Digital mental health services in general practice

Claire Harding and colleagues have highlighted the potential of digital interventions in general practice and the need for NHS accredited or ‘kitemarked’ apps, but also raise questions about the need for evidence of their safety and efficacy.¹

They state that ‘ ... there is broad consensus in the field that traditional randomised controlled trials are not fit for purpose with digital interventions (largely because services develop and expectations change faster than trials can be run) ...’. We acknowledge that good interventions take time to develop and test, but do not agree that this is a reason to abandon evidence-based practice. Users and commissioners should expect robust evidence before choosing to invest time or resources in such interventions.

For simple health information on the web, common sense ‘kitemarking’ may be sufficient. However, for interventions aimed at behaviour change, randomised controlled trials are warranted, regardless of whether they are delivered digitally. Rapid changes in services are not sufficient reason to negate this necessity, as well-developed interventions can be adapted to new delivery systems.