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Manjul Rathee, chief executive and co-founder of BFB Labs, argues that digital mental health is falling at the last hurdle.
Around 160,000 brilliant, dedicated people work to deliver mental health care in the UK. But demand is overwhelming. More than four million people are in contact with mental health services, CAMHS caseloads have more than doubled since 2020, and many people wait years to be seen. Accessible, scalable digital support is desperately needed to help services reach more people, sooner, and deliver the care they need.
Yet in the UK, despite a wealth of approved, rigorously tested digital tools ready to make an impact, many fail to reach the patients who need them most. Routes to adoption across health and care services are fundamentally complicated and hard to navigate. They are littered with barriers that stall procurement, inhibit effective implementation, and prevent tools from being made available long-term.
With a new administration currently setting its national health priorities, now is the moment for change. Smoother, more streamlined routes to adoption are needed to get digital mental health solutions where they are needed and ensure the innovation poised to ease the UK’s mental health crisis does not fall at the last hurdle.
Identifying the barriers to adoption
Barriers to effective implementation of digital mental health tools occur at multiple stages of the procurement process. From how tools are commissioned and get funded, to how they are integrated into existing systems.
The commissioning processes for digital mental health in England are deeply fragmented. In the NHS, providers face a groundhog day of repeated regional applications and tenders: 36 Integrated Care Boards (ICBs), each with their own priorities, procurement cycles, and challenges, commission for different areas. The same region-by-region approach exists for partnering with other local authorities, such as councils. The result is slow, sporadic adoption of solutions, and a postcode lottery for those seeking support.
Meanwhile, changing priorities across commissioning cycles can mean that promising new tools are continually piloted, trialled with patients, and then phased out. This phenomenon, known as ‘pilotitis,’ means even the best solutions often fail to achieve long-term adoption, and service users lose access to digital tools they have come to rely on. It can also cause frustration for practitioners, who are left unsure which tools will be available and for how long, while services waste an inordinate amount of time and resources picking up pilot after pilot.
The services commissioning digital mental health tools operate with limited resources. A finite pool of funds has to be carefully allocated across a vast number of competing priorities and targets. Digital mental health faces fierce competition for its share.
Even when a digital tool is approved and commissioned, funding is often tied to short-term cycles. Re-commissioning can be an annual process, requiring providers to prove year after year, region after region, their value from scratch. In turn, this uncertainty can discourage third-party investment in the tech itself as revenue is hard to forecast and growth can be inhibited by the risk of contract non-renewal.
The final hurdle is integration. New digital tools face lengthy regulatory processes that often have to be repeated for every region: from completing DPIAs to ensuring Information Governance and DTAC standards are met. While regulation is crucial, this repetitive process can complicate implementation and stall the scaling of effective treatments.
On the ground, clinicians face their own challenges with implementation. The innovation fatigue created by a cycle of short-term rollouts can mean there’s a lack of trust or motivation to engage with new tools. Poorly managed rollouts have been shown to directly increase staff stress and workload.
What we can do
While there is no quick fix to any of these barriers, a more joined-up approach to commissioning and funding could help significantly unblock progress and create real economies of scale for digital mental health.
One step would be to end pilotitis by standardising success criteria, establishing a more consistent framework for measuring pilots’ effectiveness, and restructuring contracts so a successful pilot can transition straight into a longer-term agreement. This could significantly streamline recommissioning, remove the need for repeated proof of impact, and enable successful rollouts to be replicated across different regions. All of which would provide a clearer, more stable path to long-term adoption, while ensuring the best-fit solutions are implemented, based on real impact data.
National certification and regulatory approval could also help to end the fragmented cycle of regional adoption, increasing treatments’ reach and removing the postcode lottery for care.
The technology to ease the UK’s mental health crisis is ready, and backed by evidence. Numerous solutions have been approved by the National Institute for Health and Care Excellence (NICE) for use in mental health support. What we need now is a system that enables more consistent, widespread adoption and unlocks access for those who need it most.
As it stands, countless people are waiting years for a face-to-face appointment while the digital tools that could deliver the mental health support they need sit idle. Fixing the barriers to digital implementation is crucial to help increase access to care, while freeing up vital capacity for existing services.
