Examining the Feasibility of Implementing Digital Mental Health Innovations Into Hospitals to Support Youth in Suicide Crisis: Interview Study With Young People and Health Professionals

Demee Rheinberger; Rachel Baffsky; Lauren McGillivray; Isabel Zbukvic; Ann Dadich; Mark Erik Larsen; Ping-I Lin; Daniel Z Q Gan; Catherine Kaplun; Holly C Wilcox; Valsamma Eapen; Paul M Middleton; Michelle Torok

doi:10.2196/51398

Examining the Feasibility of Implementing Digital Mental Health Innovations Into Hospitals to Support Youth in Suicide Crisis: Interview Study With Young People and Health Professionals

JMIR Form Res. 2023 Nov 16:7:e51398. doi: 10.2196/51398.

Authors

Demee Rheinberger¹, Rachel Baffsky¹, Lauren McGillivray¹, Isabel Zbukvic^{2

3}, Ann Dadich⁴, Mark Erik Larsen^{1

5}, Ping-I Lin^{6

7

8}, Daniel Z Q Gan¹, Catherine Kaplun^{9

10}, Holly C Wilcox¹¹, Valsamma Eapen^{6

8

10}, Paul M Middleton^{12

13

14}, Michelle Torok¹

Affiliations

¹ Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
² Orygen, Parkville, Victoria, Australia.
³ Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
⁴ School of Business, Western Sydney University, Parramatta, NSW, Australia.
⁵ Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
⁶ Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.
⁷ Mental Health Research Unit, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
⁸ Academic Unit of Infant Child and Adolescent Services (AUCS), South Western Sydney Local Health District, Liverpool, NSW, Australia.
⁹ Transforming Early Education and Child Health (TeEACH) Research Centre, Western Sydney University, Sydney, NSW, Australia.
¹⁰ The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
¹¹ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
¹² South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
¹³ Department of Emergency Medicine, Liverpool Hospital, Liverpool, NSW, Australia.
¹⁴ South Western Emergency Research Institute (SWERI), Ingham Institute, Liverpool, NSW, Australia.

PMID: 37971790
PMCID: PMC10690533
DOI: 10.2196/51398

Abstract

Background: Hospitals are insufficiently resourced to appropriately support young people who present with suicidal crises. Digital mental health innovations have the potential to provide cost-effective models of care to address this service gap and improve care experiences for young people. However, little is currently known about whether digital innovations are feasible to integrate into complex hospital settings or how they should be introduced for sustainability.

Objective: This qualitative study explored the potential benefits, barriers, and collective action required for integrating digital therapeutics for the management of suicidal distress in youth into routine hospital practice. Addressing these knowledge gaps is a critical first step in designing digital innovations and implementation strategies that enable uptake and integration.

Methods: We conducted a series of semistructured interviews with young people who had presented to an Australian hospital for a suicide crisis in the previous 12 months and hospital staff who interacted with these young people. Participants were recruited from the community nationally via social media advertisements on the web. Interviews were conducted individually, and participants were reimbursed for their time. Using the Normalization Process Theory framework, we developed an interview guide to clarify the processes and conditions that influence whether and how an innovation becomes part of routine practice in complex health systems.

Results: Analysis of 29 interviews (n=17, 59% young people and n=12, 41% hospital staff) yielded 4 themes that were mapped onto 3 Normalization Process Theory constructs related to coherence building, cognitive participation, and collective action. Overall, digital innovations were seen as a beneficial complement to but not a substitute for in-person clinical services. The timing of delivery was important, with the agreement that digital therapeutics could be provided to patients while they were waiting to be assessed or shortly before discharge. Staff training to increase digital literacy was considered key to implementation, but there were mixed views on the level of staff assistance needed to support young people in engaging with digital innovations. Improving access to technological devices and internet connectivity, increasing staff motivation to facilitate the use of the digital therapeutic, and allowing patients autonomy over the use of the digital therapeutic were identified as other factors critical to integration.

Conclusions: Integrating digital innovations into current models of patient care for young people presenting to hospital in acute suicide crises is challenging because of several existing resource, logistical, and technical barriers. Scoping the appropriateness of new innovations with relevant key stakeholders as early as possible in the development process should be prioritized as the best opportunity to preemptively identify and address barriers to implementation.

Keywords: digital health; hospitals; mHealth; mental health; mobile health; mobile phone; self-harm; suicide prevention; young people.

©Demee Rheinberger, Rachel Baffsky, Lauren McGillivray, Isabel Zbukvic, Ann Dadich, Mark Erik Larsen, Ping-I Lin, Daniel Z Q Gan, Catherine Kaplun, Holly C Wilcox, Valsamma Eapen, Paul M Middleton, Michelle Torok. Originally published in JMIR Formative Research (https://formative.jmir.org), 16.11.2023.