that can support the integration of digital mental health tools into the interaction between client and provider. The tools have a wide range of objectives, formats and audiences. The primary audience for this page is health care providers working in mental health in Canada who are looking for support in integrating digital health tools into their clinical practice.
Last update: March 2021
Health care providers and other providers in mental health care, including psychiatrists, psychologists, counsellors, psychotherapists, nurses, primary care physicians, social workers, occupational therapists and peer support workers
Health care providers and other providers in mental health care, including psychiatrists, psychologists, counsellors, psychotherapists, nurses, primary care physicians, social workers, occupational therapists and peer support workers
Administrators wishing to increase the uptake of digital mental health tools, such as program planners, digital health implementation specialists, information management / information technology specialists and process improvement specialists.
In addition, clients and caregivers are the audience for several of the resources on this page. We invite clients and caregivers to use the page to identify resources that might be helpful to them. The primary audience for this page will vary between organizations, depending on contextual factors such as size, policies and existing infrastructure. We encourage you to consult within your organization before implementing a resource listed here.
These types of tools remain relatively new. Much of the focus to date has been in helping users choose and integrate apps and in implementing digital mental health programs through comprehensive guides. The COVID-19 pandemic of 2020 resulted in a sharp increase in the use of telemedicine tools. However, many gaps remain.
This project is not:
Information on how to use a given resource is often provided in the resource itself. For many resources, it is self-evident. In the summary of each resource, we provide some basic information on how to use it.
Information on how to use a given resource is often provided in the resource itself. For many resources, it is self-evident. In the summary of each resource, we provide some basic information on how to use it.
When thinking about how you might use a resource in your clinical practice, consider the discussion in the next section on barriers and facilitating factors that influence the uptake of digital mental health tools.
Administrator: A person working in the mental health care sector who performs business operations roles that support the clinical care functions of an organization.
Administrator: A person working in the mental health care sector who performs business operations roles that support the clinical care functions of an organization.
App assessment resource: A resource that provides a generic model or framework that the user follows to evaluate an app of their choice; the resource does not provide an assessment of an app but rather guidance on how to assess an app.
App rating resource: A resource that provides summaries and expert ratings of different apps; the resource offers an expert assessment of different apps.
App selection tool: An interactive tool that provides access to a collection of apps. Apps are presented based on a series of questions or filters based on specific characteristics of the app, such as audience or type of therapy.
Caregiver: An informal care provider, such as a family member, friend or other social support, whom a client calls upon for help, care and support.
Client: A person who accesses mental health services or seeks mental health care.
Health care provider: A trained health professional or allied health worker who provides care and services to people looking for mental health care.
Implementation resource: A resource that provides information and guidance on how to establish and operate a program or practice that incorporates a digital mental health tool; these resources often target larger projects that involve changes to workflow and care practices.
Resource: A website, document, poster, or other material that can help to integrate different digital mental health tools into practice; for example, a website that reviews and rates apps can help identify the right tool for a client.
Resource collection: A collection of resources curated to focus on a particular topic.
Tool: An app, website, device or other digital mental health technology that is to be used by the client or the provider, together or separately; for example, a tool could be a cognitive behavioural therapy app.
App libraries
App Library (Health Navigator New Zealand) https://www.healthnavigator.org.nz/apps/
App libraries
App Library (Health Navigator New Zealand) https://www.healthnavigator.org.nz/apps/
Apps Library (National Health Service, United Kingdom) https://www.nhs.uk/apps-library/
Reviewed Mental Health Apps (Anxiety and Depression Association of America) https://adaa.org/finding-help/mobile-apps
App assessment frameworks
Guiding Principles for Physicians Recommending Mobile Health Applications (Canadian Medical Association) https://policybase.cma.ca/en/permalink/policy11521
Mobile Application Rating Scale (MARS) App Classification (Ministry of Health, New Zealand) https://www.health.govt.nz/system/files/documents/pages/guidance-evaluating-developing-health-app-oct17-v2.pdf
Implementation guides
Digital Health Implementation Playbook (American Medical Association) https://www.ama-assn.org/amaone/ama-digital-health-implementation-playbook
e-Mental health guide and strategic planning worksheet (ACCESS Open Minds) https://accessopenminds.ca/wp-content/uploads/dlm_uploads/2018/08/ACCESS-Open-Minds-eMental-Health-Guide-EN-vers20180723.pdf
Best Practice Guideline: Adopting eHealth Solutions: Implementation Strategies (Registered Nurses Association of Ontario) https://rnao.ca/sites/rnao-ca/files/bpg/Digital_Health_Guideline.pdf
Telemental health
Center for Care Innovations Resource Center (USA) https://www.careinnovations.org/resources/
Telepsychiatry toolkit (American Psychiatric Association) https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit
Therapy decision guides
Stepped Care Guide: A promising model to improve access to mental health care on campus (Memorial University, St. John’s, Newfoundland) https://campusmentalhealth.ca/wp-content/uploads/2019/07/Stepped-Care-Guide-V10.pdf
Therapy option guide (Anxiety and Depression Association of America) https://adaa.org/sites/default/files/final-therapygu_23840851_3ad732e6e2a37020f3ac49fcaf48f6305f631dcf_0.jpeg
Comprehensive web resources
E-Mental Health in Practice (Black Dog Institute, Australia) https://www.blackdoginstitute.org.au/education-training/health-professionals/emental-health-in-practice
Improving Patient-Centred Technology Use (iPaCT) Education and Evaluation Toolkit (University of Chicago) https://www.mededportal.org/publication/9953/
(Based on a literature search conducted in late 2019.)
Advances in technology continue to revolutionize the health care system and influence the practice of health care professionals.
(Based on a literature search conducted in late 2019.)
Advances in technology continue to revolutionize the health care system and influence the practice of health care professionals.
The COVID-19 world pandemic of 2020 provided additional impetus to use digital mental health tools, both to provide care while adhering to public health prevention guidelines and to support people manage the stress of the pandemic. Introducing digital tools and technology into the mental health care system has the potential to shorten wait times, increase access in rural and remote communities, and provide cost-effective access to care.(1) Research has demonstrated that many mental health care providers are aware of and ready to utilize these opportunities.
Nonetheless, several factors specific to mental health care need to be considered when implementing digital tools. One overarching consideration to keep in mind is that no single tool will work for everyone.(1) Other factors to consider are described below.
Potential uses
Enthusiasm for the use of digital tools is high among mental health care providers: in one survey, 98% of respondents said they were ready to use technology to support their clients.(2) Providers see the potential for digital health tools to increase access to mental health care and support for their clients.
There are many potential ways in which digital health tools may be used in mental health care. Here are a few examples:
Ethical, legal, privacy and confidentiality considerations
It is important to help clients to understand the ethical, legal, privacy and confidentiality considerations of digital tools. Areas to consider include:
Emergency and crisis situations
Face-to-face contact
Research shows that mental health care providers are beginning to incorporate digital health tools in providing ongoing face-to-face services.(6) They express strong interest in the ability of these tools to extend therapy beyond each individual session.(4) However, there are also concerns about this trend:
Reliability of digital tools and technologies
Providers may need to discuss the reliability of digital tools and technologies with clients. This may include discussing the challenges in choosing the most appropriate tool, especially for clients with complex and comorbid clinical presentations, or presentations that change over time.(2,7,11,12) It is possible that unintended consequences may arise from using digital mental health tools that lack empirical support.(7)
Not all providers may be open to using technology-based interventions, leading to additional skepticism about reliability.(11)
Logistical factors
Three logistical factors to consider are training, time, and the interaction between new tools and existing policy and procedures:
Additional considerations
References
Project team
Gillian Strudwick, RN, PhD, CAMH, Toronto
Project team
Gillian Strudwick, RN, PhD, CAMH, Toronto
David McLay, PhD, CAMH, Toronto
Leanne M. Currie, RN, PhD, University of British Columbia, Vancouver
Nicole Thomson, OT Reg. (Ont.), PhD, CAMH, Toronto
Eric Maillet, RN, PhD, University of Sherbrooke, Longueil
Janis Campbell, MEd, Memorial University of Newfoundland, St. John’s
Alanna Miller, BSc, McGill University, Montreal
Hwayeon Danielle Shin, BScN, RN, Dalhousie University, Halifax
Vanessa Strong, MSc, Memorial University of Newfoundland, St. John’s
Project genesis
In Canada, numerous digital health tools have been developed specifically for people with mental illness, which has the potential to lead to significant benefits. However, engagement of providers and clients with these tools is often inconsistent, and in many cases poor. Uptake needs to be improved for benefits to be realized. Some resources to support the uptake of these digital tools have been developed, but these resources are not well known and have not been consolidated into a single document. Thus, a project that aims to consolidate these resources was identified as a need. The project was completed in April 2020. An update to the resource list was completed in early 2021.
Version 1 of the resource collection: https://tinyurl.com/digitalMH
Guiding principles
Discussions by the project team, along with valuable feedback from stakeholders from across Canada—including those with lived experience of mental illness—led to the definition of guiding principles for the project. These principles include the following:
Goals and objective
The goals of this project are to:
Project design
The project was developed using methods recommended by the United States Agency for Healthcare Research and Quality (AHRQ) on toolkit creation.(16)
The project design including environmental scan (participants list below), grey literature search methodology (lists of organizations included below), and workshop are published in:
Strudwick G, McLay D, Lo B, Shin HD, Currie L, Thomson N, Maillet E, Strong V, Miller A, Shen N, Campbell J. Development of a Resource Guide to Support the Engagement of Mental Health Providers and Patients with Digital Health Tools: A Multi-method Study
J Med Internet Res. 2021 Apr 22;23(4):e25773.
https://doi.org/10.2196/25773
Environmental scan participants
Organizations included in original grey literature scan
Mental health organizations
Medical organizations or hospitals
Client organizations or websites
Governmental organizations
Other
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Digital Mental Health Lab / Dr. Gillian Strudwick
Canada Health Infoway
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Project commissioned by Canada Health Infoway.
This project is a collaboration between the Centre for Addiction and Mental Health (CAMH) and Canada Health Infoway, in consultation with many stakeholders from across Canada.
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