How Digital Innovation Can Transform Ireland’s Mental Health Services

Digital innovation has the potential to revolutionise Ireland's mental health services. As demand continues to outstrip supply, leveraging technology can help bridge the gap, ensuring timely, personalised, and effective care for all.

In brief

• Evolving Mental Health Services: Ireland has transitioned from inpatient to community-based mental health care, but demand still exceeds capacity, especially for children and adolescents.
• Challenges Ahead: Population growth and staffing shortages are likely to exacerbate the gap between supply and demand for mental health services.
• Digital Health Technologies: Embracing digital health technologies can offer personalised care, rapid assessment, real-time monitoring, and more, transforming the mental health care system.
• Leadership and Partnerships: Bold leadership, innovative thinking, and partnerships across the health and technology sectors are essential to fully integrate technology into mental health care.

Over the course of the 20^th century, Ireland’s approach to mental health care evolved significantly. In the late 1950s Ireland held the unenviable position as the country with the highest number of people admitted to psychiatric institutions in the world¹. As understanding of mental health and illness developed, there was a transition away from inpatient care, with community-based care increasingly recognised as more appropriate for the majority of people experiencing mental health difficulties. Today, the statutory service system largely comprises community-based mental health teams providing specialist care, alongside primary care supports provided through a combination of GPs, psychologists and voluntary organisations. 

Notwithstanding this welcome evolution in care, the last decade has seen demand for mental health services far exceed the capacity of the system. This issue is particularly acute in child and adolescent mental health services (CAMHS). As of May 2024, there were more than 3,800 young people waiting for appointments with CAMHS; more than 400 were waiting for more than a year². Data from February 2024 indicates that 18,588 children were waiting for a primary care psychology appointment with 40% of those children waiting for more than a year³. 

This gap between supply and demand for mental health services is set to continue and indeed may be exacerbated due to population growth and staffing shortages. The recommended staffing levels outlined in successive policy documents, i.e. A Vision for Change, 2006⁴ and Sharing the Vision, 2020⁵, are still some distance from being met. While there has been a significant increase (44%) in funding for mental health services (from €1.03 billion in 2020 to €1.48bn in 2025)⁶ in recent years, further increases will be necessary if it is to reach the 10% of the overall health budget as recommended in Sláintecare⁷.

If we are to overcome these challenges, a radical transformation of our system of care will be needed to ensure that all those who need help, can access good quality, timely care. It’s time for the next evolution in how we conceive of and deliver mental health care in Ireland. Doing more of the same will not lead to sustainable improvement. We cannot design a system for the 21^st century based on models of care from the past. The last 20 years alone has seen so much change socially, politically, economically and technologically that we need a new starting point when designing truly equitable, accessible, effective mental health services for the future.

We need leadership that is bold and brave to question and challenge prevailing thinking, service models and practices. Leadership that compels us to do better, differently. In this regard, the World Economic Forum has highlighted the capacity for health information technologies to transform mental health care⁸. Given the ways in which technology is transforming other sectors and given the increasingly interconnected world in which we now live, it would be short sighted to assume that mental health care will not experience similar seismic shifts. This presents a rich opportunity for us to embrace the benefits and possibilities offered by technology in order to design a world-class mental health system across the domains of prevention, early intervention, treatment and recovery.

There are understandable fears and anxieties evoked by the prospect of technology replacing clinicians. There is no disputing that human connection and empathy are central to healing and recovery in the context of mental health and illness. Empathy - that ability to identify, understand and share another person’s feelings and perspective, while maintaining a self-other distinction – is associated with greater patient satisfaction and improved clinical outcomes and is central to a partnership model of care between clinician and patient, motivating feelings of compassion and the desire to help⁹. Technology will not replace this central component of the clinician-patient relationship. However, by harnessing the capability of technology and AI to support and augment clinician delivered care, there is potential to reap a whole range of benefits for service users, families and clinicians.

Digital health technologies can support personalised smart triage, rapid assessment, real-time risk monitoring, early identification of problems, between session tracking and monitoring and provision of real-time feedback. The choice is not one of human versus machine; instead our focus should be on taking advantage of all that mobile apps, online platforms, augmented intelligence and chatbots have to offer to elevate the capacity and capability of our current service models.

Technology offers the potential to support services in moving beyond solutions that are solely centred on the traditional approach of one-to-one care between professional and patient. However, to fully exploit this opportunity, people are going to have to think and behave differently. A paradigm shift is needed in our assumptions about what constitutes good quality care and who can provide it. Equally, it will be imperative that a whole of system approach to delivering integrated care is adopted, resisting the temptation to focus on improving capacity within isolated parts of the system. Otherwise, we run the risk of papering over the cracks and unwittingly digitising and perpetuating the problems that exist in current approaches to care delivery. International experts in the field have warned that integrating digital health technologies into existing services without changing the underlying models of care will not result in the kind of transformation required to increase timely access to measurement based, personalised, high-quality care¹⁰.

Of course, digitally enhanced care will not be suitable, acceptable or appropriate for some, so flexibility will need to be designed into new service models to take account of personal preference, individual need and clinical governance. Noone should be forced down a digital first care pathway and we need to avoid viewing technology as a panacea for what are complex issues; rather the opportunity is about creating flexible models of care which can be configured in a variety of different ways to enhance access and offer truly personalised care.

It is highly unlikely that this kind of transformative change will emerge from within the health service alone. Partnerships with the wider technology and health ecosystem, including service users, will be essential in order to successfully leverage the resources, capability and expertise needed to design and implement an intelligent, digitally enabled mental health system. Globally, public-private partnerships are emerging as a potential mechanism for fostering innovation in health care delivery¹¹, and here in Ireland we have already seen some good examples of digital health technologies successfully incorporated into the suite of services provided or funded by the HSE, e.g. Text About It, Silvercloud and blended care through a combination of in person and virtual sessions. 

As we look to the future, the HSE is due to publish its Digital Mental Health Strategy by the end of this year. This should provide a clear sense of the appetite and ambition for fully embracing all that technology has to offer mental health service provision in Ireland. While clearly the path forward will need to be navigated with care, paying close attention to issues of trust, privacy, digital literacy, regulatory compliance, quality assurance and clinical governance, there is nevertheless an opportunity now for the field of mental health to propel itself forward - to break out of its outdated mould as the underfunded, poor relation of the physical health care system. We have a choice to make. Do we enter into this next evolution in the delivery of mental healthcare in a piecemeal, siloed manner or do we coalesce around a daring vision of a world class, connected and digitally enabled mental health system with service users, clinicians and technology firmly at the centre?