On March 28th almost 90 stakeholders in the field of e-mental health came together at the VU University in Amsterdam to discuss e-mental health implementation in the ‘real world’. SMEs, mental health professionals, insurance companies, researchers, students, policy makers and end-users discussed various implementation topics and approaches, which resulted in a very interesting multidisciplinary event that gave a good reflection of the different implementation barriers.
In order to learn more about implementation from regions outside Europe an e-mental health implementation expert was invited from Canada, Dr. Lori Wozney. Dr. Wozney works for the IWK Health Center in Nova Scotia and is one of the authors of the ‘e-mental health implementation toolkit’ which was issued by the Mental Health Commission of Canada in 2018. The eMEN partners are actively promoting this toolkit as it presents a holistic and practical approach towards implementation; Europe is facing the similar implementation challenges as those experienced in Canada and currently no such toolkit is available in Europe (re-inventing the wheel is not the best approach). The toolkit has already received a lot of positive feedback from mental health professionals in Canada.
As the first speaker of the day, Dr. Wozney emphasized the importance of action-focused conversations and the conditions for successful implementation. The latter includes: acceptance, value, evidence, resources, engagement and work process (job and task redesign). Failed projects often have to deal with negative beliefs, too much complexity and security issues.
Other speakers were e-mental health Professor Heleen Riper from the VU, who gave a presentation about the future of ‘blended care’ and the positive research results which have been achieved so far. PhD candidate Christiaan Vis (also from the VU) spoke about the importance of implementation research, which is done through various projects such as E-COMPARED, ImplementALL and iCARE.
Professor Paul Iske (Maastricht University/ Institute of Brilliant Failures) spoke about the importance of failures and learning from failures, which is not done enough. We must fail more to achieve better results and create new opportunities. We should also reduce the gap between research and practice, which is still far too large, and include more diversity in innovation projects. He gave great advice which can be summarized as follows: avoid working with like-minded people all the time, this might be comfortable but will not necessarily bring the results you need!
Another interesting topic of the day was reimbursement. Jeroen Schols and Bernard Creutzburg from the NZA (Netherlands Health Authority) talked about how the use of e-mental health is reimbursed now and how reimbursement will be in the near future. Efficient use of eHealth becomes more important, as healthcare costs become unsustainable (not only in the Netherlands, but in other parts of Europe and beyond). In the Netherlands, there is already a lot of scope for using e-mental health, i.e. face-to-face contact is no longer a requirement for treatment. A therapist must see the patient at least one time face-to-face before treatment starts, but then it is up to the therapist and patient to decide how many face-to-face sessions are necessary. From 2022, the time spent by the therapist will no longer be relevant for the reimbursement amount (the current system has negative incentives, as it focuses on the number of sessions). Via multi-annual care contracts there will be budget room for scaling down traditional mental health care services.