Dimagi’s Perspective on Digital Solutions for Mental Health Care
Introduction
In a previous post titled “How Digital Solutions Can Help Scale Mental Health Care,” Dimagi’s Chief Strategy Officer, Dr. Neal Lesh, outlined our initial efforts and long-term vision in the mental health sector. Today, we’re building on that foundation by sharing how we, as a technology partner, are positioned to transform mental health services with our partners through digital innovation. This post highlights our accomplishments so far and our ongoing efforts to expand mental health care access.
In this post, we cover:
- Our strategy as a technology partner in the mental health sector
- Digital solutions that can support mental health service delivery at scale
- Future areas for innovation in digital mental health
Three Key Takeaways from the Global Mental Health Evidence Base
Our goal is to improve access to mental health care for millions in low-and-middle-income countries (LMICs) by 2032. We focus on scalable solutions that amplify the impact of frontline workers (FLWs), particularly at the last mile. Our strategy is shaped by three critical insights from the global mental health evidence base:
- Mental health exists on a spectrum. The Lancet Commission on Global Mental Health defines this spectrum, ranging from a state of mental well-being, where individuals experience no symptoms, to severe mental syndromes, where symptoms significantly impair daily functioning. Depending on where someone falls on this spectrum, different levels of care are needed. Early-stage mental health needs can often be addressed through self-care, informal support, and primary healthcare interventions.
- Those early-stage mental health needs can often be addressed with low-cost solutions. The World Health Organization (WHO) advocates for a model called the “Optimal Mix of Services for Mental Health,” visualized as a pyramid. This pyramid includes five levels of care, starting with self-care at the base and moving up to long-stay facilities and specialized services at the top. As services become more specialized, they also become more expensive, though fewer people require them.
- Non-specialized providers (NSPs) can unlock big changes in global mental health. Despite progress over the last two decades, global mental health service coverage remains critically inadequate. Nearly one billion people live with mental health disorders, yet only 25% of those with conditions like depression receive the care they need. The shortage of specialized mental health providers, such as psychologists and psychiatrists, is particularly acute in LMICs.
However, this gap has been partially bridged by equipping non-specialist providers (NSPs), such as Community Health Workers (CHWs) and lay counselors, to deliver proven interventions like the Healthy Activity Program, Group Interpersonal Therapy (IPT-G), and Group Problem Management Plus (gPM+). The Lancet Commission also advocates for this approach, which provides an opportunity to address the mental health crisis if we can scale these solutions efficiently.
By prioritizing digital solutions that support self-care and NSP-driven mental health services in community and primary healthcare settings, we can address the global mental health crisis more efficiently. This approach is central to our mission to scale accessible, cost-effective mental health care.
Dimagi’s Digital Mental Health Solutions
Since 2020, Dimagi has completed seven digital mental health projects, with six more currently underway. Our work spans across all levels of the WHO Optimal Mix of Services Pyramid, demonstrating the potential of digital tools to drive impact.
Self-Care
FOR FRONTLINE WORKERS | Supporting FLWs involves more than just training—it requires protecting their well-being to prevent burnout, which can reduce their effectiveness. To address this, Dimagi developed WellMe, a resilience app designed to help FLWs manage stress, practice mindfulness, and connect with purpose and others. WellMe is built on The Resilience Collaborative’s framework and Resilience Message Program, made available thanks to the Johnson & Johnson Center for Health Worker Innovation. WellMe is available in Hindi, English, and Tigrinya and has already supported over 1,000 FLWs across Ethiopia, India, Kenya, Nigeria, Uganda, and Malawi, ensuring they can continue delivering quality care within their communities.
FOR CLIENTS | Psychosocial interventions often require clients to engage in at-home practice between sessions, which is key to achieving positive therapeutic outcomes. For instance, Cognitive Behavioral Therapy outcomes improve significantly when clients complete between-session assignments (68% vs. 32%). Yet client adherence is low. Dimagi partnered with Sangath in an Agency Fund-supported project to develop PracticePal, a chatbot that guides clients through their assignments. Currently used in the Healthy Activity Program, PracticePal prompts patients to log daily activities and track their feelings, helping them identify behaviors that improve their well-being. Piloted in Madhya Pradesh, India, with 30 participants, PracticePal has demonstrated strong engagement (publication forthcoming).
Informal (non-governmental) Community Care
DIGITAL JOB AIDS FOR NSPs | Dimagi’s open-source platform, CommCare, is the world’s most widely-used data collection and service delivery tool, supporting over a million FLWs. CommCare can serve as a job aid for NSPs and an M&E tool for organizations, enabling NSPs to screen for mental disorders, register individuals for care, and ensure they receive appropriate treatment or referrals as needed.
Friendship Bench, a global leader in community-based mental health care, uses CommCare to support its NSPs. The model equips grandmothers (NSPs) with cognitive behavioral techniques to support informal conversations with people who need someone to talk to. They collect client data, including depression screenings, while regional teams track training and outreach efforts. The data helps Friendship Bench’s M&E team continuously monitor and assess the project’s impact.
Similarly, earlier in 2024, Zvandiri, an NGO supporting young people living with HIV, integrated CommCare into its youth workforce. Community Adolescent Treatment Supporters (CATS) are peer counselors trained to provide mental health and support services. They use the app for screening, registration, and follow-up support to improve the overall well-being of the youth they serve.
GROUP THERAPY TOOLS | Group therapy, an effective alternative to one-on-one counseling, can be delivered by FLWs to groups of 6-10 clients. Dimagi and World Vision Ethiopia have co-developed and implemented a gPM+ application in Ethiopia for adults in the conflict-affected Tigray region, providing mental health support to over 2,500 clients across 300+ groups. A total of 151 FLWs and 31 supervisors deliver the intervention.
Additionally, Dimagi partnered with Nama Wellness and Komo Learning Center in Uganda to co-develop an IPT-G app, reaching 100 individuals with essential mental health services, further extending the reach of FLWs in group therapy settings. This application is currently being piloted with StrongMinds and has supported over 1400+ clients to date.
Primary Health Care
ENABLING PEER SUPERVISION | In India, Dimagi is working with partners to equip government-employed ASHAs (Accredited Social Health Activists) to deliver HAP – a brief psychological intervention for depression, using a CommCare app. ASHAs use the app to register and screen clients, which provides tailored recommendations to the ASHA based on screeding data. ASHAs can audio record sessions (with consent) for self-review of the quality of their sessions, and are assigned selected peers’ recordings to do a peer supervision review using a validated quality check-list. Part of a Grand Challenges Canada Scale-Up Award, this app is a key component of the EMPOWER Platform to scale-up the mental health workforce worldwide.
CAPACITY BUILDING | Dimagi is partnering with Sangath and the University of Manchester to develop a mobile app as part of the NIHR-funded NAMASTE project, a multi-country initiative in India, Sri Lanka, and Nepal. The project focuses on early detection and intervention for young children with autism, addressing the critical shortage of community-based services and specialist providers in South Asia. ASHAs will use the app to deliver counseling sessions to parents of children with autism. These sessions guide parents on key development strategies, facilitate video recording of parent-child interactions, and offer feedback. The NAMASTE project aims to create a scalable solution for delivering autism interventions while building capacity in neurodevelopmental care.
UNLOCKING STEPPED CARE PATHWAYS | Finemind, a provider of stepped-care mental health services including Interpersonal Counseling (IPC)–a form of Interpersonal Psychotherapy–and Problem Management Plus (PM+), is utilizing CommCare to coordinate their multi-tiered care system in Uganda. A single point of registration is used to screen and direct patients to an appropriate care pathway based on the level of treatment required, with the ability to refer patients to a different care pathway based on their progress throughout their treatment program. Since the application was rolled out earlier this year, over 250 sessions have been conducted across the IPC and PM+ care pathways.
Future Areas for Innovation
Dimagi is continually exploring new frontiers in digital mental health care, including:
- Expanding WellMe to include peer support communities, allowing FLWs to connect, share experiences, and build resilience together.
- Scaling our group therapy solutions to include interventions like the Early Adolescent Skills for Emotions (EASE) program to address adolescent mental health challenges.
- Enhancing the PEERS app to address common mental disorders like anxiety, expanding its impact.
- Leveraging Large Language Models (LLMs) to develop AI-powered chatbots for self-care and single-session interventions.
- Using LLMs to revolutionize NSP training and supervision, ensuring real-time guidance and support as they deliver essential mental health services.
These innovations represent the next step in scaling digital mental health interventions, allowing us to meet the growing demand for care in LMICs.
Closing
We are seeing our digital solutions transform the way mental health services are being delivered, especially in low-resource settings. By partnering with incredible organizations and equipping FLWs and NSPs with the tools they need, we are making mental health care more accessible and effective.
To learn more about how our digital tools can support your mental health programs, get in touch with our team.
