Background
Mobile health and mental health
Suicide
Safety planning intervention
Engagement
Employee engagement
Diffusion of innovation
Object relations theory
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What are the experiences of mental health professionals engaged in the use of mobile apps as part of their practise?
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What are the drivers and barriers to the adoption of such technology by mental health professionals?
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What theoretical model best accounts for the experiences of mental health professionals engaged in adopting this technology?
Methodology
Research design
Participants
Materials and procedure
Data analysis
Ethical issues
Results
Description of participants
Thematic analysis
Major Themes | Sub-themes |
---|---|
Accessibility | 1. Service Accessibility 2. Client Engagement 3. Immediate Access |
Transitional Object | 1. Adjunct to Therapy 2. Therapeutic Relationship |
Integration | 1. Infrastructural Support 2. Enhancing treatment |
Trust | 1. Trust in the Technology 2. Trust in the Organisation |
“Clients could access support whenever they need it and wherever they are” (Participant 11, line 15)
“It would make available an immediate connection that could be flagged in advance and could be used in a crisis”. (Participant 9, lines 34-35).
Participants also described the potential for digital technology to help in engaging individuals for whom traditional face-to-face mental health services are not appropriate or accessible.“I think really it could have the potential to reduce the number of face to face contacts with children and increase the number of children who can access the service” (Participant 15, lines 113-115).
In contrast, some participants discussed accessibility as a barrier. In these cases participants were concerned about increased accessibility to smartphones, internet and social media as a result of the mobile app, particularly with children. In this case, the increased accessibility offered was seen as a risk.“It would offer another means of engaging service users, particularly service users who find direct social interaction challenging, or who have an interest in technology” (Participant 13, lines 88–90)
“I would be worried I suppose that it would encourage children to have access to a smart phone at an earlier age” (Participant 10, lines 176-177).
“Using the phone/app as a transitional object and a means of staying connected with clients outside of sessions” (Participant 11, lines 89–90)
“There is a need though to prioritise real human face to face interaction within the services and then use technology to support this when that is appropriate”(Participant 9, lines 102-104).
“Given that the therapeutic relationship is the strongest agent of change in a therapeutic setting, I wonder about the potential consequences of reliance on technology and screen based interventions. This is not to say I don't support their use, certainly as an add on, but I don't know enough about their use and potential consequences as yet” (Participant 7, lines 92-97).
The ‘Transitional Object’ theme accounts for all of these views by describing the necessity to generalise coping skills to outside of the therapeutic relationship while also highlighting the primary importance of the therapeutic relationship itself.“With young people we would need to remind them that apps are not a substitute for letting a real person help” (Participant 5, lines 18-20).
“I feel this could help clients to complete between-session work and increase their recording of information. A lot of clients find recording on paper sheets tedious” (Participant 8, lines 81-83).
A number of participants addressed health service infrastructural support for the technology and the extent to which this may impact on the integration of such technology into practise.“It would help clients complete homework tasks and mood and goal monitoring” (Participant 2, lines 15-16).
“It would need to be available on HSE computers and phones and supported by the HSE’s IT systems” (Participant 7, lines 64-66).
“I think more exploratory research on mobile technology is needed and communication to professionals about the research and the implications for best practice. More practical training on this technology would be helpful” (Participant 9, lines 134-137).
Four participants reported a fear of such technology being used to undermine traditional services if it were to be used by the organisation to save resources.“usability and reliability of use are so important. Nothing worse than persuading someone to give an app a try and it doesn't function at all or only in a very clunky way” (Participant 14, lines 72-75).
In addition, participants were observant of features in place to protect both clients and professionals.“My fear would be that it would be used as a cost saving measure only and would undermine the quality of the service” (Participant 15, lines 79-80).
“If clients record information on their phones and phone gets hacked or stolen there are safeguards in place” (Participant 2, lines 43-45).