# In-Depth Co-Design of Mental Health Monitoring Technologies by People with Lived Experience
## 4 Discussion
### Discussion in Light of the Wider Literature
#### 4.2.4 What This Study Tells Us about Consumer Engagement with Mental Health Monitoring Technologies  
Beyond these broad population-based indicators, our smaller consultation study emphasizes that interactions between the various factors that influence consumer engagement with DMHIs, including trust, consumer and service capacity, confidence, and well-being are complex and, ultimately, individual. This reaffirms the assertions highlighted in the recovery literature [69; 70; 71; 72; 73] that the acknowledgment and integration of individual experiences, needs, and contexts into a consumer's care are crucial to recovery-oriented practice. Additional themes revealed in this consultation process that have not been highlighted in previous studies include the consumer's desire to shift the focus of digital mental health care towards wellness maintenance, thriving, and recognizing the human within the system in a way that enhances the digital therapeutic relationship. The importance of providing comparative benchmarks to help consumers compare and evaluate \"normal\" treatment outcomes, as well as the therapeutic utility of providing ways to help identify and manage a consumer's signature wellness signs and triggers, are unique to this study, being specifically informed by mental health lived experience. Our study recognizes the (often) undervalued role that informal carers can play in recovery. Shared engagement within DMHIs between carers and consumers can potentially help to support consumer self-advocacy within services, through the provision of additional external insights into their day-to-day life, and can, in turn, lower the burden associated with self-monitoring for consumers. These interventions can enable informal carers supporting consumers to engage in interventions and in their recovery plans; this is a potentially potent strategy to embed a digital mental health care service in daily life, previously recognized as being key to the successful implementation of interventions [25]. Integration of the consumer and carer relationship within DMHIs can enable pathways for carers to access ongoing peer support, psychoeducation, and networking functionalities that digital technologies can provide at scale with relative ease. However, the participants made it clear how important it is to protect consumer independence and privacy equally and to ensure that all consumer-carer involvement is voluntary and is supported by strong boundary-setting options. Independence and privacy emphasize the need to develop system protocols that foster respect for the patient's dignity, appreciation for patient uniqueness, and humanity [60]. Previous studies show that highlighting the humanity of both the consumer and the context of health care can influence the perceived quality of care and the rate of healing [61]. Shared outcome measures are linked to improvements in both patient and clinician satisfaction, consultation time, medication adherence, and symptom severity. Humans are complex, which is why collaboration is not always a simple exercise, nor is it necessarily equal. Negotiating the borders between wellness and crisis care, for example, can be a highly sensitive matter that is complicated by broader systemic issues. In the context of mental health care, adherence is likely to be as much about relationships as it is about directives [74]. Indeed, these relationships are key to building trust, which is so important for DMHI success. Enhancing the consumer's engagement with patient-centered care through the use of mobile digital technologies can improve clinician-consumer relationships as well [75]. The ready provision of digital extension services, such as real-time symptom assessments, pre-programmed reminders, and personalized feedback, can supplement clinical care for better health outcomes [76]. It is essential to consider the limitations of self-management in addressing a mental health consumer's emotional and psycho-social recovery needs [25; 68; 77].