User involvement in digital mental health: approaches, potential and the need for guidelines

Over the past decades, the importance of mental health is increasingly being acknowledged, with more people reaching out for help. However, mental healthcare struggles to help all in need. Those finding their way to formal services face long waiting lists, while for others, the associated stigma is still too large to reach out. Both cases result in unmet needs, which remain a pressing issue. One attempt to overcome these challenges is to rely on digital mental health, the use of technology for mental health interventions, ranging from promotion, prevention, and treatment to maintenance. Technologies can for example include computers and smartphones, extended reality, wearables, social media, chatbots (1) and may or may not make use of artificial intelligence. A wealth of evidence already supports the efficacy and effectiveness of online interventions for common mental health conditions, such as depression and anxiety in older adults (2), and in adolescents and young people (3) as well as – to a lesser extent - their cost-effectiveness (4). Despite this potential, successful implementation of these interventions and other forms of digital mental health has proven to be challenging, particularly concerning adaptation, uptake and adherence (5). As this is a multifaceted challenge a single solution is non-existent. Addressing this challenge requires taking into account many aspects and perspectives, with implementation sciences gaining increased attention as a result. In this opinion paper, we highlight user involvement as one important aspect in the development, implementation and international adaptation of digital mental health interventions which, to date, still often seems to be overlooked. In the following paragraphs we will define the concept, highlight the potential of involving users to facilitate uptake of digital mental health, and argue for the need for clear guidelines on how to do so, not only for initial development, but also for subsequent international adaptation.