Cautious Interest: Stakeholder Perspectives on the Value of a Digital Mental Health Clinic in Aotearoa

<p dir="ltr">Evidence-based digital mental health interventions can be effective and scaled up to serve large numbers of people; however, user engagement is often low. Digital mental health clinics, where practitioners collaborate with clients to support them, assess their needs, and guide them in selecting and using digital interventions, have been implemented in several countries. I aimed to explore key stakeholders’ perspectives on whether and how such a model might offer opportunities to improve mental health service provision or support in Aotearoa.</p><p dir="ltr">To achieve this, I carried out semi-structured interviews (n=5), two co-design workshops (n=17) involving diverse whole-group, small-group, and written activities, and follow-up email questionnaires (n=3). Participants were a purposive sample of Aotearoa leaders and experts in mental health policy and service delivery, digital mental health, and psychology or health research, as well as mental health practitioners and workers with lived experience.</p><p dir="ltr">I created transcripts and written summaries of all data collected across these interviews, workshops, and questionnaires, and analysed these in relation to my overall research questions using thematic analysis. I developed five themes: First, <i>Mental health is tapu, it is important to get this right</i>, emphasised the important nature of work in mental health and the critical need for safe, effective, and culturally appropriate support. Second, <i>“We are creatures of habit” – caution and hesitancy around change</i>, explored apprehension toward virtual and digital approaches and the resistance that can accompany new approaches to mental health care. Third, <i>Human support is essential, we feel that digital is not enough</i>, reflected the benefits of human support and the need for it to be a central component of a digital clinic. Fourth, <i>Logistics matter</i>, highlighted the importance participants placed on the digital clinic model and how it is implemented in determining its success. The fifth and concluding theme, <i>Cautious optimism and cautious interest</i>, captured both the opportunities a digital clinic presents, such as supporting those who face barriers to accessing services and those on waitlists or who do not meet service criteria, as well as participants’ concerns, including virtual risk assessment and the ‘digital divide’ contributing to inequity in access. I conclude by discussing implications and suggestions for implementation of a digital clinic in Aotearoa.</p><p dir="ltr">My findings suggest there is potential value in a digital clinic in Aotearoa alongside, and not replacing, Aotearoa’s mental health services. Safety, equity, accessibility, and human support must be at the forefront to ensure that a digital clinic adds to the capacity of mental health services to better reach and meet the needs of diverse groups. Further research should explore the needs of indigenous and minoritised populations, costs, benefits, policy alignment, and opportunities for appealing and effective piloting.</p>