Digital mental health in Italy: findings from the multicentric DIGIT-PSY study

Introduction: Despite an increasing interest in upscaling the digitalization process in mental health care services, there is still a gap in a deeper knowledge of the main barriers and facilitators allowing a capillary and consolidated implementation of digital mental health (DMH) and digital psychiatry (DP), particularly in the Italian context. A multicentric nationwide study (DIGIT-PSY) was designed with the aim to overview the current digitalization level of Italian mental health systems and professionals, by investigating needs/gaps to be addressed to accelerate the availability/access to DMH/DP interventions in Italy, as well as specific internal/external determinants of the process. The final goal of the DIGIT-PSY was to provide a roadmap for implementation strategies to reach a satisfactory level of digitalization of mental health care settings in Italy. Methods: A survey was distributed to a multiprofessional cohort of mental health professionals (psychiatrists, psychiatry trainees, psychologists, technicians in psychiatric rehabilitation and professional mental health educators), from public and private Italian settings, from May 1st, 2023 to September 30th, 2023. Internal/external determinants influencing the level of digitalization, as assessed by using the Digitalization index (DIGi score) were explored, by also comparing mental health (MH) professionals in three groups: a) low (DIGi ranged 4-9); b) moderate (DIGi ranged 10-15); and, c) high level of digitalization (DIGi ranged 16-20). Results: Only 16.4% of the sample declared an optimal/good clinical practice experience in the field of DP/DMH interventions, being mostly among psychiatrists and psychologists and those who currently practice psychotherapy (all, p < 0.001). Only 6.5% (N = 90) of mental health professionals received a formal DMH/DP training. The mean DIGi index was 9.9 ± 3.5. MH professionals owning a pre-COVID-19 and/or post-COVID-19 clinical experience in DMH/DP showed the highest DIGI scores (both p<0.001), suggesting a COVID-19 effect in boosting the digitalization of MH services. Working with DMH/DP knowledgeable colleagues and with colleagues who routinely deliver DMH/DP in their clinical practice increased the digitalization level of MH professionals and services (both p<0.001). Both education/training in DMH/DP (p=0.002) and regular clinical practice in DMH/DP (p<0.001) improved the chance to reach a high DIGi score. While working in a public job setting negatively predicted the DIGi index (p=0.007). Discussion: National initiatives should firstly address education and training needs of the youngest mental health professionals, particularly those without a mentor/supervisor experienced in providing DMH/DP and in educating younger professionals in the digital clinical practice. Sex-sensitive consolidating strategies should be implemented in those mental health services already digitalized. Longitudinal studies should evaluate the efficacy in the long-term of country-based digitalization strategies.