This study explores Digital Mental Health (DMH), referring to the use of digital technologies in mental health, from the perspective of users and system builders – individuals ‘in the wild’. Using an adapted constructive Grounded Theory Methodology (Charmaz, 2014), it qualitatively explores DMH and how it is applied to everyday life. Interviews with users, developers and academics were supported by data collected from extant documents and observations. Findings addressed the complexity of development and use, where differences in priority between the technical and clinical paradigms in development challenged the usability and usefulness for consumers of DMH. Changes implemented within, and the transience of, DMH resources were constructed by users as potentially distressing and difficult for system builders to mitigate. DMH is a new and emerging way to self-manage mental health. However, whilst it provides options, it does not inform as to how to choose and, whilst it supports change, it is not in itself motivating. In understanding the role of DMH it is essential to consider it alongside existing mental health prevention and management. DMH is constructed not as use of a single resource, but rather a toolkit for self-management where resources are used in different ways and at different times. Some will be integral whilst others may be used more occasionally. Many of the participants identified the difficulties and challenges of managing their mental health with only traditional tools and interventions available, and how DMH offered additional ways of doing so. DMH offers users autonomy and a way to explore their experiences in a simulated environment, contributing to its purpose as a supplement to existing mental health provision. Understanding how DMH can supplement the existing treatment and management of mental health is essential. One key area is addressing the opportunities provided by the simulative functions of new technologies and how mobile technologies have enabled these to become part of the everyday lives of so many people. Finally, the concept of Technology-asAdvocate was constructed to identify the ways that technology can help individuals to help themselves. This study recommends that DMH stakeholders invest and conduct further research that bring together clinical, technical and user paradigms to better understand how changes to devices and resources impact users. It positions DMH within the initial stages of help-seeking and addresses its role as one of many tools in the individual’s self-care. It proposes that technology be viewed as supporting self-advocacy and theorises that future technologies, such as personal assistants, be designed to advocate rather than to dictate. It is vital that policymakers recognise the impact of changes for users who find resources that support them in their mental health and apply them within their everyday life.
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