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For Institutions

Resources for hospitals, health systems, and community mental health centers considering digital tools. We focus on realistic implementation, not hype.

The System Challenge

Mental health systems face structural challenges that technology alone cannot solve. But technology may help at specific points.

160K+
provider shortage
HRSA, 2024
23+ hrs
average psychiatric boarding
ACEP, 2023
60%
counties without psychiatrist
HRSA data
97%
reduction in state beds since 1955
TAC

Where Technology Can Help

Technology cannot create more providers or beds. But it can address specific points of system strain:

Extending Provider Reach

  • Telepsychiatry: Proven effective for reaching rural areas
  • Asynchronous care: Message-based consultation
  • Digital between-session support: Maintaining momentum

Evidence: Telepsychiatry shows comparable outcomes to in-person for many conditions.

Reducing Administrative Burden

  • Automated assessments: Pre-appointment screening
  • Outcome measurement: Systematic PHQ-9, GAD-7 tracking
  • Documentation support: (With appropriate safeguards)

Evidence: Measurement-based care improves outcomes; automation can improve compliance.

Stepped Care Support

  • Self-help first step: For mild presentations
  • Guided digital interventions: Coach-supported
  • Post-discharge maintenance: Relapse prevention

Evidence: UK IAPT demonstrates stepped care at scale. Digital tools fit naturally at lower steps.

Crisis System Support

  • Bed registries: Real-time availability tracking
  • Telepsychiatry in ED: Faster disposition decisions
  • Crisis text/chat: Expanding 988 capacity

Caution: AI chatbots fail at crisis detection. Human oversight remains essential.

What Technology Cannot Do

Be realistic about limitations:

  • Cannot replace workforce. Technology augments; it doesn't substitute for trained providers.
  • Cannot create beds. Psychiatric boarding requires physical infrastructure and staffing.
  • Cannot replace therapeutic relationship. Hybrid models consistently outperform pure digital.
  • Cannot safely handle crisis alone. AI crisis detection is unreliable.
  • Cannot solve engagement. 80%+ of users stop using apps within 2 weeks.

Implementation Considerations

1. Start with Clear Use Cases

Don't adopt technology in search of a problem. Identify specific points of system strain where technology has evidence of benefit.

2. Evaluate Evidence Carefully

Many digital mental health vendors make claims not supported by evidence. Ask for:

  • Peer-reviewed publications on the specific product
  • Real-world engagement data (not just trial data)
  • Independent evaluation (not just company-funded)
  • Crisis protocol documentation

3. Plan for Integration

Digital tools that don't integrate with clinical workflow tend to fail:

  • EHR integration for data sharing
  • Staff training and buy-in
  • Clear referral pathways
  • Monitoring and outcome tracking

4. Prioritize Safety

Any digital tool used with patients must have:

  • Robust crisis protocols
  • Clear disclaimers about limitations
  • Human oversight mechanisms
  • Escalation pathways

5. Consider Equity

Digital tools risk widening disparities if not designed carefully:

  • Digital divide (not everyone has smartphones)
  • Literacy requirements
  • Language and cultural appropriateness
  • Algorithmic bias testing

Models Worth Studying

NHS IAPT

The UK's Improving Access to Psychological Therapies program treats 1.5+ million people annually using stepped care with digital tools at lower steps.

Key lessons: Self-referral, measurement-based care, clear step-up criteria, national standards.

More details →

CCBHCs

Certified Community Behavioral Health Centers show 60% increase in persons served, 12% reduction in ED visits, 18% reduction in hospitalizations.

Key lessons: Comprehensive services, 24/7 crisis, integration with primary care.

More details →

Digital Clinic Model

Dr. Torous's "Digital Clinic" combines app-based tools (mindLAMP) with clinician support and digital navigators.

Key lessons: Hybrid model, digital phenotyping, measurement-based care, digital navigator role.

More on Dr. Torous's work →

Crisis Stabilization Units

23-hour observation units as alternatives to ED boarding and inpatient admission for many presentations.

Technology role: Telepsychiatry, monitoring, handoff coordination.

More details →

Further Resources

Full Whitepaper

80+ page synthesis including systems reform section with workforce, boarding, and community mental health data.

Systems Reform Research

Detailed data on workforce shortage, psychiatric boarding, CCBHCs, and international models.

Ethics Framework

Our principles and commitments. Use as reference for evaluating vendors.

AI Fairness (22b1)

Research on algorithmic bias in healthcare from our parent initiative.