Use of the Internet and Mobile Phones for Self-Management of Severe Mental Health Problems: Qualitative Study of Staff Views

Background
Researchers are currently investigating the feasibility, acceptability and efficacy of digital health interventions (DHIs) for people who experience severe mental health problems (SMI) such as psychosis and bipolar disorder. Although the acceptability of DHIs for SMI appears to be relatively high and some people report successfully using the Internet and smartphones to manage their mental health, mental healthcare staff attitudes towards such approaches have yet to be considered.
Objective
This study aimed to explore mental healthcare staff experiences of clients with SMI engaging with the Internet and smartphones to self-manage their mental health and their views towards these behaviours. The study also sought to examine the opinions expressed by mental healthcare staff towards DHIs for SMI in order to identify potential facilitators and barriers to implementation.
Methods
Four focus groups were conducted with 20 staff working in mental healthcare services in the North West of the United Kingdom (UK) using a semi-structured topic guide. Focus groups involved 10 staff working in secondary care psychological services (7 participants in Focus Group 1 and 5 participants in Focus Group 4), 4 staff working in a rehabilitation unit (Focus Group 2) and 4 staff working in a community mental health team (Focus Group 3). Focus groups were transcribed verbatim and transcripts were analysed thematically to identify key themes that emerged from the data.
Results
Four overarching themes, two with associated subthemes, were identified: 1) staff have conflicting views about the pros and cons of using online resources and DHIs to manage mental health, 2) DHIs could increase access to mental health support options for SMI, but may perpetuate the digital divide; 3) DHIs impact on staff roles and responsibilities; 4) DHIs should be used to enhance, not replace, face-to-face support.
Conclusions
This study is the first, to our knowledge, to qualitatively explore the experiences and attitudes of mental healthcare staff towards individuals with SMI using the Internet, smartphones and DHIs to self-manage their mental health. Understanding the positive and negative experiences and views shared by staff towards both current and potential DHI use has enabled the identification of several considerations for implementation. Additionally, the findings suggest mental healthcare staff need clear guidance and training in relation to their responsibilities in recommending reputable and secure websites, forums and DHIs and in how to manage professional boundaries online. Overall, the study highlights that DHIs could be well received by staff working in mental health services, but importantly such management options must be presented to frontline staff as an avenue to enhance care and extend choice, rather than as a method to reduce costs.