Digital mental health interventions: exploring the implementation of digital practice for BPD/EUPD symptomatology and delivery of an eHealth platform within an NHS Mental Healthcare Service

Mental health is crucial for overall well-being, but access to treatment is limited. Digital mental health interventions (DMHIs) offer accessible, low-threshold options. DMHI implementation is affected by a large range of stakeholder, organisational, and cultural contexts. Although DMHIs have shown success in treating mental health difficulties, their use for populations with BPD/EUPD symptoms is rare. This thesis presents the Sussex Partnership NHS Foundation Trust (SPFT) as a DMHI implementation case study aiming to provide generalisable lessons.

Firstly, a systematic review and meta-analysis are presented investigating the impact of using DMHIs with individuals with BPD/EUPD symptomatology. Meta-analyses revealed significant reductions in BPD/EUPD symptoms and improvements in well-being. DMHI groups had lower post-intervention symptoms than waitlist or treatment-as-usual control groups. While service user engagement, satisfaction, and acceptability were high, drop‐out rates and between‐study heterogeneity call for careful interpretation of these results.

Secondly, a Quality Improvement (QI) evaluation of a digital DBT and CBT-informed skills-based intervention for subthreshold BPD/EUPD offered in primary care services is presented. This DMHI was found feasible for delivery and well received by both service users and staff, although more training and support for staff was requested. Preliminary evidence for the effectiveness of the intervention on symptomatology was found.

Thirdly, a second QI project aiming to identify factors influencing staff use of and attitudes towards the eHealth platform Minddistrict is presented. Using the COM-B model, it was found that the model, especially ‘Social Opportunity’, eHealth literacy and current use, predicted staff’s intended future use of Minddistrict. Yet, analyses were not able to identify significant predictors from the COM-B model for staff’s current use of Minddistrict.

Finally, a general discussion Chapter synthesises learning across the empirical work presented in the thesis, explores the strengths and limitations of the methods used and makes recommendations for future theory, research, and practice.