Enhancing social inclusion through the implementation of evidence-based digital health interventions for mental health and alcohol/other drug use problems in the wake of COVID-19

At any one time, over 900 million people globally experience a mental disorder (including alcohol/other drug use disorders, Whiteford et al., 2013), and this is increasing by about 3% each year (ABS, 2018). Adding to these challenges, the COVID-19 pandemic presents clear risks for a substantial decline in global mental health. Preliminary evidence points towards an overall rise in symptoms of anxiety and coping responses to stress (Holmes et al., 2020), including increased drug and alcohol use amongst the general population. The greatest mental health impacts of the COVID-19 pandemic will be felt, however, by those who are already most marginalised and people with pre-existing mental health and substance use disorders, who have a higher susceptibility to stress than the general population (Yao et al., 2020). eCliPSE is an online clinical portal developed by CI Professor Frances Kay-Lambkin in partnership with the research team and the NSW Ministry of Health to facilitate access to evidence-based ehealth treatments for mental health and alcohol/other drug [AOD] use problems. However, since the testing of eCliPSE in 2017, uptake of this tool via clinician referral has been low, and no clear models existed for digital treatment integration into health services (Batterham et al., 2015). There are very few examples in the available literature of successful implementation of digital interventions in clinical services, and many failures (Mohr et al., 2017). In response to this, our team has developed an evidence-informed Integrated Translation and Engagement Model (ITEM) to drive the uptake of digital therapeutics into mental health and alcohol/other drug services across NSW. Based on the latest evidence for effective implementation, a consideration of individual, social, environmental, and structural factors, the ITEM synthesises diverse theoretical approaches into a coherent, integrated model. The pandemic has highlighted (and exacerbated) social inequities in relation to the prevalence of mental illness, as well as treatment options. Technology has the potential to respond to this challenge, but Australia lags behind the rest of the world in implementing sustainable, effective digital tools into health service delivery. Additionally, no tool currently exists for the evaluation of dual diagnosis capability of digital programs. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Ramsay Hospital Research Fund Translational Challenge Grant (G2101217) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: REGGS Ethics and Governance of Ramsay Health Care have given ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes This submission contains a protocol but data collection has not commenced.