Digital assessment is simply assessment administered using technology. This could include smartphones or tablets, computers, wearable devices or even virtual reality. Information may be collected actively, where the patient or client responds to specific questions or scenarios, or passively, where the data is gathered without any effort by the patient or client, and sometimes even without their awareness.

Using technology to conduct assessment of mental health symptoms and status has a number of advantages. For example:

• It can be cost-effective – can be administered to large numbers of people
• It is accessible – can be accessed remotely, removing need for travel or fitting in appointments
• It can measure actual behaviour in real time, improving accuracy
• It improves fidelity – the assessment is administered the same way every time
• Automatic scoring can reduce errors
• Patients and clients can find it engaging and even fun
• It can lead to greater disclosure, particularly around sensitive topics

Digital mental health assessment can take many forms depending on the aims and technology used.

Synchronous

This is assessment conducted in real-time with a patient or client. It generally follows the same format as in-person assessment, with a question-answer style format. Examples of technology typically employed to conduct synchronous assessments includes telehealth, chatbots and social robots.

Self-report

This is assessment where the patient or client responds to a set of questions themselves. Self-report assessments are commonly employed in mental health apps and online programs to assess current symptoms.

Real-time monitoring

This is a from of passive assessment where data is collected automatically. Smartphones and wearables such as Fitbits and Garmins are the most common technologies used to collect real-time data. The types of data collected can include activity levels, sleep indices, location and heart rate.

Data trawling

Passive data such as social media activity and posts, text messages, patterns of phone use, location information etc can be collected and analysed using machine learning to identify patterns that may associate with poor or declining mental health, or even indicate a mental health diagnosis.

Virtual

Virtual reality is a technology that can replicate realistic versions of environments and scenarios. The reactions and responses of patients and clients can be observed and potentially offer a more accurate assessment of behaviour than self-report.

Digital assessment can be useful in clinical practice in a number of ways.

• Pre-intake or pre-referral screening. This can give an indication of type and severity of problem and provide a baseline for later comparison.
• Identifying potential co-occurring disorders.
• Monitoring symptoms and progress during and after treatment.
• Building insight into contributing factors and triggers when data is plotted against episodes of worsening symptoms.

Alongside some strong advantages to the digital delivery of mental health assessments, there are also some limitations and challenges that need to be considered.

• The privacy and security of information being collected and stored. Who has access? How is it protected?
• The initial set up expense can be quite high, and it may take a lengthy time for cost benefits to be realised.
• Controlling the conditions of the assessment can be challenging. There may be distractions, compromises to confidentiality, or other people assisting or interfering with responses.
• Technical problems can disrupt or derail the assessment, which may put the patient or client off from continuing or trying again.
• Detecting and managing risk can be more challenging when conducting assessments remotely.
• The service may not be suitable for everyone, for example First Nations or CALD people, or those with disabilities.
• Passive data collection can be intrusive and result in harmful surveillance. The patient or client may not be fully aware of the data being collected from them, how it is being used, or be able to easily opt out if they change their mind.

Despite the challenges, technology offers exciting opportunities to extend the depth and breadth of mental health assessment, potentially resulting in faster diagnoses and detection of deterioration. Digital assessments can also free up clinician time, leaving more time for discussion and intervention.