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

Article


Smith, K., Hardy, A., Vinnikova, A., Blease, C., Milligan, L., Hidalgo-Mazzei, D., Lambe, S., Marzano, L., Uhlhaas, P., Ostinelli, E., Anmella, G., Zangani, C., Aronica, R., Dwyer, B., Torous, J. and Cipriani, A. 2024. Digital mental health in schizophrenia and other severe mental illness: an international consensus on current challenges and potential solutions. JMIR Mental Health. 11, pp. 1-22. https://doi.org/10.2196/57155
TypeArticle
TitleDigital mental health in schizophrenia and other severe mental illness: an international consensus on current challenges and potential solutions
AuthorsSmith, K., Hardy, A., Vinnikova, A., Blease, C., Milligan, L., Hidalgo-Mazzei, D., Lambe, S., Marzano, L., Uhlhaas, P., Ostinelli, E., Anmella, G., Zangani, C., Aronica, R., Dwyer, B., Torous, J. and Cipriani, A.
Abstract

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.

KeywordsDigital; mental health; severe mental illness; consensus; lived experience; ethics; user-centred design; patient and public involvement
Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
PublisherJMIR Publications
JournalJMIR Mental Health
ISSN
Electronic2368-7959
Publication dates
Print08 May 2024
Publication process dates
Submitted07 Feb 2024
Accepted21 Mar 2024
Deposited27 Mar 2024
Output statusPublished
Publisher's version
License
File Access Level
Open
Copyright Statement

©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

Web address (URL)https://mental.jmir.org/2024/1/e57155
Digital Object Identifier (DOI)https://doi.org/10.2196/57155
PubMed ID38717799
PubMed Central ID11112473
LanguageEnglish
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The impact of personal psychotherapy and supervision on volunteer counsellors.
Ciclitira, K., Marzano, L., Starr, F., Brunswick, N., Costa, A. and Berger, S. 2009. The impact of personal psychotherapy and supervision on volunteer counsellors. 2009 BPS Annual Conference. Brighton, UK 01 - 03 Apr 2009
Supporting staff working with prisoners who self harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales
Marzano, L. and Adler, J. 2007. Supporting staff working with prisoners who self harm: a survey of support services for staff dealing with self-harm in prisons in England and Wales. International Journal of Prisoner Health. 3 (4), pp. 268-282. https://doi.org/10.1080/17449200701682501
Afghan nationals in the UK: professional capacity and views on return
Sales, R., Blitz, B. and Marzano, L. 2002. Afghan nationals in the UK: professional capacity and views on return. Research commissioned by Refugee Action and the International Organization for Migration, London..
Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study
Rivlin, A., Hawton, K., Marzano, L. and Fazel, S. 2010. Psychiatric disorders in male prisoners who made near-lethal suicide attempts: case-control study. The British Journal of Psychiatry. 197 (4), pp. 313-319. https://doi.org/10.1192/bjp.bp.110.077883
Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study
Marzano, L., Fazel, S., Rivlin, A. and Hawton, K. 2010. Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study. The British Journal of Psychiatry. 197 (3), pp. 219-226. https://doi.org/10.1192/bjp.bp.109.075424
Visuospatial superiority in developmental dyslexia: myth or reality?
Brunswick, N., Martin, G. and Marzano, L. 2010. Visuospatial superiority in developmental dyslexia: myth or reality? Learning and Individual Differences. 20 (5), pp. 421-426. https://doi.org/10.1016/j.lindif.2010.04.007
Justice and care: theorising the 'new man' and the 'caring father.'
Marzano, L., Capdevila, R., Ciclitira, K. and Lazard, L. 2009. Justice and care: theorising the 'new man' and the 'caring father.'. Psychology of Women Secton Review. 11 (2), pp. 11-20.
Theoretical and ethical issues in conducting research at a women’s centre.
Ciclitira, K. and Marzano, L. 2004. Theoretical and ethical issues in conducting research at a women’s centre. Proceedings of the British Psychological Society. 12 (2).
Being a man: justice and care.
Capdevila, R., Ciclitira, K., Lazard, L. and Marzano, L. 2006. Being a man: justice and care. Psychology of Women Section Annual Conference 2005.. University of Huddersfield. The British Psychological Society.
Theoretical and ethical issues in conducting research at a women’s health centre.
Ciclitira, K., Marzano, L., Brunswick, N., Starr, F. and Berger, S. 2004. Theoretical and ethical issues in conducting research at a women’s health centre. Psychology of Women Section Review. 6 (1), pp. 60-69.
Non voluntary return? The politics of refugee return to Afghanistan
Sales, R., Blitz, B. and Marzano, L. 2005. Non voluntary return? The politics of refugee return to Afghanistan. Political Studies. 53 (1), pp. 182-200.