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A survey of people with severe mental illness found that 4 in 10 (42%) lacked basic digital skills, such as changing passwords or connecting to Wi-Fi. The researchers say these people could be struggling to access digital health and social care. Tailored training programmes could help, they say, but some people will continue to need written information and telephone communication.

Before this study, it was not clear how the increase in online services would affect people with severe mental illness. People with psychosis, for example, may struggle if they see or hear things that other people don’t (hallucinations), believe things that are not true (delusions), have difficulties concentrating or lack motivation.

The study found that people who lacked basic digital skills were more likely to have psychosis, be over 66, unemployed, and lack access to the internet.

Most respondents had access to technology and the internet, but lacked the skills to use them. The researchers say training programmes tailored for people with severe mental illness could help. But services may need to continue to provide non-digital alternatives, to ensure that everyone can access healthcare.

More information on psychosis, schizophrenia and bipolar disorder is available on the NHS website.

The issue: the digital divide

Since the pandemic, many face-to-face services in health and social care have remained online. People routinely have virtual consultations, for example. This could mean that those without digital skills are struggling to access online health services and support networks.

Equal access to digital health and care resources (digital inclusion) is an NHS priority. But some groups, including those with severe mental illnesses, may be missing out. Unequal access to the internet is known as the digital divide.

Severe mental illnesses include schizophrenia, bipolar disorder, and other psychotic illnesses. Many people with these conditions have depression, anxiety, hallucinations, and disordered thinking. It is not known if this group is able to use online services, though many have reported difficulties.

In this study, people with severe mental illnesses rated their information technology (IT) skills using the Government-approved Essential Digital Skills framework. It describes 3 levels of skill:

  • foundation skills (such as knowing how to connect to Wi-Fi)
  • skills for life (such as setting up an email account, and buying goods)
  • skills for work (such as sharing information professionally).

What’s new?

The study included 249 people with severe mental illnesses who were taking part in a larger project on wellbeing during self-isolation. Their average age was 52 years, and almost half lived in deprived areas. Most (86%) had a digital device and used the internet (78%).

The researchers asked people about their digital skills. They found that:

  • around 4 in 10 (42%) lacked foundation skills, especially changing passwords and settings; those who had psychosis, were over 66, unemployed, and without internet access were least likely to have these skills
  • almost all (93%) of those with foundation skills had skills for life; problem-solving was the skill most often lacking, but most people wanted to learn more
  • only 50 of the 249 participants had both skills for life and a job, but almost all of these people (92%) had skills for work.

Why is this important?

This study was the first to assess the Essential Digital Skills framework among people with severe mental illness. The researchers found that almost half (46%) lacked foundation skills or skills for life. That is twice as many as in the general population (22%).

Most people had access to technology, but many lacked the skills required to use it. During the pandemic, efforts were made to provide devices and improve internet access. However, this study shows that this may not be enough; people also need support to use technology.

The lack of digital skills could have a serious impact on people with severe mental illness. This group may struggle to access online services including booking of appointments, virtual consultations, and online support tools. The researchers say this is likely to deepen the health inequalities that this group faces.

People with bipolar disorder were more likely to have foundation skills than those with psychosis. Both groups could have reduced concentration, which was a barrier to using digital services. People with psychosis may also experience hallucinations, which increases the difficulties.

What’s next?

The design of online services needs to take into account the barriers experienced by people with severe mental illness.

Tailored programmes for people with severe mental illnesses could improve people’s digital skills, and boost their confidence and motivation to use online services. The researchers are working with people with lived experience of severe mental illness to investigate how best to develop these programmes.

As more services move online, the researchers say there is an ongoing need to accommodate people who would prefer face-to-face contact. Even with better training, some people may find online services difficult to access, or overwhelming, and services should also cater for these people.

The study was relatively small and included only those who had participated in a larger project. People self-reported their own skills so they may have over- or underestimated them. Further research could confirm these findings, and explore whether improved digital skills increases the rate of employment among people with severe mental illness.  

You may be interested to read

This Alert was based on: Spanakis P, and others. Measuring the digital divide among people with severe mental ill health using the essential digital skills framework. Perspectives in Public Health 2022; doi: 10.1177/17579139221106399.

A blog from the authors about the importance of the project, as well as what it aimed to achieve.

A Government report on the impact of the pandemic on the digital divide.

A commentary from the researchers on the effects of the digital divide among people with severe mental illness.

A recent NIHR Evidence Collection What is digital health technology and what can it do for me?

Funding: This study was supported by the NIHR Applied Research Collaboration Yorkshire and Humber.

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.

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