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Digital skills support is needed among people with severe mental ill health to avoid exacerbating existing inequalities

Published: 15 November 2022

Dr Panos Spanakis, Honorary Fellow at the University of York explains how more needs to be done to ensure people with severe mental ill health have the skills they need to fully engage with and benefit from the internet and digital technologies. He considers the negative impacts of being digitally excluded and suggests ways to promote digital inclusion.   

“Two years of transformation done in two weeks.”

That was what a BBC report proclaimed at the height of the pandemic in spring 2020, due to the novel demands brought by the COVID-19 pandemic. 

Hospitals were ordering custom-made apps, the NHS 111 saw a huge rise in demand, and video-consultations with patients became routine, among other advancements. To some this was good news and with good reason. 

Technologies that could save the NHS time and money which were on the back burner for years, constantly competing for funds with other more pressing needs, are now coming to the forefront. Most crucially, what might have started as a temporary contingency plan seems to have developed into a mainstream option.

People who are not confident with digital technologies, or who are lacking digital skills, are at risk for exclusion in this new landscape of health services. This is not just about accessibility of services, but also about potentially greater hassle and stress experienced as people try to get the help they need - such as using new digital services taking too long for them, or leaving them feeling frustrated or unsure. It is our most vulnerable populations that seem to be at greater risk for digital exclusion, such as people with long-term physical disabilities or mental illnesses, or unemployed low-income or homeless people (see reports from the ONS  and the All-party parliamentary group).

Among those at greater risk of digital exclusion are people with severe mental ill health (SMI), such as psychosis spectrum and bipolar disorder. People with SMI often have comorbid long-term physical illnesses, leading to complex health needs and increased need to visit doctors and other healthcare services. Any added difficulties in accessing these services may amplify the profound health inequalities already experienced by this population, including a reduced life expectancy of 20 years, compared to the general population.

Existing data on digital engagement among people with SMI are limited and from the pre-COVID era. We did not know how people with SMI were adapting to the new digitalisation of health services, and the general shift online. To address this, University of York’s SPIDER project (Skills and Proficiency in Digital Essential Requirements) received funding from the NIHR and was supported by ARC Yorkshire and Humber to assess digital skills in people with SMI. Most of our participants reported they had access to a digital device and internet access at home (over 80%), but over 20% did not use the internet. Using the Essential Digital Skills framework for the first time in this population, we revealed a stark digital divide with the general population; 42% of our sample lacked basic digital skills compared to 19% in the general population. These are skills like using device settings and passwords. People were more likely to be lacking digital skills if they were older, not in employment, or had a condition that involved mainly psychosis rather than mood symptoms. However, people were interested in learning more about almost half of the things they did not know how to do, disproving a common misconception that people with SMI are not interested in digital technologies.

What this tells us is that people who already experience a divide in healthcare are now threatened by another one: the digital divide. This is not to argue against the long due technological upgrade of the NHS. We are advocating for making digital inclusion an integral part of designing new digital services, right from the beginning, rather than as an afterthought. The two main paths that can lead to a more inclusive system is offering people the training and support they need to use the new services as well as making sure traditional off-line options are still on the offer for those who need them.  

Dr. Panagiotis Spanakis, Honorary Fellow, Department of Health Sciences, University of York and Lecturer, Department of Psychology, Mediterranean College, Athens

Co-author: Dr Ruth Wadman, Research Fellow, Mental Health and Addictions Research Group, Department of Health Sciences, the University of York

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