Introduction

Digital mental health services have seen significant growth over the past decade, offering new and innovative ways for consumers, carers and families to access services. Digital mental health services can be used as standalone supports that are self-managed or therapist-guided, or as a complement to in-person services. Digital services may be easier to access than in-person services, and sometimes can be accessed anonymously to protect service user identity¹ and encourage fuller disclosure and engagement.

There is growing evidence regarding the important role digital mental health services can play in the delivery of services to consumers, carers and families.² Some digital mental health services can be as effective as in-person services, while others have not been subject to rigorous evaluation processes or evidence collection.

The Australian Commission on Safety and Quality in Health Care (the Commission) developed the National Safety and Quality Digital Mental Health (NSQDMH) Standards in collaboration with consumers, carers, families, clinicians, service providers and technical experts.

The development of the NSQDMH Standards is a significant first step in providing safety and quality assurance for digital mental health service users and their support people, and best practice guidance for service providers and developers across the three areas outlined below.

The primary aim of the NSQDMH Standards is to improve the quality of digital mental health service provision and to protect service users, and where relevant, their support people, from harm. The NSQDMH Standards provide a quality assurance mechanism that tests whether relevant systems are in place to ensure that expected standards of safety and quality are met. The NSQDMH Standards provide a nationally consistent statement about the standard of care service users and their support people can expect from a digital mental health service.

What is a digital mental health service?

It is recognised that there are distinct specialist mental health, suicide prevention and alcohol and other drug sectors that provide services to often distinct cohorts.

For the purpose of the NSQDMH Standards, mental health, suicide prevention and alcohol and other drug services delivered via a digital platform come under the term of digital mental health services. These can include provision of information, digital counselling services, treatment services (including assessment, triage and referral services) and peer-to-peer support services, that are delivered via telephone (including mobile phone), videoconferencing, web-based (including web-chat), SMS or mobile health applications (apps). 

The NSQDMH Standards are not intended to apply to more generic wellness services, which are not offering specific health services to service users or their support people. Standalone electronic health or medical records, decision support tools for clinicians, analytic services, services that primarily provide support and education to health professionals, clinical practice management software, and clinical workflow and communication software are excluded under the definition of digital mental health services for the purposes of the NSQDMH Standards. 

What do the NSQDMH Standards cover?

There are three NSQDMH Standards, which cover clinical and technical governance, partnering with consumers, and the model of care which includes communicating for safety and recognising and responding to acute deterioration. 

The three NSQDMH Standards are:

Clinical and Technical Governance Standard, which describes the clinical and technical governance, safety and quality systems and the safe environment (including privacy, transparency, security and stability of digital systems) that are required to maintain and improve the reliability, safety and quality of digital mental health care, and improve health outcomes for service users.

Partnering with Consumers Standard, which describes the systems and strategies to create a person-centred digital mental health system in which service users and where relevant, their support people are:

• Included in shared decision-making 
• Partners in their own care 
• Involved in the development and design of quality digital mental health care.

Model of Care Standard, which describes the processes for developing and delivering digital mental health services, minimising harm to service users, their support people and others, communicating for safety and recognising and responding to acute deterioration in mental state.

Each standard contains:

• A description of the standard
• A statement of intent
• A list of criteria that describe the key areas covered by the standard
• Explanatory notes on the context of the standard
• Item headings for groups of actions in each criterion
• Actions that describe what is required to meet the standard.

How should the NSQDMH Standards be applied?

The NSQDMH Standards are voluntary and should be applied at the level of the service provider that makes digital mental health services available to service users and their support people. 

Not all actions within each standard will be applicable to every digital mental health service. A service provider may provide more than one digital mental health service and may see the application of the NSQDMH Standards differ across those services.

The applicability of actions and the extent of the strategies required will be determined by the size, risk to service users and their support people, and the complexity of the service provider’s digital mental health services. The model of care for the digital mental health service may also inform whether an action is relevant. To meet the NSQDMH Standards, service providers will need to work closely with developers of digital mental health services in relation to the design, development and delivery of their products to service users and their support people.

While service providers may provide services other than digital mental health services, the NSQDMH Standards are not intended to be applied to those other service components.

The Commission intends to develop further guidance for service providers and service users to support the implementation of the NSQDMH Standards.

Alignment with other standards

In developing the NSQDMH Standards, the Commission has adapted some actions and terminology from the National Safety and Quality Health Service (NSQHS) Standards (second edition).³

Where a service provider that is required to meet the NSQHS Standards offers digital mental health services, only the actions unique to the NSQDMH Standards are recommended for implementation in addition to the NSQHS Standards. This ensures that the issues specific to digital mental health services are given appropriate focus.

A word about language 

The language we use is important and must be selected wisely. It has the power to offer hope and encouragement or to convey pessimism or low expectations. It can exacerbate or mitigate the significant stigma that exists towards mental illness, alcohol and other drug use and suicide. 

The terminology in common use across different domains in the health sector is not universal, particularly in referring to those who seek assistance from health services. The NSQDMH Standards refers to those who use digital mental health services as service users. 

Where reference is made to consumers, carers and families, as opposed to service users, this is intended to specifically refer to those with lived experience, who may or may not have used digital mental health services. 

Individuals who provide support and reassurance to service users are referred to as support people and may be a family member, friend or paid support worker.

An organisation that makes digital mental health services available to service users and their support people is referred to as a service provider.

The services, whether they are information services, digital counselling services, treatment services (including assessment, triage and referral services), or peer-to-peer services, and irrespective of the digital medium through which they are provided, are referred to in the NSQDMH Standards as digital mental health services. 

This terminology is adopted for clarity of purpose within the NSQDMH Standards, but it is not a requirement that service providers adopt the language used in the NSQDMH Standards within their own organisation.

A glossary is provided within this document to aid the reader in understanding the terms used.

More information

For more information on the NSQDMH Standards visit the Commission’s website: www.safetyandquality.gov.au/dmhs

You can access a range of digital mental health services on the Australian Government’s digital mental health gateway Head to Health: headtohealth.gov.au