Advancing equitable access to digital mental health in the Asia-Pacific region in the context of the COVID-19 pandemic and beyond: A modified Delphi consensus study
The COVID-19 pandemic had an unprecedented impact on global mental health and well-being, including across the Asia-Pacific. Efforts to mitigate virus spread led to far-reaching disruption in the delivery of health and social services. In response, there was a rapid shift to the use of digital menta...
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Published in | PLOS global public health Vol. 4; no. 6; p. e0002661 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Public Library of Science
2024
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Abstract | The COVID-19 pandemic had an unprecedented impact on global mental health and well-being, including across the Asia-Pacific. Efforts to mitigate virus spread led to far-reaching disruption in the delivery of health and social services. In response, there was a rapid shift to the use of digital mental health (DMH) approaches. Though these technologies helped to improve access to care for many, there was also substantial risk of access barriers leading to increased inequities in access to mental health care, particularly among at-risk and equity-deserving populations. The objective of this study was to conduct a needs assessment and identify priorities related to equitable DMH access among at-risk and equity-deserving populations in the Asia Pacific region during the first year of the COVID-19 pandemic. The study consisted of a modified Delphi consensus methodology including two rounds of online surveys and online consultations with stakeholders from across the region. Study participants included policy makers, clinicians and service providers, and people with lived experience of mental health conditions. Results demonstrate that vulnerabilities to negative mental health impacts and access barriers were compounded during the pandemic. Access barriers included a lack of linguistically and culturally appropriate DMH options, low mental health literacy and poor access to technological infrastructure and devices, low levels of awareness and trust of DMH options, and lack of policies and guidelines to support effective and equitable delivery of DMH. Recommendations to improve equitable access include ensuring that diverse people with lived experience are engaged in research, co-design and policy development, the development and implementation of evidence-based and equity-informed guidelines and frameworks, clear communication about DMH evidence and availability, and the integration of DMH into broader health systems. Study results can inform the development and implementation of equitable DMH as its use becomes more widespread across health systems. |
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AbstractList | The COVID-19 pandemic had an unprecedented impact on global mental health and well-being, including across the Asia-Pacific. Efforts to mitigate virus spread led to far-reaching disruption in the delivery of health and social services. In response, there was a rapid shift to the use of digital mental health (DMH) approaches. Though these technologies helped to improve access to care for many, there was also substantial risk of access barriers leading to increased inequities in access to mental health care, particularly among at-risk and equity-deserving populations. The objective of this study was to conduct a needs assessment and identify priorities related to equitable DMH access among at-risk and equity-deserving populations in the Asia Pacific region during the first year of the COVID-19 pandemic. The study consisted of a modified Delphi consensus methodology including two rounds of online surveys and online consultations with stakeholders from across the region. Study participants included policy makers, clinicians and service providers, and people with lived experience of mental health conditions. Results demonstrate that vulnerabilities to negative mental health impacts and access barriers were compounded during the pandemic. Access barriers included a lack of linguistically and culturally appropriate DMH options, low mental health literacy and poor access to technological infrastructure and devices, low levels of awareness and trust of DMH options, and lack of policies and guidelines to support effective and equitable delivery of DMH. Recommendations to improve equitable access include ensuring that diverse people with lived experience are engaged in research, co-design and policy development, the development and implementation of evidence-based and equity-informed guidelines and frameworks, clear communication about DMH evidence and availability, and the integration of DMH into broader health systems. Study results can inform the development and implementation of equitable DMH as its use becomes more widespread across health systems. |
Author | Irrarazaval, Matias Greenshaw, Andrew Chan, Yuen Mei Michelle Ibrahim, Nurashikin Chen, Jun Hwang, Tae-Yeon Michalak, Erin E Wang, Xing Withers, Mellissa Nguyen, Vu Cong O'Neil, John Lam, Raymond W Khan, Amna Evans, Vanessa Hatcher, Simon Minas, Harry Saker, Shirley Ng, Chee H Paric, Angela Ananyo Chakraborty, Promit Ravindran, Arun Murphy, Jill K |
AuthorAffiliation | University of California San Francisco, UNITED STATES 4 School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China 11 Centre for Addiction and Mental Health/ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada 8 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia 5 Pan American Health Organization, Santiago, Chile 3 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada 6 Department of Psychiatry, University of Melbourne, Melbourne, Australia 15 Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada 12 Shanghai Mental Health Centre, Shanghai, China 9 Institute of Population, Health and Development, Hanoi, Vietnam 13 Korea Foundation for Suicide Prevention, Seoul, South Korea 10 Centre for Mental Health, University of Melbourne, Melbourne, Australia 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada 7 D |
AuthorAffiliation_xml | – name: 9 Institute of Population, Health and Development, Hanoi, Vietnam – name: 1 Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada – name: 11 Centre for Addiction and Mental Health/ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada – name: 7 Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada – name: 2 Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, United States of America – name: 4 School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China – name: 3 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada – name: 15 Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada – name: 6 Department of Psychiatry, University of Melbourne, Melbourne, Australia – name: 8 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia – name: 5 Pan American Health Organization, Santiago, Chile – name: 10 Centre for Mental Health, University of Melbourne, Melbourne, Australia – name: 14 Mental Health, Injury and Violence Prevention and Substance Abuse Sector Section, Ministry of Health, Kuala Lumpur, Malaysia – name: University of California San Francisco, UNITED STATES – name: 12 Shanghai Mental Health Centre, Shanghai, China – name: 13 Korea Foundation for Suicide Prevention, Seoul, South Korea |
Author_xml | – sequence: 1 givenname: Jill K orcidid: 0000-0001-8613-4429 surname: Murphy fullname: Murphy, Jill K organization: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada – sequence: 2 givenname: Shirley surname: Saker fullname: Saker, Shirley organization: Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, United States of America – sequence: 3 givenname: Promit surname: Ananyo Chakraborty fullname: Ananyo Chakraborty, Promit organization: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada – sequence: 4 givenname: Yuen Mei Michelle orcidid: 0009-0002-1187-8540 surname: Chan fullname: Chan, Yuen Mei Michelle organization: School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China – sequence: 5 givenname: Erin E surname: Michalak fullname: Michalak, Erin E organization: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada – sequence: 6 givenname: Matias surname: Irrarazaval fullname: Irrarazaval, Matias organization: Pan American Health Organization, Santiago, Chile – sequence: 7 givenname: Mellissa surname: Withers fullname: Withers, Mellissa organization: Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, United States of America – sequence: 8 givenname: Chee H surname: Ng fullname: Ng, Chee H organization: Department of Psychiatry, University of Melbourne, Melbourne, Australia – sequence: 9 givenname: Amna surname: Khan fullname: Khan, Amna organization: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada – sequence: 10 givenname: Andrew surname: Greenshaw fullname: Greenshaw, Andrew organization: Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada – sequence: 11 givenname: John surname: O'Neil fullname: O'Neil, John organization: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia – sequence: 12 givenname: Vu Cong orcidid: 0000-0002-4486-4535 surname: Nguyen fullname: Nguyen, Vu Cong organization: Institute of Population, Health and Development, Hanoi, Vietnam – sequence: 13 givenname: Harry orcidid: 0000-0003-1719-7367 surname: Minas fullname: Minas, Harry organization: Centre for Mental Health, University of Melbourne, Melbourne, Australia – sequence: 14 givenname: Arun surname: Ravindran fullname: Ravindran, Arun organization: Centre for Addiction and Mental Health/ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada – sequence: 15 givenname: Angela surname: Paric fullname: Paric, Angela organization: Centre for Addiction and Mental Health/ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada – sequence: 16 givenname: Jun surname: Chen fullname: Chen, Jun organization: Shanghai Mental Health Centre, Shanghai, China – sequence: 17 givenname: Xing surname: Wang fullname: Wang, Xing organization: Shanghai Mental Health Centre, Shanghai, China – sequence: 18 givenname: Tae-Yeon surname: Hwang fullname: Hwang, Tae-Yeon organization: Korea Foundation for Suicide Prevention, Seoul, South Korea – sequence: 19 givenname: Nurashikin surname: Ibrahim fullname: Ibrahim, Nurashikin organization: Mental Health, Injury and Violence Prevention and Substance Abuse Sector Section, Ministry of Health, Kuala Lumpur, Malaysia – sequence: 20 givenname: Simon orcidid: 0000-0003-3117-2350 surname: Hatcher fullname: Hatcher, Simon organization: Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada – sequence: 21 givenname: Vanessa surname: Evans fullname: Evans, Vanessa organization: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada – sequence: 22 givenname: Raymond W surname: Lam fullname: Lam, Raymond W organization: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada |
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Copyright | Copyright: © 2024 Murphy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 2024 Murphy et al 2024 Murphy et al |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 I have read the journal’s policy and the authors of this manuscript have the following competing interests: EEM has received funding from Otsuka-Lundbeck for patient educational activities. CHN had served as a consultant for Janssen-Cilag, Lundbeck, Grunbiotics, Servier and Eli Lilly, received research grants from National Health and Medical Research Council and Medical Research Future Funds, and speaker honoraria from Servier, Lundbeck, Eli Lilly, Janssen-Cilag, Astra-Zeneca, and Pfizer – all unrelated to this study. RWL has received honoraria for ad hoc speaking or advising/consulting, or received research funds, from: Abbvie, Asia-Pacific Economic Cooperation, Bausch, BC Leading Edge Foundation, Brain Canada, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, CAN-BIND Solutions, Carnot, Grand Challenges Canada, Healthy Minds Canada, Janssen, Lundbeck, Medscape, Michael Smith Foundation for Health Research, MITACS, Neurotorium, Ontario Brain Institute, Otsuka, Pfizer/Viatris, Shanghai Mental Health Center, Sunnybrook Health Sciences Centre, Unity Health, Vancouver Coastal Health Research Institute, and VGH-UBCH Foundation. This does not alter our adherence to PLOS Global Public Health policies on sharing data and materials JKM, SS, YMC, PAC, MI, MW, AK, AG, JON, VCN, HM, AR, AP, JC, XW, TYH, NI, SH, and VE have declared that no competing interests exist. |
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Title | Advancing equitable access to digital mental health in the Asia-Pacific region in the context of the COVID-19 pandemic and beyond: A modified Delphi consensus study |
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