Key messages

• many digital health services fail to meet needs when communities are not meaningfully involved in design
• lack of trust and relevance contributes to low uptake among underserved groups
• community co-design improves usefulness, accessibility and legitimacy of digital services
• ‘margins-first’ approaches prioritise people most likely to be excluded
• measuring success should go beyond uptake to include confidence, access and trust.

Policy implications

• digital health programmes should embed community co-design from the outset
• power-sharing with communities is central to building trust
• evaluation frameworks should include equity-relevant outcomes, not just usage metrics
• commissioners and designers should resource sustained engagement rather than one-off consultation.

Gaps

• limited empirical evaluation of long-term impacts of co-designed digital services
• challenges in scaling community-led approaches within national programmes
• need for clearer guidance on measuring trust and confidence outcomes.

Commentary
This analysis argues that the use of technology in care often falls short when digital services are designed without the active involvement of the communities they aim to serve. It highlights how exclusion can be embedded through design choices that assume access, confidence and trust.

In terms of care equity, the emphasis on ‘margins-first’ co-design is significant. By centring people most at risk of exclusion, digital services are more likely to address structural barriers rather than reproduce them.

The report reframes success in digital health away from simple uptake metrics. Confidence, trust and perceived usefulness are presented as equally important indicators of whether technology supports equitable access to care.

Overall, the analysis reinforces that inclusive digital health requires cultural and organisational change, not just better technology. Without genuine community involvement and power-sharing, digital transformation risks widening inequalities rather than reducing them.

Key messages

• digital technologies are increasingly used in secondary mental health care settings
• co-production with people who experience chronic mental health conditions is essential to effective digital design
• digital tools offer opportunities to improve understanding, monitoring and sharing of mental health data
• innovation is occurring unevenly across services
• evidence on effectiveness and long-term impact remains limited.

Policy implications

• digital mental health tools should be co-produced with service users
• secondary care services need support to evaluate digital interventions robustly
• data governance and information-sharing arrangements are central to safe digital innovation
• implementation should proceed cautiously alongside ongoing evaluation.

Gaps

• lack of long-term outcome studies in secondary mental health care
• small sample sizes limit generalisability
• limited consideration of multiple protected characteristics
• insufficient evidence on equity impacts of digital mental health tools.

Commentary
This paper highlights both the promise and the uncertainty surrounding digital technologies in mental health care. While new tools offer opportunities to enhance data sharing and clinical insight, their success depends heavily on alignment with service users’ needs and experiences.

A recurring theme is the importance of co-production. Digital tools designed without meaningful involvement of people living with mental health conditions risk being poorly adopted or misaligned with real-world care. This is particularly relevant in secondary care, where needs are often complex and long term.

At the same time, the review points to a thin evidence base. Small studies and short follow-up periods make it difficult to judge whether digital interventions improve outcomes or simply add complexity to already stretched services.

Overall, the paper suggests that digital innovation in secondary mental health care should prioritise learning and evaluation over rapid scale-up. Careful design, inclusive involvement and longer-term evidence are needed if technology is to strengthen care without introducing new forms of exclusion or risk.

Key messages

• technology enabled care services have been used in UK adult social care for decades, but digital technologies and mainstream consumer devices are increasingly being considered for service delivery
• the planned UK switchover from analogue to digital telecommunications networks requires large-scale replacement or upgrading of existing telecare systems
• uneven broadband infrastructure and mobile connectivity create a digital divide, limiting the reliability of digital care technologies in some regions
• mainstream technologies such as smart speakers are being trialled in adult social care but are not designed or regulated as safety-critical alarm systems
• privacy, data security and informed consent issues arise when consumer technologies collect and process personal data
• the evidence base on outcomes from technology use in adult social care remains limited, and commissioning decisions are not always informed by research evidence.

Policy implications

• the digital switchover requires coordinated national and local planning to ensure continuity of telecare services
• regulatory frameworks and safety standards may need updating to address the use of mainstream consumer technologies in care contexts
• digital infrastructure and connectivity must be considered when designing technology-enabled services
• commissioning should prioritise user outcomes and needs rather than starting with available technologies
• stronger research evidence is required to inform large-scale adoption of new technologies in adult social care.

Gaps highlighted

• limited empirical evidence on outcomes from mainstream technologies used in adult social care
• the paper flags an insufficient understanding of how technology interacts with social context, user routines and care relationships
• this review also comments on the limited evidence on how digital infrastructure inequalities affect access to technology-enabled care.

Commentary

This review examines how technology is positioned as a potential response to long-standing challenges in adult social care, including population ageing, workforce pressures and increasing demand for care. It highlights the growing interest among commissioners in using digital and mainstream consumer technologies as part of technology-enabled care services.

However, the paper emphasises that this shift is occurring alongside a major infrastructure change: the transition from analogue telephone systems to digital networks. Many existing telecare devices rely on analogue connections, meaning they must be replaced or adapted to function in digital environments. This transition introduces practical and safety challenges, particularly if systems are not upgraded in time or if connectivity is unreliable.

The review also highlights regulatory and ethical considerations associated with the use of mainstream technologies. Devices such as smart speakers are not designed as social alarm systems and therefore do not follow the same safety standards or fail-safe protocols. At the same time, concerns around data privacy, security and informed consent arise when such devices collect and process personal information.

In relation to care equity, the paper identifies the digital divide as a major concern for technology-enabled care. Differences in broadband availability, mobile connectivity, income and digital literacy mean that some communities may not be able to benefit from digital care technologies. If technology becomes a central mechanism for delivering services, these disparities could reinforce existing inequities in access to support.

Overall, the paper argues that the adoption of technology in adult social care should be guided by robust evidence and user-centred commissioning. Rather than assuming that digital innovation will automatically improve care, policymakers and commissioners must consider infrastructure, regulation, safety and user experience when designing technology-enabled services.

Key statistics 

• between 38% and 78% of people with severe mental health conditions report seeking mental health information online 

• 90% of UK households had internet access at the time of the study 

• smartphone ownership among UK adults increased from 52% to 85% over a five-year period 
   

Key messages 

• digital technologies are increasingly used for mental health support, including self-monitoring, online information seeking and remote interventions 

• co-production with clinicians, frontline staff and people with lived experience is important to design tools that are relevant and usable 

• digital tools can improve access to support, particularly for people who may not engage with face-to-face services 

• there are significant barriers to adoption, including lack of staff training, limited digital literacy and unequal access to technology 

• concerns about data privacy, confidentiality and how information is used can reduce trust in digital platforms 

• some staff and service users are concerned that digital tools may weaken therapeutic relationships or replace face-to-face care 

• digital interventions are developing faster than the evidence base, creating challenges for evaluation and implementation 

Policy implications 

• invest in digital infrastructure and training across the health and social care workforce 

• embed co-production approaches in the design and implementation of digital mental health tools 

• develop clear governance frameworks for data security, privacy and ethical use of digital health data 

• ensure digital tools are used to complement, not replace, face-to-face care where needed 

• address digital exclusion by improving access to devices, internet connectivity and digital skills support 

• support ongoing evaluation of digital interventions to ensure they are effective and safe 

Gaps 

• limited high-quality evidence on long-term effectiveness of many digital mental health interventions 

• digital tools are often developed without a clear theoretical framework explaining how they work 

• lack of consistent evaluation methods, with traditional trials often too slow for rapidly evolving technologies 

• limited research on how digital approaches affect therapeutic relationships and care quality over time 

• insufficient focus on how digital exclusion affects access for different population groups 

Commentary 
This paper looks at how digital technology is changing mental health care. It shows that more people are using the internet and smartphones to find information, track their symptoms and access support. For some people, this can make it easier to get help, especially if they feel uncomfortable with face-to-face services or live in areas with limited provision. 

However, access to digital care is not equal. While many people now use the internet regularly, not everyone has the same level of access, confidence or skills. Some people may not have reliable internet or devices, while others may struggle to use digital tools. This creates a risk that digital approaches could widen existing inequities if they are not designed and implemented carefully. 

The paper also highlights concerns from staff and service users. Some worry that digital tools could reduce human contact or be used as a cheaper alternative to proper care. Others are concerned about how personal data is collected and used. These concerns can affect trust and willingness to engage with digital services. 

Another key issue is the gap between how quickly digital tools are being developed and how slowly they are evaluated. Many tools are introduced before there is strong evidence on how well they work or who they work best for. This makes it harder for services to know which tools to adopt. 

From a health and social care equity perspective, digital technology has both potential and risk. It can improve access by reaching people in their everyday lives and offering flexible support. At the same time, if issues like digital exclusion, workforce readiness and trust are not addressed, it may reinforce existing inequities. 

Overall, the paper suggests that digital mental health care should be developed alongside, not instead of, wider investment in services and support. A balanced approach is needed so that technology improves access without reducing the quality or equity of care.