JMIR Publications

ABSTRACT

Although efficacious psychotherapies exist, a limited number of mental health providers and significant demand make their accessibility a fundamental problem. Clinical researchers, funders, and investors alike have converged on online, self-directed mental health interventions (OSMIs) as a low-cost, low-burden, and broadly scalable solution to the global mental health burden. Consequently, exorbitant financial and time-based resources have been invested in developing, testing, and disseminating these interventions. However, the public’s assumed desirability for OSMIs by experts has largely proceeded without question. This commentary critically evaluates whether OSMIs can, and will, reach their purported potential as a solution to the public burden of mental illness, with an emphasis on evaluating their real-world desirability. Our review finds that OSMIs are often perceived as less desirable and credible than in-person treatments, with lower usage rates and, perhaps accordingly, clinical trials testing OSMIs suffering from widespread recruitment challenges. We highlight two fundamental challenges that may be interfering with the desirability of, and engagement in, OSMIs: 1) difficulty competing with technology companies that have advantages in resources, marketing, and user experience design (but may not be delivering evidence-based interventions); and 2) difficulty retaining (versus initially attracting) users. We discuss a range of potential solutions, including highlighting OSMIs in public mental health awareness campaigns; public education about evidence-based interventions that can guide consumers to appropriate OSMI selection; increased financial and expert support to clinical researchers for marketing, design, and user experience in OSMI development; increased involvement of stakeholders in design of OSMIs; and investing in more research on ways to improve retention (versus initial engagement). We suggest that, through these efforts, OSMIs may fully realize their promise for reducing the global burden of mental illness.