Enhancing Standards and Principles in Digital Mental Health With Recovery-Focused Guidelines for Mobile, Online, and Remote Monitoring Technologies.

Before the 1970s, the notion that people diagnosed as having a mental health condition could manage symptoms and return to work, school, and a full life in the community was not widespread. Through advocacy efforts by people with lived experience of a mental health condition, recoveryfocused care has become a fundamental part of mental health service delivery across the globe (1) and is considered a complementary approach to traditional biomedical psychiatric care (2). Recovery-focused care has received international acceptance from service users (2) and shown benefits in multiple areas, such as hope, quality of life, symptomatology, and functioning (2, 3). With the advent of recoveryfocused care, the therapeutic relationship has been redesigned to include goals and outcomes that aremeaningful to service users, to promote shared decision making, and to help people regain control over their lives. This shift has disrupted the delivery, priorities, and skill sets of established biomedical services. At the same time, digital mental health interventions (including mobile, online, and remotemonitoring interventions) have also transformed mental health care. Services that were once provided only in person at clinical environments are now delivered at any time and in any geographical location. As leaders in the mental health recovery movement, we believe that digital mental health has emerged as a promising approach to enhance mental health practice and delivery, and we consider ourselves innovators in the study of recovery-focused digital mental health interventions. However, the standards and principles needed for recoveryfocused digital mental health research and practice have yet to be defined. In this Viewpoint, we seek to promote a consensus on how recovery-focused guidelines can be used to enhance the standards and principles for research and practice in digital mental health. Building off existing digital mental health standards and principles in research (4), we provide several recommendations for embedding recovery in digital mental health interventions. Digital mental health interventions should embrace multiple dimensions of health. People with lived experience of a mental health condition commonly present with other difficulties such as health conditions, substance use issues, and lack of social support—all of which affect overall health. Mental health recovery is not a singular task of monitoring and addressing psychiatric symptoms; rather, recovery involves addressing the complex interaction between an individual’s biological, psychological, and sociocultural environment—also referred to as “whole health” (5). The World Health Organization’s International Classification of Functioning, Disability and Health supports this notion and emphasizes that health is made up of intertwined components, including bodily functions and structures, activities, and participation in the community (5). Mental health conditions are multidimensional and are influenced by the mind, body, spirit, and community (5). Therefore, we recommend that mental health interventions embrace multiple dimensions of health. Technology has the ability to affect multiple aspects of a persons’ health by incorporating personalized digital services. Although this is a complex task, enhancing the ability of digital mental health to affect multiple dimensions of health will require investment in innovative analytical techniques. It will also require recognition that whole health cannot be achieved through technology alone—rather, human connections and participation in the real world (not solely a virtual world) are essential to healing themind, body, and spirit and developing a sense of community. Partnerships between service users and stakeholders with expertise in diverse fields of study— including engineering, medicine, psychology, public health, anthropology, and social work—will be needed.