Digital mental health in schizophrenia and other severe mental illness: an international consensus on current challenges and potential solutions

Background: Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly in schizophrenia and severe mental illness (SMI).

Objectives: An international multidisciplinary group was convened to reach consensus on the challenges and potential solutions in collecting data, delivering treatment and the ethical challenges in digital mental health approaches in schizophrenia and SMI.

Methods: The consensus development panel method was used, with an in-person meeting of two groups: the expert group and the panel. Membership was multidisciplinary, including those with lived experience with equal participation at all stages, and co-production of the consensus outputs and summary. Relevant literature was shared in advance of the meeting and a systematic search of the recent literature on digital mental health interventions in schizophrenia and psychosis was completed to ensure the panel was informed before the meeting with the expert group.

Results: Four broad areas of challenge and proposed solutions were identified: (i) user involvement for real coproduction, (ii) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies and mechanistic research (iii) regulation and funding issues (iv) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, social and population-focussed approaches). Examples are provided with more detail on human-centred research design, lived experience perspectives and biomedical ethics in digital mental health approaches in SMI.

Conclusions: The consensus agreed on a number of recommendations: (i) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols) (ii) equal emphasis on social and population research as well as biological and psychological approaches (iii) meaningful collaborations across varied disciplines that have previously not worked closely together (iv) increased focus on the business model and product with planning and new funding structures across the whole development pathway (v) increased focus and reporting on ethical issues and potential harms (vi) organisational changes to allow true communication and coproduction with those with lived experience of SMI.
This approach, combining an international expert meeting with PPIE (patient and public involvement and engagement) throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas, and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields, to focus research and organisational change and effect improved real-world clinical implementation.

©Katharine A Smith, Amy Hardy, Anastasia Vinnikova, Charlotte Blease, Lea Milligan, Diego Hidalgo-Mazzei, Sinéad Lambe, Lisa Marzano, Peter J Uhlhaas, Edoardo G Ostinelli, Gerard Anmella, Caroline Zangani, Rosario Aronica, Bridget Dwyer, John Torous, Andrea Cipriani. Originally published in JMIR Mental Health (https://mental.jmir.org), 08.05.2024. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on https://mental.jmir.org/ , as well as this copyright and license information must be included