eMEN Summer 2018 Newsletter

Welcome to the eMEN Summer newsletter, updating you on our progress and achievements across Europe in digital mental health technologies.

What is happening across the eMEN project?

Each partner is piloting an e-mental health product. The examples below illustrate some of the innovative approaches developing from our studies, which aim to address barriers to the uptake of e- mental health. We creatively disseminate evidence-based policy and research learnings from across our network, including through seminars taking place in May (Edinburgh, UK) and June (Düsseldorf, Germany). If you missed eMEN events so far, we have many upcoming seminars and conferences listed at the end of this newsletter. Combined expertise across the project has supported our policy work, with a coordinated approach to using product pilots to create an impact in the sphere of European digital mental health.

Why are product pilots important?

Throughout eMEN, each partner is testing an e-mental health product. The examples below illustrate some of the learnings from development and implementation of digital mental health products.

StopBlues is born!

The eMEN project is happy to announce the launch of the StopBlues website and apps, available for downloaded on the iTunes App and Google play stores. Every year in France 200,000 suicide attempts and 10,500 deaths by suicide are reported, almost three times more deaths than traffic accidents and likely underestimated due to taboos. Suicide prevention remains complex, and StopBlues aims to fill the "primary" prevention gap by giving the general population a free digital tool to manage psychological distress and destigmatise mental health problems.

StopBlues has been developed within the Printemps research project of the French National Institute of Health and Medical Research (Inserm), with the support of the French national action plan against suicide and the eMEN project. The app and website aim to break isolation by informing on where to find help and providing solutions such as relaxation or positive psychology exercises. The project aims to study the effectiveness of StopBlues and its promotion strategy in the population, to identify the favourable conditions and the actors to involve for efficient e-health prevention intervention at the local level.

The main objective of the research project is to demonstrate the effectiveness of a mobile Internet intervention in primary suicide prevention including a smartphone application and associated website. A second objective is to study two promotion strategies: by local governments only and by local governments and general practitioners. Although health policies are not their direct responsibility, a considerable number of cities have begun to develop actions in favour of the health of their residents by following the movement launched by the World Health Organization (WHO), the WHO Healthy Cities, to involve municipal authorities in the implementation of health policies. Involvement by general practitioners in community-based approaches to depression and suicide prevention has also been found effective.

HappyCare - an online tool to promote resilience in your employees

Pulso Europe’s mission is to assist and guide organisations in developing and implementing their well-being strategies, policies and programmes. One way of doing so, is by implementing e-mental health tools such as HappyCare, an innovative, online application for self-testing, self-help, coaching and advice about mental resilience.

We can no longer deny it: work-related stress is increasingly more present within organisations. Moreover, it is expected to become the most prevalent cause of absenteeism and occupational disability. In short, if you feel good, you function better and research has shown that some strategies help you feel better about yourself. Pulso Europe developed HappyCare, an online tool to help increase mental resilience. Based on positive psychology, cognitive behavioural therapy, mindfulness and health psychology, these strategies are taught and improved via seven topics (live towards your goals, invest in relationships, think positively, be aware of yourself, live here and now, take control of your life and lead a healthy and active life). The topics contain exercises, testimonials, movies, advice and information on how to increase and retain mental resilience.

When piloting the tool, a significant increase in happiness score was found after 6 weeks of using the application, which lasted after 6 and even 18 months. The effect is slightly more pronounced in women compared to men. Furthermore, HappyCare was evaluated positively and considered useful by the user sample. In conclusion, HappyCare offers the possibility to work on long-term well-being and resilience via an online platform, in a pleasant, evidence-based way!

Recent eMEN events

Place based approaches to e-mental health (Edinburgh, UK)

On 24th May, the Mental Health Foundation with NHS Lothian ran a seminar looking at how e-mental health in different settings can help prevent mental health problems and provide support to people with unmet mental health needs. The day was chaired by Dr Donald MacIntyre, Associate Director of NHS 24.

The keynote speaker Dr Diane Pennington (University of Strathclyde, Glasgow) considered the internet as a virtual place where people can access e-mental healthcare, but which can also perpetuate social exclusion through the ‘digital divide’ where they are unable to access the technology due to cost and lack of knowledge or skills. Five workshops then explored what e-mental health has to offer to young people (schools and colleges), the criminal justice system (prisons), social isolation (rural communities), positive mental health practice (on the go), and interpersonal connections (clinical setting). Nigel Henderson (Penumbra) and Lucy Gunatillake (Mindfulness Everywhere) described the inception and development of their digital innovations, and potential barriers to implementation.

A panel discussion looked at emerging themes and barriers in place-based e-mental health and concluded that the advantage of e-mental health is its ability to extend mental health support to hard to reach groups. With a combination of presentations from those working in Scotland and knowledge and insights from other parts of the UK and other countries, the seminar shared learning and facilitated networking focused on current and new opportunities for e-mental health in Scotland.

E-Mental health implementation: the digital revolution in mental healthcare (Düsseldorf, Germany)

The Düsseldorf seminar on 11^th June focused on the general framework necessary for the implementation of digital interventions in Germany. Around 120 participants joined the event hosted by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN), the German Alliance on Mental Health (ABSG) and the LVR Institute for healthcare research (LVR-IVF). Renowned national and international speakers presented their knowledge on current research, gave practical insights in e-mental health routines and discussed prerequisites to implementation in Germany.

Prof. Heleen Riper (VU, Amsterdam) introduced e-mental health with an overview of the current state of the art. She said that high-quality digital applications can be effective interventions and contribute to closing gaps in psychosocial care, and therefore questioned why they haven’t yet been implemented in routine care in Germany. Karsten Knöppler (Managing Director, fbeta) identified the short development cycles of digital applications as a major challenge for the implementation of digital interventions into the healthcare system and called for new methods to evaluate these products. Dr. Susanne Klein (Head of Development, TK Care Management) reported positive experiences with a pilot project using internet-based interventions for people with mild to moderate depression. She emphasised that online interventions must meet high quality standards and be seen as an additional tool rather than a cost-effective alternative to routine care.

A best practice-session presented ideas from around Europe including the E-RECOVER portal (Prof. Martin Lambert, University Medical Centre Hamburg-Eppendorf), Therapy 2.0 (Evelyn Schlenk), PRONIA (Prof. Eva Meisenzahl) and Interapy (Dr. Bart Schrieken). The final panel discussion included the President of the Federal Chamber of Psychotherapists, Dr. Ernst Dietrich Munz, and Dr. Franz Joseph Bartmann, President of the Medical Association Schleswig-Holstein and Chairman of the Telematics Committee of the German Medical Association. The consensus was that online-based interventions are an effective "tool" to enable better access to mental healthcare, and e-mental health applications can increase the range of mental health care services.

How is e-mental health viewed in policy around Europe?

Remote consultations easier in Germany through moderation of media in healthcare

The German professional code for physicians describes rights and duties of practitioners towards patients, colleagues and their professional associations – including the use of media in health care practice. This part of the professional code for physicians has been the focus of discussion especially on state level for some time. The state Baden-Württemberg for example, adapted its professional code on state level already in 2016 to enable research projects using remote consultation without prior personal contact - successfully. To date, several research projects or so-called “Modellprojekte” are in place in Baden-Württemberg.

During the 121st “Ärztetag” of the German Medical Association in May 2018, the German Medical Association decided to moderate the professional code for physicians on national level concerning the use of media. Before this, the professional code stated that communication via media is only allowed if there has been prior direct contact to the patient. This decision, which has been approved by the majority of the German Medical Association members, may have a signaling effect and can be seen as a step forward in facilitating use of digital health in German health care. However, whether the decision will be implemented by all medical associations at state level, remains to be seen.

Report shows digital technology can play an important role in Irish mental healthcare

‘eMental Health: State-of-the-Art & Opportunities for Ireland’ report by Kevin Cullen was launched by the Irish Minister of State for Mental Health and Older People, Jim Daly, TD on the 16^th May in the Science Gallery, Dublin. This eMEN stakeholder engagement event was attended by over 50 participants and stimulated discussion on the significant opportunities presented by eMental Healthcare alongside limitations and possible challenges for these types of interventions.

Director of Mental Health Reform, Shari McDaid, said, “Valuable opportunities exist to exploit eMental Health technologies within the mental healthcare system in Ireland… This report is rooted in Mental Health Reform’s value of empowerment of individuals who use mental health services, we are particularly interested in the possibilities digital technology can open up for people to take the lead in their own recovery.” The report considers eMental Health applications helpful for common mental health conditions, as well as those relevant for more severe and enduring difficulties. It highlights the range of technologies and applications encompassed within eMental Health, including teleconsultation (phone, video, instant chat), online and computer-based programmes (eTherapy), mobile apps, virtual reality, gaming, social media, wearables, and data analytics.

Please see the eMEN website for the full article including select report findings and recommendations, including the need for a dedicated strategy, inclusive stakeholder engagement, practitioner and user guidance and support for research and guidance in developing products.

The long-term outlook for e-mental health policy in Europe and beyond

In May 2018, RISE (Sweden) and The Mental Health Foundation (UK) hosted 19 guests from across the world for an intensive two-day match as a platform for their pioneering work. The aim was to harness the opportunity for knowledge sharing and co-production, towards future collaboration. The two days involved multiple presentations, followed by group workshops on the digital innovation presented. This levered structured feedback from a group that offered a pool of experience, knowledge and expertise. Workshops addressed how each innovation might be reframed and meet unforeseen barriers as well as exploring the potential to scale up the solution. The result of this strategy facilitated tangible, practical and workable solutions for all attendees.

A call for formally standardised definitions of terms such as prevention and e-mental health as prominent. Different actors, including health insurance specialists, clinical psychologists, researchers, entrepreneurs, policy makers, experts by experience, and non-profit organisations offered their perspective. Overall, it was agreed that mental health challenges pose the same demand and urgency globally, and our digital era must be better harnessed to safeguard the protection of mental health over and beyond the prevention of mental illness.

What’s next?

Upcoming FREE transnational seminars and conferences

Over the life of the project, eMEN will deliver 24 transnational events across Europe addressing e-mental health evidence-based innovations, quality, access and scale.

Share our animation!

The eMEN animation explains the concept of e-mental health and the many ways it can support mental wellbeing and is available at nweurope.eu/emen.

Why not join our transnational network?

eMEN is an e-mental health project running until November 2019, funded through the Interreg North West European Innovation Programme with a value of €5.36million. The six country partners are led by the Netherlands and include Belgium, France, Germany, Ireland and the UK who together combine diverse technological, clinical, research, and policy expertise.

To sign up for our newsletter and join the long-term network evolving out of eMEN, please fill in the registration form. We welcome invitations to contribute to your event. Further contact information for all the partners is available at www.nweurope.eu/emen.