Mental health continues to be one of the major areas of healthcare where we see increasing and more innovative efforts to approach it in better ways and to deliver a more personalised and consistent experience to users who engage in the services.
The pandemic has not diminished this drive—in fact, the opposite. The effects of lockdowns, social isolation, as well as unemployment, increased inequalities and lack of connectedness are evident globally. Healthcare dictates that this takes different forms in different jurisdictions, but there are some common themes.
Many have experienced difficulties in access to mental healthcare and support, especially in the first few waves where mental health was largely de-prioritised by healthcare systems trying to grapple with an unpredictable pandemic. The effects of this are now becoming more evident with increasing levels of morbidity.
The mental health needs of an overburdened, highly stressed, and thinly spread workforce coping with burnout and overwork is another significant component of the healthcare puzzle. So is the changing burden of disease where mental health conditions become even more prevalent, or at least more visible in populations.
Care and services for those living with non-communicable diseases have also suffered during the pandemic. Managing and catching up with the increased volume of care needs inevitably has a mental health component, as we move care in the 21st century from managing failing organs to helping and supporting patients as whole persons. There are significant challenges to providing more person-centered and integrative care, but new multimodal approaches offer new opportunities for optimising care to people.
The new models of care in mental health are likely to touch everyone who receives these services. Multimodal approaches could include every modality for contact including text, video, telephone and face to face. All of these could have a role in optimising care and improving health outcomes for people.
So, what are the early patterns of multimodal approaches we are seeing within mental health, and what is the potential?
One of the mental health interventions most on the rise within mental healthcare is digital therapeutics, which is mainly based on cognitive behavioural principles (iCBT). This therapeutic approach is often multimodal in itself, in that it combines text-based, video-based and audio-based psychoeducative content with video, text and/or telephone consultations with a therapist. This type of digital mental health intervention has been gaining substantial evidence when it comes to its effectiveness and usefulness in helping people with common mental health conditions like stress, anxiety disorders, moderate to severe depression and bipolar disorder.
Although there have been some positive experiences with using digital interventions for more severe mental illness in some countries, such interventions are generally still less recommended as the only treatment or intervention modality when helping people with conditions like psychosis, schizophrenia, severe PTSD or with strong suicidal ideation. Nevertheless, in combination with face-to-face therapy and other support services, digital interventions—and especially those that are multimodal—can certainly add value and bring better continuity of care for user groups across the whole spectrum of mental health challenges.
Although the pandemic has catalysed a digital revolution within healthcare, it is unlikely that digital interventions will become the only intervention of choice. More traditional face-to-face interventions will still be necessary and preferred by many service users and healthcare professionals. However, the combination of traditional care and innovative digital solutions can bring forward the best from both worlds. This can especially be beneficial for those service users who have difficulties with disclosing personal information or with expressing their emotions through a specific modality—for example, face-to-face or video conversation.
Another great benefit of multimodal care is that it enhances the number of therapeutic points and thus has the potential of facilitating more lasting cognitive and behavioural change and care outcomes in service users. By skillfully blending the mix of modalities, it is possible to deploy these without increasing the pressure on an already overstretched workforce.
Finally, in this new dawn of healthcare, it is important to remember that any modality—digital or in-person—is a tool and a framework for facilitating care, not the means. The therapeutic relationship and the user’s active engagement with the intervention modality and its content remain significant for any positive effects of any therapeutic intervention.
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Originally published October 19, 2021, updated November 16, 2021