Table 2.

User-informed recommendations to improve DMHI^a safety.

Recommendations	Description
1. Provide ‘easy access’ versions of key information	Ensure that DMHI product manufacture and approval include a requirement to provide readily accessible, easy-to-read lay summaries of key information. At a minimum, these should cover (1) evidence of effectiveness; (2) data usage, security measures, and access (ie, who can access the data); and (3) potential negative effects.
2. Use ‘Approved by...’ badges	Introduce a sectorwide, widely recognized, branded badge to provide top-level reassurance of the quality and safety of any DMHIs bearing that badge.
3. Acknowledge the lack of personalization	DMHIs should flag to users their inability to be fully personalized and adaptable to an individual user’s needs to mitigate feelings of invalidation and disappointment.
4. Anticipate and support deterioration	Before using a product, users should be alerted to possible mood or symptom deterioration, given normalizing information, and signposted to relevant support to help mitigate these effects should they occur.
5. Provide real-time feedback	DMHIs should internally track users’ progress and provide feedback on whether they are benefiting as expected. Where there is no individual benefit, despite the appropriate use of the product, users should be automatically advised to seek alternative support.
6. Provide genuine crisis support	Content should include an acknowledgment of the DMHIs’ limitations and a summary of each crisis service’s support. It is recommended to consult the target population on wording to ensure genuine concern for users is communicated.
7. Responsibly manage access	DMHIs should incorporate an assessment of suitability focusing on risk levels and the appropriateness of the intervention for users’ specific mental health conditions and severity. This could be done with a simple set of initial built-in questions which output a recommendation to use, or not use, the product based on the user’s response.

^aDMHI: digital mental health intervention.