Accumulating evidence suggests that there has been a recent increase in the clinical diagnosis of bipolar disorder among young people.^1,2 Between 1995 and 2000, the proportion of youth in a large database of privately insured patients who received outpatient treatment for bipolar disorder increased by 67%² while the proportion who received inpatient treatment for bipolar disorder increased by 74%.¹ Recent reports^3-5 further indicate that children and adolescents commonly receive pharmacological treatments for bipolar disorder. However, 1 recent study⁶ suggests that children and adolescents diagnosed with bipolar disorder are somewhat less likely than their adult counterparts to be prescribed mood stabilizers. The extent to which there has been a recent national increase in the outpatient diagnosis of childhood bipolar disorder and the pattern of its pharmacological treatment remain unknown.

Studies^1-3 of privately and publicly insured populations indicate recent growth in the treatment of young people with antipsychotic drugs. In a large privately insured prescription database, for example, treatment of youth younger than 18 years with antipsychotic medications increased from 0.32% in 1997 to 0.50% in 2000.¹ In Texas, the number of child and adolescent Medicaid enrollees prescribed second-generation antipsychotic medications increased 494% between 1996 and 2000, and the number prescribed first-generation antipsychotic medications increased 160% during that period.² Similar increases in youth antipsychotic treatment have been reported among the Tennessee Medicaid population.³

Digital innovations in mental health offer great potential, but present unique challenges. Using a consensus development panel approach, an expert, international, cross-disciplinary panel met to provide a framework to conceptualise digital mental health innovations, research into mechanisms and effectiveness and approaches for clinical implementation. Key questions and outputs from the group were agreed by consensus, and are presented and discussed in the text and supported by case examples in an accompanying appendix. A number of key themes emerged. (1) Digital approaches may work best across traditional diagnostic systems: we do not have effective ontologies of mental illness and transdiagnostic/symptom-based approaches may be more fruitful. (2) Approaches in clinical implementation of digital tools/interventions need to be creative and require organisational change: not only do clinicians and patients need training and education to be more confident and skilled in using digital technologies to support shared care decision-making, but traditional roles need to be extended, with clinicians working alongside digital navigators and non-clinicians who are delivering protocolised treatments. (3) Designing appropriate studies to measure the effectiveness of implementation is also key: including digital data raises unique ethical issues, and measurement of potential harms is only just beginning. (4) Accessibility and codesign are needed to ensure innovations are long lasting. (5) Standardised guidelines for reporting would ensure effective synthesis of the evidence to inform clinical implementation. COVID-19 and the transition to virtual consultations have shown us the potential for digital innovations to improve access and quality of care in mental health: now is the ideal time to act.