Equity in eHealth: amplifying youth voices in mental health care
The rapid uptake of eHealth shines a light on its immense potential to close equity gaps and boost access to mental health care globally – and involving young people in developing and disseminating eHealth can bring broad benefits
While already growing prior to the Covid-19 pandemic, the prevalence of eHealth treatment options (digital health interventions delivered via phone calls, video-conferencing, websites, mobile applications and other technology-based services) has greatly accelerated across healthcare specialisations. The rapid uptake of eHealth illuminates its vast potential to address equity concerns while increasing overall access to mental health care globally. Careful governance and a broad integration of stakeholder involvement at every stage of development and testing are needed, however. Involving youth stakeholders in developing and disseminating eHealth to ensure equity and privacy are prioritised is imperative, not only for youth-focused interventions, but also for mental health care in general.
Accessing care
Many individuals in need of mental health care face practical challenges in accessing care, challenges that eHealth treatments can help to reduce or eliminate. The remote nature of eHealth options lessens the costs and time spent on transportation, and increases accessibility for those in rural areas and those without access to transportation. eHealth options can also provide a larger pool of possible providers, depending on local provider licensing regulations. Individuals thus benefit from easier scheduling, reduced waitlists and access to providers in a much larger geographic area than they would be restricted to with in-person health care. This further aids those looking for providers who offer less common specialised treatments, are covered by their health insurer or charge lower session fees. Beyond provider-dependent options such as telehealth, stand-alone eHealth interventions, such as some mobile- and web-based interventions, allow individuals to access them at any time and place as needed. This eliminates scheduling concerns, and further broadens the number of individuals able to access mental health care through eHealth interventions’ greater scalability. eHealth presents additional promise for youth, many of whom are likely to need transportation assistance, appointments outside of a rigid school-day schedule and youth-specific providers, who are likely to be comfortable with using technology to access care.
eHealth challenges
To work towards equity in accessibility, providers, institutions and governments must be mindful of ensuring that those already disadvantaged are not further left behind by the rise of eHealth. The deleterious effects of decreased investment in in-person health care, or digital health options supplanting rather than supplementing existing care options, would disproportionately affect those already less able to access mental health care. Globally, approximately one in three people do not have internet access, a requirement for many eHealth interventions. In addition to reliable internet access, privacy is a significant concern for many individuals, both in terms of access to a private space to engage with mental health care if it involves speaking to a provider, and in terms of data security, especially for eHealth interventions with private companies. In many countries, youth are legally recognised as a vulnerable population and thus protected by additional regulations, which are no less needed in eHealth where regulations are still emerging.
Momentum and governance
In the continued development of eHealth, stakeholder engagement is critical to centring equity of accessibility and privacy, and ensuring that advances in this area help to close, rather than expand, gaps in mental health care for those who are already disadvantaged. Efforts by eHealth developers to respond to youth stakeholders’ concerns about access to care and privacy benefit all those in need of mental health care. Including youth participants in the research process (from needs assessments through dissemination efforts) and groups such as the GHFutures2030 Youth Network (a global group of youth stakeholders dedicated to applying their diverse disciplines to advancing youth priorities involving digital health), intervention developers and governing bodies can improve both the fit and effectiveness
of interventions.
Governments can support these priorities through grant requirements to include stakeholders throughout the research process and encourage health insurance providers or their national healthcare systems to cover or offer more eHealth options that meet these standards. Governments can also take guidance from recommendations with global perspectives, such as the World Health Organization’s Global Strategy on Digital Health and a recent report by the Lancet and Financial Times Commission. These include a focus on greater regulation of technology companies to align with these priorities in their products and encouraging transnational cooperation to amplify the effectiveness of new health technologies and standardise regulations. Consent processes and privacy policies (such as data confidentiality and the minimisation of data collection) that address youth needs benefit everyone. International standards for developing and governing eHealth reduces the need for eHealth providers to develop and support distinct product versions and allows easier continuity of use for individuals who are travelling or who move to another country.
Standardisation also can be useful in smaller geographic areas, such as between states in the United States, where national licensure for providers and other shared regulations would produce similar benefits to providers and those in need of mental health care, for example students who reside in one state during the school year and another in the summer.
At this critical juncture, the mental healthcare field and governments globally have the ability and responsibility to respond to the rapid growth of eHealth with enthusiastic support for the integration of youth and other stakeholders at every stage of development, expansion and judicious regulation to bolster and guide the maturing domain of eHealth.
