Recommendations for Optimal eMental Healthcare with Forensic Populations

Hanneke Kip, Centre for eHealth and Wellbeing Research, University of Twente; Department of Research, Transfore
Kira Oberschmidt, eHealth Group, Roessingh Research and Development; Biomedical Signals and Systems Group, University of Twente
Joyce J.P.A. Bierbooms, Tilburg University; Research Group Evidence Based Management of Innovation, GGzE

While eHealth technologies such as web-based interventions, mobile apps, and virtual reality have the potential to be of added value for forensic mental healthcare, there is a gap between this potential and the current situation in practice. The goal of this study was to identify recommendations to bridge this gap. In total, 21 semi-structured interviews and 89 questionnaires were conducted in a Dutch forensic mental healthcare sample consisting of professionals, patients, and eHealth experts. Based on the broad range of identified recommendations, it can be concluded that attention should be paid to the characteristics of professionals, patients, technology, and the organization throughout the development, implementation and evaluation of eHealth.

eHealth, forensic mental healthcare, forensic psychiatry, web-based interventions, virtual reality

“Over the last few years, the use of eHealth technologies in the treatment of forensic psychiatric in- and outpatients has received increased attention…eHealth technologies such as web-based interventions, virtual reality or mobile apps have the potential to improve the quality and efficiency of forensic mental healthcare. However, until now, there has been little research on the actual effects and benefits of eHealth in forensic mental healthcare…A recent review…showed that different types of technologies can have different advantages for forensic mental healthcare…the current study, therefore, focusses on identifying recommendations to overcome barriers and optimally benefit from the possibilities of eHealth technology…” (p.31-32).

“Interviews were conducted with three categories of participants: professionals working in forensic mental healthcare, current or former forensic psychiatric patients, and experts on technology in forensic mental healthcare…Identified recommendations were related to development, implementation, and evaluation of eHealth in practice; the importance of guidelines and standards; the facilitation of working with technology; and constant improvement of technology…A large share of the identified recommendations revolved around the key role of the professional in enabling successful use of technology in forensic mental healthcare. In order to improve the current situation, participants indicated that more training of professionals is necessary and that training should not just focus on technical skills…education would also have to focus on, for example, developing a positive attitude toward eHealth, creating a sense of ownership for maintaining up-to-date knowledge, improving skills to discuss collected data with patients, and gaining knowledge on how to support patients in their use of eHealth technologies…” (p.33-38).

“The current study points out the importance of a good fit between the technology and the forensic psychiatric patient who is using it. Participants indicated that patients often do not possess the required skills for using technologies…it can be beneficial to further investigate how patients can be better supported in using these mostly text-based apps or websites, which are used a great deal in current practice…On the other hand, organizations might have to invest more in technologies of which the characteristics might better fit the forensic psychiatric patient population…” (p.38-39).

“With regard to technology itself, personalization appeared to be important, mostly because of the different needs and characteristics of the diverse forensic psychiatric patient population…In order to ensure that a technology seamlessly fits the needs of patients and therapists, participants indicated that a multi-method, participatory development process is pivotal…When looking at the context in which technology is used, participants emphasized the important role of the forensic organization in the technology’s implementation…The importance of thorough research was intertwined in many recommendations identified in this study. As mentioned before, research can be used to gain more insight into development and implementation methods that are suitable in forensic mental healthcare…” (p.39-40).

“…the use of technology by practitioners might require more than upgrading skills; in fact, the introduction of technology can implicate in practice a change in people’s professional roles. A therapist’s role might shift from taking the lead in treatment to a more supportive role that includes: giving feedback on assignments in a web-based module, creating environments to allow a patient to individually practice with social skills in VR, or supporting a patient in drawing conclusions on data collected by a wearable to gain insight into what triggers them. However, not much is known about this topic yet, so subsequent research should focus on the changing role of the professional…Furthermore, recent research showed that psychologists differ in the type of perceived drivers and barriers toward eMental health…This implies that there are multiple categories of therapists that have different levels of eHealth-skills and -attitudes. New research can focus on these differences in skills and preferences, and the necessity to develop tailored training programs for different types of professionals” (p.38).

“…developers of eHealth interventions should take the skill level and preferences of patients into account to prevent a mismatch between the technology and patient. Such a mismatch might result in high levels of non-adherence…An important advantage of interactive VR [virtual reality] for forensic mental healthcare is that it offers the possibility to practice specific behavior in a realistic way instead of merely discussing it…Wearables are another example of a technology that focuses less on cognitive reflection” (p.38-39).

“…Implementation of eHealth technologies should be improved to ensure successful and sustainable use, but this was seen as a complicated activity…participants provided a broad range of recommendations for improving implementation in organizations by, for example: investing more in technologies, better integrating eHealth into organizational structures, ensuring that all employees are aware of and educated in eHealth, and joining forces with other organizations to share knowledge and costs” (p.40).

“…to systematically plan and guide implementation processes, organizations can use existing implementation frameworks that are suitable for eHealth implementation, such as the non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework (Greenhalgh et al., 2017) or the consolidated frame-work for implementation research (CFIR; Greenhalgh et al., 2017)…” (p.40).

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