Background: The COVID-19 pandemic has necessitated an immediate and large-scale uptake of online treatment for mental health care. However, there is uncertainty about what the “new normal” in mental health care will be like in post–COVID-19 times. To what extent will the experiences gained during the pandemic influence a sustainable adoption and implementation of online mental health care treatment in the future? Objective: In this paper, we aim to formulate expectations with regard to the sustainability of online mental health care after COVID-19. Methods: In an interview study, 11 mental health care professionals were asked about their experiences and expectations for the future. Participants were recruited from a mental health care organization in the Netherlands. The interviews took place between April 7-30, 2020, at the peak of the COVID-19 crisis in the Netherlands. The data were analyzed using a thematic coding method. Results: From the interviews, we learn that the new normal in mental health care will most likely consist of more blended treatments. Due to skill enhancement and (unexpected) positive experiences with online treatment, an increase in adoption is likely to take place. However, not all experiences promise a successful and sustainable upscaling of online treatment in the future. Mental health care professionals are learning that not all clients are able to benefit from this type of treatment. Conclusions: Sustainable upscaling of online mental health care requires customized solutions, investments in technology, and flexibility of mental health care providers. Online treatment could work for those who are open to it, but many factors influence whether it will work in specific situations. There is work to be done before online treatment is inherently part of mental health care.

While eHealth technologies such as web-based interventions, mobile apps, and virtual reality have the potential to be of added value for forensic mental healthcare, there is a gap between this potential and the current situation in practice. The goal of this study was to identify recommendations to bridge this gap. In total, 21 semi-structured interviews and 89 questionnaires were conducted in a Dutch forensic mental healthcare sample consisting of professionals, patients, and eHealth experts. Based on the broad range of identified recommendations, it can be concluded that attention should be paid to the characteristics of professionals, patients, technology, and the organization throughout the development, implementation and evaluation of eHealth.

Aim: To examine (1) how flexibility is defined and described in healthcare literature and (2) which interventions are used at what organisational level to influence flexibility. Background: Flexibility is necessary in healthcare for continuous adaptation to the dynamic environment. In accordance with Social Ecological Theory, it takes the combination of all organisational levels to achieve flexibility (individual, interpersonal, organisational, community, and macro-policy). However, managing this is complex. Evaluation: Using Psychinfo and Web of Science, a systematic search was performed on flexibility in health care organisations. The 19 studies that met the selection criteria were analysed from a social ecological perspective. Eight publications described flexibility as a result of interventions, but provided little information about their evidence base. Key issues: It is difficult to achieve flexibility: a pro-active attitude and capability to adapt internal processes to the changing environment. Interventions promoting flexibility in healthcare need all organisational levels, since they mutually influence each other. Conclusion: This study shows that there is too little evidence on how to create flexibility in healthcare organisations. Implications for management: Change in healthcare is continuous. Therefore, flexibility should be a permanent pro-active attitude of both managers and professionals and should take all organisational levels into account.

Background: The last few decades have witnessed significant advances in the development of digital tools and applications for mental health care. Despite growing evidence for their effectiveness, acceptance and use of these tools in clinical practice remain low. Hence, a validated and easy-to-use instrument for assessing professionals’ readiness to adopt eMental health (EMH) is necessary to gain further insights into the process of EMH adoption and facilitate future research on this topic. Objective: The aim of this study is to develop and validate an instrument for assessing mental health care professionals’ readiness to adopt EMH. Methods: Item generation was guided by literature and inputs from mental health care professionals and experts in survey development. Exploratory factor analyses were conducted on an initial set of 29 items completed by a sample of mental health care professionals (N=432); thereafter, the scale was reduced to 15 items in an iterative process. The factor structure thus obtained was subsequently tested using a confirmatory factor analysis with a second sample of mental health care professionals (N=363). The internal consistency, convergent validity, and predictive validity of the eMental Health Adoption Readiness (eMHAR) Scale were assessed. Results: Exploratory factor analysis resulted in a 3-factor solution with 15 items. The factors were analyzed and labeled as perceived benefits and applicability of EMH, EMH proactive innovation, and EMH self-efficacy. These factors were confirmed through a confirmatory factor analysis. The total scale and subscales showed a good internal consistency (Cronbach α=.73-.88) along with acceptable convergent and predictive relationships with related constructs. Conclusions: The constructed eMHAR Scale showed a conceptually interpretable 3-factor structure having satisfactory characteristics and relationships with relevant concepts. Its ease of use allows for quick acquisition of data that can contribute to understanding and facilitating the process of adoption of EMH by clinical professionals.

Purpose: This two-part study aims to contribute to the body of knowledge on team development by examining the development of self-managing teams (SMTs) in healthcare. Based on an exploration of the team development literature, a perspective on SMT development was created, which suggested that SMTs develop along a non-sequential pattern of three processes–team management, task management and boundary management and improvement–that is largely the result of individual, team, organizational and environmental-level factors.Design/methodology/approach: The perspective on SMT development was assessed in a Dutch mental healthcare organization by conducting 13 observations of primary mental healthcare SMTs as well as 14 retrospective interviews with the self-management process facilitator and advisors of all 100 primary mental healthcare SMTs.Findings: Empirical results supported the perspective on SMT development. SMTs were found to develop along each of the three defined processes in a variety or possible patterns or simultaneously over time, depending on many of the identified factors and three others. These factors included individual human capital, team member attitudes and perceived workload at the individual level, psychological safety, team turnover, team size, nature of the task and bureaucratic history at the team level, and management style and material and social support at the organizational level.Practical implications: This study provides a non-sequential model of SMT development in healthcare, which healthcare providers could use to understand and foster SMTs development. To foster SMT development, it is suggested that cultural change need to be secured alongside with structural change.Originality/value: Even though various team development models have been described in the literature, this study is the first to indicate how SMTs in the healthcare context develop toward effective functioning.

Background: E–mental health (EMH) offers various possibilities for mental health care delivery, with many studies demonstrating its clinical efficacy. However, the uptake of EMH technologies by mental health care professionals remains to be low. One of the reasons for this is the lack of knowledge and skills in using these technologies. Skill enhancement by means of serious gaming has been shown to be effective in other areas but has not yet been applied to the development of EMH skills of mental health care professionals. Objective: The aim of this paper is to describe a study protocol for the user requirements analysis for the design of a game-based training environment for mental health care professionals to enhance their skills in EMH. Methods: The user requirements are formulated using three complementary outputs: personas (lively descriptions of potential users), scenarios (situations that require EMH skills), and prerequisites (required technical and organizational conditions). We collected the data using a questionnaire, co-design sessions, and interviews. The questionnaire was used to determine mental health care professionals’ characteristics, attitudes, and skill levels regarding EMH and was distributed among mental health care professionals in the Netherlands. This led to a number of recognizable subuser groups as the basis for personas. Co-design sessions with mental health care professionals resulted in further specification of the personas and an identification of different user scenarios for the game-based training environment. Interviews with mental health care professionals helped to determine the preferences of mental health care professionals regarding training in EMH and the technical and organizational conditions required for the prospective game-based training environment to be used in practice. This combination of requirement elicitation methods allows for a good representation of the target population in terms of both a broad view of user needs (through the large N questionnaire) and an in-depth understanding of specific design requirements (through interviews and co-design). Results: The questionnaire was filled by 432 respondents; three co-design sessions with mental health care professionals and 17 interviews were conducted. The data have been analyzed, and a full paper on the results is expected to be submitted in the first half of 2021. Conclusions: To develop an environment that can effectively support professionals’ EMH skill development, it is important to offer training possibilities that address the specific needs of mental health care professionals. The approach described in this protocol incorporates elements that enable the design of a playful training environment that is user driven and flexible and considers the technical and organizational prerequisites that influence its implementation in practice. It describes a protocol that is replicable and provides a methodology for user requirements analyses in other projects and health care areas. International Registered Report Identifier (IRRID): RR1-10.2196/18815