Upscaling e-mental health in Europe: a six-country qualitative analysis and policy recommendations from the eMEN project

Abstract

E-mental health (eMH) encompasses the use of digital technologies to deliver, support, or enhance mental health services. Despite the growing evidence for the effectiveness of eMH interventions, the process of implementation of eMH solutions in healthcare remains slow throughout Europe. To address this issue, the e-Mental Health Innovation and Transnational Implementation Platform North-West Europe (eMEN) project was initiated to increase the dissemination and quality of eMH services in Europe. In this project, status analyses regarding eMH in the six participating countries (i.e., Belgium, France, Germany, Ireland, The Netherlands, and the UK) were conducted and eight recommendations for eMH were developed. Expert teams from the six participating countries conducted status analyses regarding the uptake of eMH based on a narrative literature review and stakeholder interviews. Based on these status analyses, the eMEN consortium developed eight policy recommendations to further support the implementation of eMH in Europe. The status analyses showed that the participating countries are in different stages of implementing eMH into mental healthcare. Some barriers to implementing eMH were common among countries (e.g., a limited legal and regulatory framework), while others were country-specific (e.g., fragmented, federal policies). The policy recommendations included fostering awareness, creating strong political commitment, and setting reliable standards related to ethics and data security. The eMEN project has provided the initial recommendations to guide political and regulatory processes regarding eMH. Further research is needed to establish well-tailored implementation strategies and to assess the generalizability of the recommendations beyond the countries involved in the eMEN project.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    World Health Organization (2019) Fact sheet-mental health. https://www.euro.who.int/__data/assets/pdf_file/0004/404851/MNH_FactSheet_ENG.pdf?ua=1. Accessed 7 May 2020

  2. 2.

    OECD/EU (2018) Health at a Glance: Europe 2018: State of Health in the EU Cycle. Paris. https://doi.org/10.1787/health_glance_eur-2018-en

    Article  Google Scholar 

  3. 3.

    Cuijpers P, Donker T, van Straten A, Li J, Andersson G (2010) Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med 40(12):1943–1957. https://doi.org/10.1017/s0033291710000772

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Richards D, Richardson T (2012) Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev 32(4):329–342. https://doi.org/10.1016/j.cpr.2012.02.004

    Article  PubMed  Google Scholar 

  5. 5.

    Firth J, Torous J, Nicholas J, Carney R, Pratap A, Rosenbaum S, Sarris J (2017) The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry 16(3):287–298. https://doi.org/10.1002/wps.20472

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Andersson G, Titov N, Dear BF, Rozental A, Carlbring P (2019) Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry 18(1):20–28. https://doi.org/10.1002/wps.20610

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    World Health Organization (2018) Mental Health: Strengthening our Response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response. Accessed 9 January 2020

  8. 8.

    Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T, Ferrari AJ, Hyman S, Laxminarayan R, Levin C, Lund C, Medina-Mora ME, Petersen I, Scott JG, Shidhaye R, Vijayakumar L, Thornicroft G, Whiteford HA (2016) Global priorities for addressing the burden of mental, neurological, and substance use disorders. In: Jamison DT, Nugent R, Gelband H, Horton S, Jha P, Laxminarayan R, Mock CN (eds) Mental, neurological, and substance use disorders, 3rd edn. The World Bank, Washington, pp 1–27

    Google Scholar 

  9. 9.

    World Psychiatric Association (2017) WPA position statement on e-mental health. https://imh.org.rs/wp-content/uploads/2017/07/1FINAL-WPA-Positionstatement-on-eMental-Health-10072017.pdf. Accessed 7 May 2020

  10. 10.

    Riper H, Andersson G, Christensen H, Cuijpers P, Lange A, Eysenbach G (2010) Theme issue on e-Mental Health: a growing field in internet research. J Med Internet Res 12(5):e74. https://doi.org/10.2196/jmir.1713

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Gaebel W, Grossimlinghaus I, Kerst A, Cohen Y, Hinsche-Bockenholt A, Johnson B, Mucic D, Petrea I, Rossler W, Thornicroft G, Zielasek J (2016) European Psychiatric Association (EPA) guidance on the quality of eMental health interventions in the treatment of psychotic disorders. Eur Arch Psychiatry Clin Neurosci 266(2):125–137. https://doi.org/10.1007/s00406-016-0677-6

    Article  PubMed  Google Scholar 

  12. 12.

    Gaebel W, Grossimlinghaus I, Mucic D, Maercker A, Zielasek J, Kerst A (2017) EPA guidance on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD). Eur Psychiatry 41:140–152. https://doi.org/10.1016/j.eurpsy.2017.01.001

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Ebert DD, Van Daele T, Nordgreen T, Karekla M, Compare A, Zarbo C, Brugnera A, Øverland S, Trebbi G, Jensen KL, Kaehlke F, Baumeister H (2018) Internet- and mobile-based psychological interventions: applications, efficacy, and potential for improving mental health. Eur Psychol 23(2):167–187. https://doi.org/10.1027/1016-9040/a000318

    Article  Google Scholar 

  14. 14.

    e-Mental Health Innovation and Transnational Implementation Platform North West Europe (eMEN) (2020) Project Summary. https://www.nweurope.eu/projects/project-search/e-mental-health-innovation-and-transnational-implementation-platform-north-west-europe-emen/undefined. Accessed 9 Jan 2020

  15. 15.

    Baumeister RF (2013) Writing a literature review. In: Prinstein M (ed) The portable mentor. Springer, New York, pp 119–132

    Google Scholar 

  16. 16.

    Siddaway AP, Wood AM, Hedges LV (2019) How to do a systematic review: a best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses. Annu Rev Psychol 70:747–770

    Article  Google Scholar 

  17. 17.

    Mayring P (2015) Qualitative inhaltsanalyse. In: Flick U, von Kardorff E, Steinke I (eds) Qualitative Forschung. Ein Handbuch, vol 11. Auflage, Rowohlt Taschenbuch Verlag, Hamburg, pp 468–475

    Google Scholar 

  18. 18.

    Schmidt C (2015) Analyse von Leitfadeninterviews. In: Flick U, von Kardorff E, Steinke I (eds) Qualitative Forschung Ein Handbuch, vol 11. Auflage, Rowohlt Taschenbuch Verlag, Hamburg, pp 447–456

    Google Scholar 

  19. 19.

    Steunpunt Welzijn VeG (2014) Bouwstenen voor een Vlaams Actieplan Onlinehulp. https://steunpuntwvg.be/images/rapporten-en-werknotas/bouwstenen-voor-een-vlaams-actieplan-online-hulp. Accessed 15 Mar 2018

  20. 20.

    Interministeriële Conferentie Volksgezondheid (IMC VG) (2019) Protocolakkoord: Actieplan e-Gezondheid 2019–2021. https://www.e-health.fgov.be/file/view/AWjHQ9zDgwvToiwBkf13?filename=Actieplan%202019-2021%20e-Gezondheid_final.pdf. Accessed 9 Jan 2020

  21. 21.

    mHealthBELGIUM (2018) History of mHealthBELGIUM. https://mhealthbelgium.be/en/about-us/. Accessed 7 May 2020

  22. 22.

    Kabinet van Jo Vandeurzen Vlaams minister van Welzijn Volksgezondheid en Gezin (2016) Vlaams Actieplan Geestelijke Gezondheid. Strategisch plan 2017–2019. https://www.vlaanderen.be/publicaties/vlaams-actieplan-geestelijke-gezondheid-strategisch-plan-2017-2019. Accessed 7 May 2020

  23. 23.

    Vlaams Minister van Welzijn Volksgezondheid en Gezin (Jo Vandeurzen) (2015) Minister Vandeurzen schakelt versnelling hoger inzake onlinehulpverlening. https://files.onlinehulpverlening-ahs.webnode.nl/200000270-6d9686f8de/1%20-%20Persbericht_JoVandeurzen_Onlinehulp.pdf. Accessed 7 May 2020

  24. 24.

    Federal Public Service Health Food Chain Safety and Environment (2016) Mental health professions. https://www.health.belgium.be/en/health/mentalhealth-professions#article. Accessed 7 May 2020

  25. 25.

    Minister van Sociale Zaken en Volksgezondheid (Maggie de Block) (2018) 120.000 patients pourront se faire rembourser leur aide psychologique. https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.maggiedeblock.be%2Fwp-content%2Fuploads%2F2018%2F05%2F2018-05-18-FR-120.000-patients-pourront-se-faire-rembourser-leur-aide-psychologique.docx. Accessed 7 May 2020

  26. 26.

    Ministère des Affairs Sociales et de la Santé (2016) Stratégie nationale e-santé 2020. https://solidarites-sante.gouv.fr/IMG/pdf/strategie_e-sante_2020.pdf. Accessed 15 Mar 2017

  27. 27.

    Ministère des Solidarités et de la Santé (2018) Feuille de Route: santé mentale et psychiatrie. https://solidarites-sante.gouv.fr/IMG/pdf/180628_-_dossier_de_presse_-_comite_strategie_sante_mentale.pdf. Accessed 08 Sept 2018

  28. 28.

    Ministère des Solidarités et de la Santé (2018) Dossier de presse—Ma santé 2022: un engagement collectif. https://solidaritessante.gouv.fr/IMG/pdf/ma_sante_2022_pages_vdef_.pdf. Accessed 7 May 2020

  29. 29.

    Ministère des Solidarités et de la Santé (2019) Feuille de Route: Accélérer le virage numérique. https://solidarites-sante.gouv.fr/IMG/pdf/190425_dossier_presse_masante2022_ok.pdf. Accessed 12 Dec 2019

  30. 30.

    Bundesministerium für Gesundheit (BMG) (2016) Gesetz für sichere digitale Kommunikation und Anwendungen im Gesundheitswesen sowie zur Änderung weiterer Gesetze. Bundesgesetzblatt Teil I (54)

  31. 31.

    Bundesärztekammer (Arbeitsgemeinschaft der deutschen Ärztekammern) (2018) Beschlussprotokoll des 121. Deutschen Ärztetages in Erfurt. Änderung des § 7 Abs. 4 MBO-Ä (Fernbehandlung). Deutsches Ärzteblatt Jg. 115 (Heft 20–21):285–296

  32. 32.

    Bundespsychotherapeutenkammer (BPtK) (2018) Videosprechstunde auch für Psychotherapeuten möglich. https://www.bptk.de/videosprechstunde-auch-fuer-psychotherapeuten-moeglich/. Accessed 25 Mar 2019

  33. 33.

    Bundestag D (2018) Gesetz zur Stärkung des Pflegepersonals (Pflegepersonal-Stärkungsgesetz-PpSG)

  34. 34.

    Beerheide R (2019) Der Weg der Apps in die Versorgung. Deutsches Ärzteblatt 116(29–30):1123–1124

    Google Scholar 

  35. 35.

    Gemeinsamer Bundesausschuss (G-BA) (2018) Der Innovationsfonds und der Innovationsausschuss beim Gemeinsamen Bundesausschuss. https://innovationsfonds.g-ba.de/. Accessed 24 July 2018

  36. 36.

    Department of Health (2013) e-Health Strategy for Ireland. https://www.e-healthireland.ie/Knowledge-Information-Plan/e-health-Strategy-for-Ireland.pdf. Accessed 16 May 2018

  37. 37.

    Department of Health and Children (DOHC) (2006) A Vision for Change: Report of the Expert Group on Mental Health Policy. Stationery Office Dublin

  38. 38.

    Chambers D, Murphy F (2015) Technology, Mental Health and Suicide Prevention in Ireland—a Good Practice Guide. ReachOut Ireland.

  39. 39.

    National Youth Mental Health Task Force (YMHTF) (2017) National Youth Mental Health Task Force Report 2017. https://health.gov.ie/wp-content/uploads/2017/12/YMHTF-Final-Report.pdf. Accessed 23 Aug 2018

  40. 40.

    Irish Association for Counselling and Psychotherapy (IACP) (2017) Recommended Approach for Online Counselling and Psychotherapy. https://iacp.ie/onlinecounselling. Accessed 25 May 2018

  41. 41.

    Cullen K (2018) eMental Health: State-of-the-art & Opportunities for Ireland. Work Research Centre. https://www.mentalhealthreform.ie/wp-content/uploads/2018/05/eMental-health-review_report_final_may10_NEWcover.2.pdf. Accessed 25 May 2018

  42. 42.

    Nederlandse Patiënten Consumenten Federatie (NPCF) (2012) Nationale Implementatie agenda (NIA) e-health. https://www.rijksoverheid.nl/documenten/rapporten/2012/06/07/nationale-implementatieagenda-e-health-nia. Accessed 16 Aug 2018

  43. 43.

    Government of the Netherlands (2014) Government Encouraging Use of e-health. https://www.government.nl/topics/e-health/government-encouraging-use-of-e-health. Accessed 09 Aug 2017

  44. 44.

    Nederlandse Vereniging van Ziekenhuizen (2017) Versnellingsprogramma Informatie-uitwisseling Patiënt en Professional: de patiënt meer inzicht in zijn eigen zorg (VIPP) [Acceleration program information exchange patient and professional]. https://www.vipp-programma.nl/. Accessed 16 Aug 2018

  45. 45.

    De Minister van Volksgezondheid Welzijn en Sport (2016) Besluit van de Minister van Volksgezondheid, Welzijn en Sport van 14 december 2016, kenmerk 159145-CZ houdende vaststelling van beleidsregels voor het subsidiëren van ziekenhuizen en de NVZ voor het stimuleren van elektronische gegevensuitwisseling tussen patiënt en zorgaanbieder (Besluit vaststelling beleidskader subsidiëring Versnellingsprogramma Informatie-uitwisseling Patiënt en Professional). https://zoek.officielebekendmakingen.nl/stcrt-2016-68985.pdf. Accessed 7 May 2020

  46. 46.

    Nictiz, NIVEL (2017) Consciously choose e-health. Summary e-health monitor. https://www.e-health-monitor.nl/wp-content/uploads/2017/09/Nictiz_-Samenvatting_Eng.pdf. Accessed 7 May 2020

  47. 47.

    Nederlandse Zorgautoriteit (2017) State of the Healthcare Markets 2017. https://puc.overheid.nl/nza/doc/PUC_3676_22/1/. Accessed 7 May 2020

  48. 48.

    National Information Board Department of Health (2014) Personalised health and care 2020. Using data and technology to transform outcomes for patients and citizens: a framework for action. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/384650/NIB_Report.pdf. Accessed 7 May 2020

  49. 49.

    The Independent Mental Health Task Force (2016) Five year forward view on mental health: a report from the independent mental health task force to the NHS in England. https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf. Accessed 7 May 2020

  50. 50.

    Department of Health (2017) A framework for mental health research. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/665576/A_framework_for_mental_health_research.pdf. Accessed 7 May 2020

  51. 51.

    NHS England (2017) Mental health global digital exemplars. https://www.england.nhs.uk/digitaltechnology/info-revolution/exemplars/mental-healthglobal-digital-exemplars/. Accessed 7 May 2020

  52. 52.

    Bennion MR, Hardy G, Moore RK, Millings A (2017) E-therapies in England for stress, anxiety or depression: what is being used in the NHS? A survey of mental health services. BMJ Open 7(1):e014844. https://doi.org/10.1136/bmjopen-2016-014844

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Foley T, Woollard J (2019) The digital future of mental healthcare and its workforce: a Report on a mental health stakeholder engagement to inform the topol review. Health Education England. https://topol.hee.nhs.uk/wp-content/uploads/HEE-Topol-Review-Mental-health-paper.pdf. Accessed 15 Aug 2019

  54. 54.

    The Department of Health (Northern Ireland) (2016) Health and wellbeing 2026: delivering together. https://www.healthni.gov.uk/sites/default/files/publications/health/health-and-wellbeing-2026-delivering-together.pdf. Accessed 7 May 2020

  55. 55.

    Invest Northern Ireland (2017) Digital Northern Ireland 2020. https://www.investni.com/sites/default/files/documents/static/library/investni/documents/digital-northern-ireland-2020-report.pdf. Accessed 7 May 2020

  56. 56.

    Expert Panel Report (2016) Systems, not structures: changing health and social care. https://www.healthni.gov.uk/sites/default/files/publications/health/expert-panel-full-report.pdf. Accessed 7 May 2020

  57. 57.

    The Scottish Government (2016) Health and Social Care Delivery Plan. https://www.gov.scot/Resource/0051/00511950.pdf. Accessed 17 July 2018

  58. 58.

    The Scottish Government (2017) Mental health strategy 2017–2027. https://www.gov.scot/Resource/0051/00516047.pdf. Accessed 7 May 2020

  59. 59.

    The Scottish Government (2018) Scotland's digital health and care strategy: enabling, connecting and empowering. https://www.gov.scot/publications/scotlands-digital-health-care-strategy-enabling-connecting-empowering/. Accessed 7 May 2020

  60. 60.

    Welsh Government (2016) Together for Mental Health: Delivery Plan 2016–2019.

  61. 61.

    Welsh Government (2018) A Healthier Wales: our Plan for Health and Social Care.

  62. 62.

    Stevenson D, Farmer P (2017) Thriving at work: the Stevenson/farmer review of mental health and employers. England, London

    Google Scholar 

  63. 63.

    Department for Work and Pensions, Department of Health and Social Care, Gauke D, Hunt J (2017) Improving lives: the future of work, Health and Disability

  64. 64.

    E-mental Health Innovation and Transnational Implementation Platform North-West Europe (eMEN), Gaebel W, Trost N, Diekmann S, Lukies R, Zielasek J (2019) Transnational Policy for e-Mental Health: A Guidance Document for European Policymakers and Stakeholders. Co-funded by the EU Interreg North-West-Europe programme. Düsseldorf/Köln: LVR-Institute for Healthcare Research (forthcoming)

  65. 65.

    Hennemann S, Beutel ME, Zwerenz R (2017) Ready for e-health? Health Professionals’ acceptance and adoption of e-health interventions in inpatient routine care. J Health Commun 22(3):274–284

    Article  Google Scholar 

  66. 66.

    Stallard P, Richardson T, Velleman S (2010) Clinicians’ attitudes towards the use of computerized cognitive behaviour therapy (cCBT) with children and adolescents. Behav Cogn Psychother 38(5):545–560

    Article  Google Scholar 

  67. 67.

    Drozd F, Vaskinn L, Bergsund HB, Haga SM, Slinning K, Bjorkli CA (2016) The implementation of internet interventions for depression: a scoping review. J Med Internet Res 18(9):e236. https://doi.org/10.2196/jmir.5670

    Article  PubMed  PubMed Central  Google Scholar 

  68. 68.

    Wozney L, Newton AS, Gehring ND, Bennett K, Huguet A, Hartling L, Dyson MP, McGrath P (2017) Implementation of eMental Health Care: Viewpoints from Key Informants from Organizations and Agencies with e-health Mandates. BMC Med Inform Decis Mak 17(1):78. https://doi.org/10.1186/s12911-017-0474-9

    Article  PubMed  PubMed Central  Google Scholar 

  69. 69.

    Girlanda F, Fiedler I, Becker T, Barbui C, Koesters M (2017) The evidence–practice gap in specialist mental healthcare: systematic review and meta-analysis of guideline implementation studies. Br J Psychiatry 210(1):24–30

    Article  Google Scholar 

Download references

Funding

The eMEN project received funding from the European Union’s Interreg North-West-Europe program.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Wolfgang Gaebel.

Ethics declarations

Conflict of interests

The authors declare that they have no conflicts of interest.

Additional information

Communicated by Andrea Schmitt.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 39 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gaebel, W., Lukies, R., Kerst, A. et al. Upscaling e-mental health in Europe: a six-country qualitative analysis and policy recommendations from the eMEN project. Eur Arch Psychiatry Clin Neurosci (2020). https://doi.org/10.1007/s00406-020-01133-y

Download citation

Keywords

  • e-Mental health
  • eMH
  • Mental health
  • Policy
  • Upscaling
  • Implementation