The International Society for Research on Internet Interventions (ISRII) hosted its 12th Scientific Meeting in Limerick, Ireland from 2-5 June 2024. The conference hosted 435 attendees from around the world and featured over 350 presentations on eHealth advancements focusing on behavioural, mental, and psychosocial health.

eMHPrac Director Heidi Sturk gave a presentation about building health workforce capability to utilise digital mental health. Heidi also attended numerous sessions from speakers around the world and noted that Australian researchers are making a significant contribution to research in this space.

The conference highlighted a range of innovative research work including:

• Development of blended care models that combine traditional and digital services to enhance effectiveness and accessibility
• Digital competence frameworks and e-learning programs to integrate digital skills into clinical training and enable practitioners to use digital tools effectively
• Industry partnerships
• Tailored digital platforms for children and adolescents
• VR applications to treat phobias, social anxiety, and PTSD with immersive therapies
• National digital CBT services to expand access to mental health resources
• Implementation plans to guide the integration of digital mental health services into healthcare organisations.Top of Form

Summaries from a selection of presentations are outlined below.

A digital competence framework for psychological practitioners.

Professor Helen Pote and Dr Alesia Moulton-Perkins, University of London

A digital competence framework for psychological practitioners in the UK aims to integrate digital skills into clinical training. Initiated in 2017 and supported by the British Psychological Society, the framework progressed through mapping current training, defining competences, and rolling out eLearning by 2023. Challenges include outdated NHS IT infrastructure, lack of digital competence among trainers, and fitting digital training into existing curricula. The framework outlines core and advanced competencies, covering areas like clinical governance, assessment, intervention, research, and communication. Implementation support includes eLearning, a Digital Skills Book, and the DCAPP measurement tool. The framework emphasizes ethical practice, legal requirements, and the ability to maintain therapeutic alliances online.

Developing and evaluating an e-learning package to develop psychological practitioners digital competency.

Dr Alesia Moulton-Perkins, Gemma Rides, University of London and Graham Threw, University of Oxford

An e-learning package has been developed to enhance digital competencies among psychological practitioners in the UK. The modules cover client-therapist interactions, therapeutic interventions, and supervision in digital practice. Evaluated with trainee clinical psychologists, the e-learning showed significant improvements in digital competence, knowledge, abilities, and confidence. Qualitative feedback highlighted the program’s informativeness and engagement but noted issues with comprehensiveness and video length. Despite some reservations regarding privacy and ethical concerns, the e-learning package is deemed effective for workforce development.

Working collaboratively with XR digital industries to develop effective products and digital competencies.

Professor Helen Pote, University of London

This presentation emphasized the importance of collaboration between psychology and digital industries to develop digital practice skills. This partnership enhances innovation, implementation, and evaluation of digital mental health interventions, ensuring they are ethical, evidence-based, and quality-controlled. Psychologists contribute clinical expertise, engagement, understanding, and ethical insights, while industry partners provide technological and business acumen. Real-life examples, like the “Dragons of Afterlands” game, show how co-design and rigorous testing can improve adolescent well-being. Collaboration develops competences in digital consultation, research, and ethical practice for both practitioners and industry partners.

All talk, tech and transformation: Adoption of digital psychological interventions for common mental health disorders in England.

Dr James Woollard, Psychiatrist, Oxleas NHS Foundation Trust

This presentation highlighted the adoption of digital psychological interventions for common mental health disorders in England. Key milestones included the launch of the NHS Apps library and the NICE IAPT assessment project. The pandemic significantly increased virtual therapy use, with one-third of mental health treatments now online. Digital therapies, integrated into the stepped care model, show a recovery rate of 64%. Challenges to adoption include a limited evidence base, governance complexities, digital confidence among staff, and digital poverty among patients. Sustainable adoption requires improving digital skills, leadership capacity, evolving technical architecture, and combining patient-facing and staff-facing technologies. Future efforts focus on regulatory complexity and managing an ecosystem of interconnected systems.

Barriers and facilitators of user engagement with digital mental health tools for people with severe mental health problems: systematic review of quantitative and qualitative evidence.

Dr Emily Eisner, University of Manchester

This review focused on digital mental health interventions (DHIs) for individuals with severe mental health issues like bipolar disorder or schizophrenia. While these interventions show promise in feasibility, acceptability, and efficacy, user engagement is inconsistent, and clinical integration remains low. A framework examined intervention characteristics, settings, individual traits, and implementation processes. Key findings emphasized the importance of DHIs enhancing rather than replacing human care, addressing practical barriers like digital literacy and poverty, and ensuring financial support for implementation. Engagement is maximized by tailoring DHIs to specific needs, providing human support, and minimizing patient and staff effort.

Scale scaling digital mental health interventions in Ireland: The Health Service Executive (HSC) National Digital CBT Service.

Derek Richards, Amwell

In 2021, the Health Service Executive (HSE) in Ireland, a publicly funded national healthcare system with over 100,000 employees, launched a national digital CBT service in partnership with SilverCloud. This initiative aimed to make mental health support more accessible across Ireland. Since its inception, the service has received over 30,496 referrals, averaging 1,200 referrals and 770 account activations per month. The most utilized programs are for anxiety (50%), depression and anxiety (29%), and depression (18%). Each patient undergoes a seamless five-phase experience: from referral and online sign-up to being assigned a supporter, undergoing weekly reviews, and finally being discharged, with continued access to the program for a year

Development of an implementation playbook for integrating digital mental health services into healthcare organisations.

Professor David Mohr, Northwestern University

A workgroup, consisting of healthcare representatives and DMH company representatives, developed a structured implementation plan to integrate digital mental health services into healthcare organisations. The plan involves determining objectives, selecting products, managing care and referral pathways, addressing risk and technology considerations, and supporting human resources. The pilot phase focuses on roles, training, clinician and patient engagement, data acquisition, ongoing feedback, and final determination. Trust and continuous quality improvement are essential throughout the process. The implementation playbook will be available through the Society for Digital Mental Health and aims to provide a comprehensive guide for effective implementation and scaling of digital mental health services in healthcare settings.

Plenary Session: Digital Mental Health Today.

Professor David Mohr, Northwestern University

Professor David Mohr’s presentation on Digital Mental Health (DMH) examined the landscape and effectiveness of digital therapeutics (DTxs), which are health software systems designed to deliver medical interventions with proven therapeutic impacts. While RCTs show promise for conditions like bipolar disorder, depression, and suicide prevention, further research is needed. Virtual reality effectively treats phobias, social anxiety, and PTSD, but SMS text messaging shows variable outcomes. Studies in low and middle-income countries indicate moderate effectiveness for DMHTxs. Human support enhances DMHTxs’ efficacy, though fully automated DTxs also work. Implementation faces challenges such as high abandonment rates for apps, necessitating integration into healthcare systems. Developing regulatory frameworks, ensuring safety, and fostering collaborations between stakeholders are essential for scaling DMHTxs.

Barriers and Facilitators to Implementation of Internet-Delivered Therapist-Guided Therapy in Child and Adolescent Mental Health Services: A Systematic Review.

Dr Annika Sannes et al, University of Oslo

This research examined the factors affecting e-therapy implementation in CAMHS. It emphasizes the need for effective, evidence-based treatments due to limited resources. The review uses the Consolidated Framework for Implementation Research (CFIR) to categorize barriers and facilitators. Engaging content and structured formats are key facilitators, while technical issues and adaptation challenges are barriers. Organizational support, training, and positive attitudes from therapists and patients enhance implementation. Conversely, time constraints, administrative complexities, motivational issues, and clinical complexity pose significant challenges. Addressing these factors can improve e-therapy implementation, making mental health services more accessible and efficient for children and adolescents.

Implementation of guided Internet delivered treatment in Norway: A comparative study of service delivery in four hospitals.

A/Prof Jorn Heggelund, St Olavs Hospital, Trondheim University Hospital

In 2020, Norway launched the “eCoping” program to improve digital mental health services. This study compared the organizational structures of four hospitals to assess the impact on service accessibility, efficiency, and cost. Hospitals either had dedicated outpatient clinics allowing self-referrals and GP referrals or integrated therapist teams accepting only GP referrals. Data revealed that dedicated clinics offered better coverage and potentially lower costs per patient. The study underscored the need for strategic planning in digital health services to balance accessibility and economic sustainability, highlighting that organizational context significantly affects service delivery effectiveness.

What steps can I take to ensure that my intervention is utilized in the real world? – Determinants and strategies for digital mental health implementation.

Dr Anne Etzelmueller and Dr Elena Heber, Technische Universität München

Strategies are being developed to integrate digital mental health applications (DiGAs) into Germany’s healthcare system. Despite their proven efficacy, implementation into routine care is slow due to complex organizational structures and diverse stakeholder needs. The study identifies 55 criteria for successful implementation, categorized into five main areas: patient characteristics, healthcare provider characteristics, intervention characteristics, context, and unmet needs. By addressing these factors, the study aimed to develop tailored implementation strategies to improve adoption and sustainability of digital health solutions. Key recommendations include ensuring interventions are user-friendly, fit within existing healthcare frameworks, and address specific needs of patients and providers. The study highlights the importance of strategic planning and continuous monitoring to facilitate the integration of evidence-based digital mental health interventions into routine healthcare practice, thereby improving accessibility, efficiency, and overall patient care.

Digital or Analog? Attitudes and expectations towards digital mental health support in a general population.

Fien Buelens, Thomas More University of Applied Sciences Antwerp  

This study evaluated the importance of twelve different dimensions in seeking help, comparing treatment options such as self-help books, face-to-face counselling, blended counselling, and digital interventions. Survey results indicated that the top dimensions included personal support, accessibility, credibility, and motivation. While patients preferred face-to-face therapy, positive attitudes towards digital treatments have increased since 2014. Digital interventions and blended care need to be carefully implemented to ensure patient acceptance.

Building health workforce capability to utilise digital mental health: Learnings from the eMHPrac program in Australia.

Heidi Sturk, Queensland University of Technology

eMHPrac was established to provide education, training, and support about digital mental health to Australia’s primary care workforce and First Nations service providers. Over the past decade, eMHPrac has trained thousands of health practitioners and established extensive networks with service providers, professional bodies, government departments, and community organisations. Since 2015, contacts to online programs have increased by 151%, and health practitioner referrals by 202%. eMHPrac has also developed the WellMob website, an online library of over 500 social and emotional resources for First Nations Australians.

Integrated digital mental health technologies and blended care: Barriers and enablers to large scale real world implementation.

Dr Jennifer Nicholas, Orygen

Major issues in the current mental health system include inaccessibility, fragmentation, high dropout rates, and relapse. Digital support can be valuable during wait times, in-person support, and post-discharge. These interventions can reduce clinician burden, provide continuous support, and fill gaps in care, however key barriers to implementation include access to knowledge, turnover and high workloads. Blended care represents a new, integrated approach where traditional and digital services strengthen each other, necessitating tailored solutions for different roles within services. Understanding these differences is crucial for fostering collaboration between traditional and digital services for more effective mental health care.

The experiences and recommendations of clinicians when delivering adaptive, stepped-care digital CBT for child and adolescent anxiety.

Professor Sonja March, University of Southern Queensland

This presentation explored the implementation of stepped-care iCBT for anxiety among youth, focusing on clinician experiences and model refinements. Interviews with clinicians revealed that while the self-directed component benefits motivated youth, it poses challenges for those with severe anxiety or minimal parental support. Transitioning to clinician support and managing exposure hierarchies were significant issues. Support modalities like videoconferencing were preferred for building therapeutic alliances, though some youth found it overwhelming. Key findings emphasized the effectiveness and cost-efficiency of the stepped-care model, highlighting the need for immediate application post-training and adaptable support methods, such as chat, phone, video calls, and group sessions, to ensure comprehensive engagement and support.

Understanding the successful implementation of digital mental health tools in clinical settings: A case study approach.

Dr Lou Farrer, Australian National University

This study explored how traditionally non-digital clinicians adopt evidence-based interventions. Key factors for starting digital implementation include high demand, burnout, regulatory needs, and client readiness. Successful continuation is supported by autonomy, creativity, and the desire to offer comprehensive client options. Effectiveness is assessed through standard rating tools, feedback, and outcome-based adaptations. Future research will focus on organizational dynamics and team processes to further understand implementation success.

Attitudes towards the use and implementation of virtual reality within early psychosis services amongst clinicians and young people.

Dr Imogen Bell, Orygen

Psychotic disorders impact over 20 million people globally, with early adulthood being a critical period. Early psychosis services face challenges like high drop-out rates and limited accessibility. VR treatments for psychosis include CBT exposure, AVATAR therapy, and virtual worlds for group treatment. Orygen Digital’s research aims to transform telehealth, gamify interventions, and create immersive recovery environments. Effective implementation requires early end-user involvement and trials in real-world contexts. VR offers a safe space for youth to practice life skills, necessitating more tailored programs and research into areas like symptom relief and treatment engagement.

An adaptive model of digital mental health implementation: outcomes and insights from a large scale real world integration of a digital tool into a network of youth mental health services.

Dr Jennifer Nicholas, Orygen

Modernizing youth mental health services involves integrating digital interventions with in-person care for efficient, timely support. Implementation often fails due to non-theory-informed strategies and lack of adaptation. The ATLAS Implementation Model addresses this by adapting strategies based on data, implementing, monitoring, and evaluating outcomes. MOST Digital has been developed on these strategies and is used across various states in Australia. In Iterative cycles targeting barriers like capability and priority have increased weekly referrals, showing that adaptive implementation improves outcomes. Effective digital intervention requires continuous adaptation and practical application, highlighting the importance of being guided by implementation science while addressing real-world challenges.

Momentum – A tailored digital platform for child and adolescents anxiety and depression: Co-design with young people, parents and clinicians.

Professor Sonja March, USQ and Professor Alison Calear, ANU

This presentation highlighted the need for new digital approaches to mental health, based on 20 years of research with the BRAVE-ONLINE program. Current programs often target single problems and face engagement issues. Young people and parents desire comprehensive assessments, personalized programs, and varied support options. Momentum is a new self-directed, integrated mental health platform for children and adolescents (7-17) focusing on depression and anxiety with tailored interventions. Key themes include simplicity, interactivity, and inclusivity, with differing preferences between children and adolescents. The platform includes features like Power Thinking Tools, Calm Calmers, and resources for urgent help, and aims to provide a comprehensive, engaging, and supportive digital mental health solution.

Things You Do: A randomised controlled trial of an ultra-brief treatment based on daily actions for managing depression and anxiety.

Dr Madelyne Bisby, Macquarie University

Things You Do is an online treatment targeting daily activities to reduce depression and anxiety. The treatment focuses on five actions: Healthy Thinking, Meaningful Activities, Goals and Plans, Healthy Habits, and Social Connections. Practicing these activities 3-4 days a week is linked to lower depression and anxiety. In a randomized controlled trial with 351 Australians, participants showed significant improvement in mental health symptoms. The intervention included an online lesson, activity planning resources, and daily motivational texts. Results indicated a strong treatment effect, high completion rates, and positive feedback, with 73% recommending the treatment. This study underscores the potential of integrating simple, action-based interventions into mental health strategies.

Evaluation of an online mental health and suicide gatekeeper resource for parents and caregivers.

Professor Alison Calear, Dr Lou Farrer, Professor Phil Batterham, ANU

The presentation discussed digital self-help resources targeting children and adolescents, addressing anxiety, depression, self-harm, and suicide with practical strategies and lived experience perspectives. “Recognise, Respond and Support – A Parent’s Guide to Youth Mental Health” is an interactive tool for parents of 5-17-year-olds and offers evidence-based information, help-seeking guidance, and downloadable resources. Positive feedback highlights its accessibility, practical advice, and real-life audio snippets from youth, making it a valuable tool for managing and discussing youth mental health.