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Mohr DC, Azocar F, Bertagnolli A, Choudhury T, Chrisp P, Frank R, Harbin H, Histon T, Kaysen D, Nebeker C, Richards D, Schueller SM, Titov N, Torous J, Areán PA. Banbury Forum Consensus Statement on the Path Forward for Digital Mental Health Treatment. Psychiatr Serv 2021; 72:677-683. [PMID: 33467872 PMCID: PMC8822332 DOI: 10.1176/appi.ps.202000561] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A major obstacle to mental health treatment for many Americans is accessibility: the United States faces a shortage of mental health providers, resulting in federally designated shortage areas. Although digital mental health treatments (DMHTs) are effective interventions for common mental disorders, they have not been widely adopted by the U.S. health care system. National and international expert stakeholders representing health care organizations, insurance companies and payers, employers, patients, researchers, policy makers, health economists, and DMHT companies and the investment community attended two Banbury Forum meetings. The Banbury Forum reviewed the evidence for DMHTs, identified the challenges to successful and sustainable implementation, investigated the factors that contributed to more successful implementation internationally, and developed the following recommendations: guided DMHTs should be offered to all patients experiencing common mental disorders, DMHT products and services should be reimbursable to support integration into the U.S. health care landscape, and an evidence standards framework should be developed to support decision makers in evaluating DMHTs.
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Affiliation(s)
- David C Mohr
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Francisca Azocar
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Andrew Bertagnolli
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Tanzeem Choudhury
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Paul Chrisp
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Richard Frank
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Henry Harbin
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Trina Histon
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Debra Kaysen
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Camille Nebeker
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Derek Richards
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Stephen M Schueller
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Nickolai Titov
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - John Torous
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Patricia A Areán
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
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- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
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