Online Mental Health: Challenges and Future Directions

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Technology and Mental Health

Online Mental Health: Challenges and Future Directions

THC Editorial Team January 8, 2021
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Integrating technology and mental health care may revolutionize therapy access and benefit people in ways that current in-person treatments struggle (or fail) to do. Although current studies on online mental health care have yielded promising results, they have also highlighted potential challenges associated with using digital mental health services to improve well-being. Studies have focused on a range of methods, such as technological applications, sensing devices, behavior-changing tools, and real-time intervention devices.1

Challenges For Online Mental Health Services

Potential challenges of e-mental health include the following:

  • Translating effective in-person therapies into equally productive digital or mobile formats—and then applying them—is a complicated, difficult, and involved process.1
  • Online mental health care relies primarily on patients reporting their emotions and feelings through online mediums. This type of self-reporting may be skewed by subjective bias, and people may fail to report their mental states accurately.1
  • Older adults may be less equipped with the technological acumen necessary to use and benefit from online mental health care.1
  • Maintaining user adherence and client engagement may be more difficult with e-mental health interventions than with conventional, face-to-face therapy—particularly if clients are unable to immediately notice the benefits of online mental health care.1
  • Online mental health is associated with an increased risk of potential privacy and confidentiality breaches due to hackers or insufficient data management and control.2
  • Currently, e-mental health technologies must be assessed by researchers before they are released to clients. However, people are developing new technologies far faster than they are researching or testing them. As a result, delays in releases of new technologies may occur.2
  • Online mental health care may further exacerbate the current global digital divide. Because access to technology and a reliable internet connection varies around the world, access to health interventions developed on technological platforms may vary.2
  • The expertise and objectives of online mental health developers, such as computer scientists, computer engineers, medical clinicians, and scientific researchers, may differ. Because people in the fields of technology and medicine often speak to different audiences with different goals, the intentions of the technologies and interventions produced may be unclear.2
  • Online mental health care interventions, like many other new technologies, are costly to develop, deploy, and evaluate.3
  • Public and government attention to improvements and funding may be diverted from conventional mental health services—which are more convenient for certain populations—and redirected toward online mental health services.3
  • Establishing a therapeutic alliance (attuned relationship) online may be challenging for both professionals and clients due to difficulties picking up nonverbal cues, which may lead to feelings of disconnect rather than instances of connection.3,4
  • An increase shift to online mental health services may further marginalize certain individuals, such as those who struggle with cognitive, physical, or financial limitations, within the mental health care system.5
  • Currently, limited research on and clinical evidence of digital-intervention effectiveness exists when compared to research and evidence related to conventional, face-to-face forms of therapy.5

Future Directions For Online Mental Health Services

Researchers and practitioners have offered solutions to address challenges as they have arisen within online mental health services. For example, people may limit digital privacy breaches by using  robust passwords, deleting messages, restricting the transfer of sensitive information, and ensuring that information is secure on a single device.2 Clients and professionals should both abide by ethical guidelines on privacy and confidentiality, and people who use online mental health services should be notified about what data is being collected and how it is being used and processed.1

According to an article published in 2019 by mental health researcher Shalini Lal, 10 key strategies should be implemented in future development and use of e-mental health:5

  1. E-mental health strategies should be incorporated into general mental health policies.
  2. A multilevel system for the implementation and sustainability of e-mental health should be developed, and leadership should be established at each level.
  3. Various mental health institutions and agencies should be assisted in both developing infrastructure and accessing technology.
  4. E-mental health education and training should be provided to professionals and clinicians.
  5. E-mental health practices that are evidence based and extensively researched should be implemented.
  6. Population diversity factors, such as gender, literacy, culture, resources, and organizational readiness, should be considered when establishing, implementing, and analyzing e-mental health initiatives.
  7. Cost-effectiveness and blended approaches to mental health care should be considered in order to tend to underserved populations and implement e-mental health in diverse, real-world settings.
  8. Consumers, caregivers, providers, and decision makers should be involved in developing, implementing, and evaluating online mental health initiatives.
  9. State, federal, and international funding should be provided for the research, implementation, maintenance, and evaluation of e-mental health innovations that have been backed by evidence.
  10. National and international collaboration should be fostered to make collective decisions regarding online mental health solutions and public awareness.

Although e-mental health services are promising, they should be used to complement—rather than replace—conventional, in-person approaches to mental health care.6 In addition, enthusiasm for the potential of digital health should not lead to using untested applications or to abandoning empirical, evidence-based efforts to improve these technologies.2 Consequently, further studies are required to determine the efficacy of e-mental health, the most effective modes of implementing it, and the populations that would benefit most from it. The future of online mental health care depends on building a solid evidence base for the effectiveness of prevalent interventions that use current technology and on supporting underutilized interventions that use cutting-edge technology.2

Integrating technology into mental health care creates a new set of opportunities and challenges as the boundaries between research, monitoring, and clinical intervention become increasingly blurred.4 Digital mental health care opens a possibility for ideological shifts regarding the evaluation and treatment of mental illness, but it also reinforces the need for researchers, clinicians, and patients to collaborate in order to accurately assess the efficacy and safety of new technologies.4


  1. Woodward, K., Kanjo, E., Brown, D., McGinnity, T. M., Inkster, B., MacIntyre, D., &Tsanas, T. (2020). Beyond mobile apps: A survey of technologies for mental well-being. IEEE Transactions on Affective Computing.
  2. Aguilera, A. (2015). Digital technology and mental health interventions: Opportunities and challenges. Arbor, 191(771), a210.
  3. Lal, S., & Adair, C. E. (2014). E-mental health: A rapid review of the literature. Psychiatric Services, 65(1), 24–32.
  4. Marzano, L., Bardill, A., Fields, B., Herd, K., Veale, D., Grey, N., & Moran, P. (2015). The application of mHealth to mental health: Opportunities and challenges. The Lancet Psychiatry, 2(10), 942–948.
  5. Lal, S. (2019). E-mental health: Promising advancements in policy, research, and practice. Healthcare Management Forum, 32(2), 56–62.
  6. World Psychiatric Association. (2017, October). WPA position statement on e-mental health.

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