After almost three years of telehealth, Zoom meetings and an app for everything, we might be forgiven for thinking that the digital divide no longer exists. Surely everyone has access to some sort of tech, right? Surely we can abandon our textbooks, worksheets and Yellow Pages and direct clients and patients instead to websites, apps and virtual social spaces?

Sadly, the digital divide is still well and truly present; according to the latest data from Australia’s Digital Inclusion Index, 11 per cent of Australians are “highly excluded” from digital services, meaning they are unable to access or afford reliable internet, or don’t know how to use it. Among those most affected by the digital divide are those living in remote areas, Australians >65 years, low income-earners and people with a disability.

Digital access becomes even more complex when you intersect it with mental health. Those of us working in the sector know that there are numerous scenarios where psychosocial circumstances affect a client or patient’s ability to engage with technology:

• People with severe and/or complex symptoms may experience cognitive impacts (e.g. memory, attention, planning) that make it difficult to engage easily with technology.
• People from disadvantaged backgrounds may have varying access to tech, e.g. access to a phone but not a computer, able to afford data one month but not the next, unable to replace or repair devices if they’re lost, stolen or damaged.
• Young clients’ access to technology might be dependent on a parent, who may not necessarily be involved in their treatment.
• For people in domestic violence or abuse situations, access to technology might be controlled or monitored.

So, what is our responsibility as health practitioners when we want to engage our clients and patients with digital mental health products and services but remain mindful of the digital divide?

Here are a couple of guiding tips:

Ask patients about their access to technology – don’t assume!

Ask patients what devices they have, and how they access and use them. Check if there are any barriers to use: a computer at the house of a parent whom the patient only sees once a week might not be particularly practical; content with lots of videos might not be viable for someone with a small amount of monthly data.

Meet your clients where they’re at.

Remember – the gold-standard intervention is that which best fits the service user at any given time.

Would your client really benefit from an online interactive depression course, but they only have access to a phone? You might instead consider an app: while apps might not deliver the level of intensity your client really needs, it might be the thing they’re most likely to engage with. And the best intervention for them is the one they engage with!

Does your client hate chatting on the phone? Be sure to only recommend crisis services that have a chat or SMS option.

Is your client hesitant to access a service because they’re not sure how? Make time to sit down and go through it with them step-by-step.

Research specific options for patient groups you see often

In our particular work settings, we might encounter similar kinds of patient groups – older adults or youth, patients with specific diagnoses, patients dealing with financial hardship, First Nations Australians and so on.

If you find that many of your patients face common problems when accessing technology, make a point to research options that address those problems, so you have a ‘go-to’ list of digital services in your arsenal.

For example, if many of your patients have patchy access to devices (e.g. they’re sharing with others), consider suggesting tools they can freely access from any device and without having to log in.

Or, if you have patients who don’t have a lot of data, consider an app that only requires data for the initial download (which they could download using Wi-Fi) but then doesn’t require ongoing data to run.

Remember, lots of products and services have been created to try and close the digital divide: if one option doesn’t suit a client’s situation, there might very well be another one that does. The more you learn about what’s available in the digital mental health landscape, the more you’ll be able to flexibly integrate these options into your clients’ care, no matter where they sit in terms of technology access.

Visit the eMHPrac eMH directory today to explore Australia’s range of free and low-cost, evidence-based mental health products and services.

Thomas, J., Barraket, J., Parkinson, S., Wilson, C., Holcombe-James, I., Brydon, A., Kennedy, J. (2021). Australian Digital Inclusion Index: 2021, Dashboard Dataset Release 1. Melbourne: RMIT and Swinburne University of Technology, and Telstra