Realising the Value of Digital Tools for Personalised and Measurement-Based Care in Youth Mental Health Services

Abstract

Mental ill-health among youth is a global concern, affecting one in seven adolescents. Despite rising demand, timely and appropriate care remains limited, partly due to the heterogeneous and comorbid nature of youth symptoms. Blended care models, which integrate digital tools into traditional services, offer scalable solutions for care stratification and personalised measurement-based care (MBC). However, the uptake of these tools in youth mental health services is suboptimal. While engagement moderators have been identified, understanding of the mechanisms driving sustained engagement remain limited.

This thesis evaluates capacities and engagement of digital tools for personalised MBC in services. Chapter 2 validates a rule-based algorithm that differentiates young people at lower and higher risk of developing full-threshold mental disorders. Chapter 3 examines a digital suicidality notification system, showing its capacity to trigger timely clinical responses based on acuity. Chapter 4 explores barriers and facilitators of digitally-enabled MBC among youth, while Chapter 5 investigates their experiences of using a digital MBC tool as part of routine care in real-time. Findings of Chapters 4 and 5 reveal their enthusiasm for integrating digital tools into care. However, they also demonstrate clinical relevance and collaborative use with clinicians as critical factors for sustained engagement. Chapter 6 further supports the importance of clinical relevance by demonstrating that personalising the tool use through a goal-setting feature enhances engagement, leading to frequent and prolonged use.

Altogether, this thesis highlights the potential of digital tools to deliver timely and personalised care. Furthermore, by introducing the Realisation Chasm, the gap between young people’s expectations for digital MBC tools and the realisation of their benefits, this thesis provides strategies for ensuring meaningful integration of digital tools into mental health services.