• Secondary care (SC) service users experienced significantly higher rates of total digital exclusion (19%) than primary care (PC) service users(0.8%).
• SC users are more likely to be older, male, and living alone. They also have lower household incomes and educational attainments than PC users.
• Digital exclusion is strongly associated with increasing age, lower household income, sensory impairments, and certain mental health conditions such as psychosis and bipolar disorder.
• Financial constraints, lack of support, and low motivation are the primary factors contributing to digital exclusion.
• SC users report higher rates of long-term physical health conditions and are more likely to have visual or hearing impairments.

This study highlights key issues of digital exclusion among mental health service users. To address these challenges, healthcare organisations could explore a range of potential solutions tailored to their specific context and resources.

1. Improving Access to Digital Devices and the Internet: One approach to addressing financial barriers could involve promoting
   awareness of social tariffs for Internet services. Organisations might explore providing financial assistance to subsidise broadband and mobile data costs for individuals facing digital exclusion due to economic circumstances. Another option could be the establishment of a device loan or donation scheme. This could potentially involve repurposing devices from organisations and businesses to create opportunities for lending or donating digital devices such as tablets, smartphones, and laptops to those in need.
    
2. Enhancing Digital Literacy through Peer Support: Given that survey respondents expressed a preference for peer support,
   organisations might consider developing a program that utilises peer support workers, either voluntary or paid, to enhance digital literacy. These workers could potentially focus on teaching simple solutions with immediate benefits, device configuration to address sensory impairments, strategies for managing digital triggers, online safety practices, and basic technical troubleshooting skills. This approach could help address the lack of support and knowledge barriers identified in the study.
    
3. Refocusing Digital Promotion: Organisations could consider refocusing their promotional efforts to enhance engagement in digital
   health. This would involve emphasising specific, immediate benefits of digital health services that are most relevant to individuals rather than promoting general digital engagement. Additionally, organisations could explore ways to educate users on using digital health tools safely and address concerns about confidentiality and data security, which the study identified as significant barriers.
   
   4. Providing Access to Local Digital Spaces: For healthcare systems where virtual consultations are integral, organisations might explore the provision of secure, private, and reliable local clinical digital spaces. This could potentially involve offering private spaces within community centres or recovery colleges, equipping public spaces with the necessary technology, or installing virtual consultation booths in GP surgeries and other community health spaces. Such an approach could help support the most digitally excluded individuals who lack private space, devices, or connectivity.
   
   5. Developing Strategies to Manage Digital Impact on Mental Health: Given the concerns raised about digital triggers, organisations might consider investing in further research to deepen understanding of how digital engagement influences the well-being of individuals with mental ill-health. This could potentially guide the development of strategies to mitigate negative effects and support the growth of clinical expertise in this relatively under-researched area.
    

The findings highlight the need for targeted interventions to address digital exclusion among mental health service users, particularly in secondary care. 

Addressing these disparities is crucial for ensuring equitable access to digital health services and potentially improving health outcomes for all service users.

The study employed a mixed-methods approach, using online and postal surveys to gather data from 29,056 of ELFT’s mental health service users with a 5.5% response rate. 

The survey included questions on demographics, digital access, health conditions, and preferences for digital health services.