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. 2022 Mar 9;9(3):e33060.
doi: 10.2196/33060.

Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy

Haley M LaMonica  1 , Frank Iorfino  1 , Grace Yeeun Lee  1 , Sarah Piper  1 , Jo-An Occhipinti  1 , Tracey A Davenport  1 , Shane Cross  1 , Alyssa Milton  1 , Laura Ospina-Pinillos  1 , Lisa Whittle  1 , Shelley C Rowe  1 , Mitchell Dowling  1 , Elizabeth Stewart  1 , Antonia Ottavio  1   2 , Samuel Hockey  1 , Vanessa Wan Sze Cheng  1 , Jane Burns  2 , Elizabeth M Scott  1 , Ian B Hickie  1
Affiliations

Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy

Haley M LaMonica et al. JMIR Ment Health. .

Abstract

Background: Globally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users' needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care.

Objective: Project Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms.

Methods: Participating health care organizations included the following: Open Arms-Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]); NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads); the Butterfly Foundation's National Helpline for eating disorders; Kildare Road Medical Centre for enhanced primary care; and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention.

Results: Despite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted.

Conclusions: Although the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care.

Keywords: co-design; health care reform; mental health; mobile phone; participatory research; stakeholder participation; technology.

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Conflict of interest statement

Conflicts of Interest: IBH is codirector of Health and Policy at the Brain and Mind Centre (BMC) at the University of Sydney. The BMC operates an early-intervention youth services at Camperdown under contract to headspace. He is the Chief Scientific Advisor to, and a 5% equity shareholder in, InnoWell Pty Ltd. InnoWell was formed by the University of Sydney (45% equity) and PwC (Australia; 45% equity) to deliver the Aus $30 million (US $21.63 million) Australian Government–funded Project Synergy (2017-2020; a 3-year program for the transformation of mental health services) and to lead the transformation of mental health services internationally through the use of innovative technologies. JO is both Head of Systems Modelling, Simulation & Data Science at the University of Sydney’s BMC and Managing Director of Computer Simulation & Advanced Research Technologies. TAD is now Director (Research and Evaluation) of the Design and Strategy Division, Australian Digital Health Agency. EMS is Principal Research Fellow at the BMC, University of Sydney. She is Discipline Leader of Adult Mental Health, School of Medicine, University of Notre Dame, and a consultant psychiatrist. She was the Medical Director at the Young Adult Mental Health Unit, St Vincent’s Hospital Darlinghurst, until January 2021. She has received honoraria for educational seminars related to the clinical management of depressive disorders supported by Servier and Eli-Lilly pharmaceuticals. She has participated in a national advisory board for the antidepressant compound Pristiq, manufactured by Pfizer. She was the National Coordinator of an antidepressant trial sponsored by Servier. The source of funding does not entail any potential conflict of interest for the other members of the Project Synergy Research and Development Team.

Figures

Figure 1
Figure 1
Example dashboard from the InnoWell Platform.
Figure 2
Figure 2
Example explanation of a health domain and assessment result from the InnoWell Platform.
Figure 3
Figure 3
Example nonclinical care options from the InnoWell Platform.
Figure 4
Figure 4
A summary of the methodologies and key outcomes from phase II of Project Synergy [14-16,18-19,21-22,23]. NSW: New South Wales.
Figure 5
Figure 5
Research methodologies and ethics approvals underpinning Project Synergy. HREC: human research ethics committee; NSW: New South Wales; NSLHD: Northern Sydney Local Health District.
Figure 6
Figure 6
Preclinic triage system enabled by the InnoWell Platform (as originally published by Davenport et al [45]).
Figure 7
Figure 7
Critical learnings from Project Synergy [Figure 7 [4,6,15,19-20,22,27-28,31,36-38,43,53-59]].
See this image and copyright information in PMC

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