# The Effectiveness, Facilitators, and Barriers of Digital Mental Health Services for First Nations People in Australia: Systematic Scoping Review

## TL;DR

This study reviews how digital mental health services can help First Nations people in Australia, highlighting what works and what challenges exist.

## Contribution

The paper provides a systematic scoping review of digital mental health services for First Nations Australians, identifying facilitators and barriers to their implementation.

## Key findings

- Digital mental health services show stronger effectiveness for nonsevere mental health conditions.
- Successful implementation requires structural support, cultural responsiveness, and improved digital infrastructure.
- Evidence remains heterogeneous due to varied study designs and outcome measurements.

## Abstract

First Nations people in Australia experience inequitable mental health outcomes and service access. Digital mental health (DMH) services, which refer to offering mental health services through digital platforms, are considered potential solutions to address such mental health service inequities and improve the mental health outcomes of First Nations Australians. However, evidence on the effectiveness of DMH services for First Nations people in Australia is yet to be synthesized.

This systematic scoping review aims to fill this gap and to identify the facilitators and barriers that influence the implementation of DMH services among First Nations people in Australia.

A systematic search was conducted across 6 academic databases to search for studies related to DMH services for First Nations people in Australia. Search terms relating to First Nations people, geographic terminologies of Australia, mental health, and DMH services were used. Studies were included if they assessed the effectiveness of DMH services or the determinants of the facilitators and barriers of implementing DMH interventions among First Nations people in Australia. Data were extracted based on study design, targeted services, and research findings, and were then synthesized using a thematic analysis framework.

In total, 22 studies met the inclusion criteria. DMH services were used to support and treat First Nations Australians and conduct psychological assessments in these individuals. Evidence of effectiveness was stronger for nonsevere mental health conditions. The determinants of the facilitators and barriers of the implementation of DMH services included the following: (1) organizational and administrative factors; (2) cultural appropriateness; (3) accessibility; (4) integration of DMH services in the existing health system; (5) engagement between clients and service providers; (6) coverage of different conditions and clients; (7) acceptability to DMH services; (8) digital literacy; and (9) efficiency.

Evidence on the use of DMH services for First Nations Australians remains heterogeneous in terms of study design and outcome measurement. DMH services appear to be most effective for managing nonsevere mental health conditions. Successful implementation requires multilevel structural support, including policy and organizational commitment, enhanced digital infrastructure, workforce training and engagement, and the design of culturally responsive DMH models to improve uptake and equitable access to mental health care among First Nations Australians.