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Digital health platforms are transforming how people access mental health support and manage their well-being. This includes not only dedicated mental health platforms but also general healthcare platforms that might track mood or well-being alongside other health metrics. These tools often work alongside, and at times replace, traditional clinician-led interactions.
This new reality creates a point of significant risk. It is especially significant for vulnerable users who may be experiencing a mental health crisis but have no immediate access to clinical support. For platforms without 24/7 crisis services, guiding users to the right support through clear, accessible signposting is vital.
This guidance provides practical advice for developers on how to effectively signpost users to help. Our approach is based on recommendations from the UK Samaritans, experts in online safety and suicide prevention, combined with our own expertise in mental health, clinical safety and digital health best practices.
Core Principles for Signposting
- Prioritise User Safety: The primary goal is to ensure your users experiencing distress are directed to appropriate and timely external support.
- Clarity and Accessibility: Signposting should be placed in prominent locations with minimal clicks to access support. The design should be simple, using plain language, clear fonts, and good colour contrast, while ensuring compatibility with assistive technologies like screen readers.
- Concise and Credible: Avoid overwhelming your users with too much information at once. Provide a curated list of two or three trusted, well-established support services.
- Cultural Sensitivity and Inclusivity: Use culturally sensitive and inclusive language in signposting that respects diverse experiences and avoids stigmatising language.
- Mobile Optimisation: Ensure that signposting to crisis support is clearly visible and easily accessible on mobile devices, which are often primary points of access for digital health platforms.
- Transparency about Product Support Limitations: Clearly state if direct crisis support isn’t offered.
- Regular Review: Establish a process to regularly review and update the information and links to ensure they remain accurate and relevant.
Implementing Signposting
To better support users, developers could explore integrating crisis signposting in the following key areas within digital health platforms:
- Mood tracking/reporting features: Support here can be persistent (a constant “Need Help?” link) or reactive. Reactive signposting could trigger a support banner based on specific inputs, such as a reported “very low” mood or a clinically significant score on a standardised screening tool.
- Free-text input fields: Consider positioning an easily visible link (e.g., “Need support?”) near any text box where users might express feelings of distress.
- Help/support sections: Create a prominent, clearly labelled section (e.g., “Crisis Support,” “Urgent Help”) that is easy to find within the platform’s main help or support area.
- Onboarding processes: During initial setup, clearly state the platform’s support limitations and point to available resources. For example: “While this platform doesn’t offer direct crisis support, you can find guidance to external help in our ‘Help’ section.”
- Terms and conditions/privacy policies: Include a statement to clarify your approach to crisis support, for example: “If you express feelings of significant distress, we may signpost you to external support services.”
To ensure effectiveness, user testing is important, particularly with vulnerable groups and those with accessibility needs.
Levels of Crisis Signposting
We’ve adopted the following framework for Basic and Gold Standard crisis signposting directly from the Samaritans’ guidelines, “Supporting the Wellbeing of Users Online”. This framework provides a robust foundation for supporting users in distress:
1. Basic Signposting (A minimum standard):
- Emergency and Non-Emergency Services (localised for each market).
- Support that can be accessed 24/7.
- Trusted helplines and services specialising in the provision of support for self-harm and suicide.
- Encouraging users to speak to family, friends or other people they trust.
2. Gold Standard Signposting (Providing a Better Level of Support):
To provide a more comprehensive level of signposting, consider integrating the following in addition to the basic standards:
- Acknowledge the barriers to help seeking users may face. Reaching out for support can be difficult and users may have tried to get help before and had negative experiences. Try to remind users that support is available, and things can change for them.
- Provide relevant signposting specific to the issues faced by the user If possible. This can be significantly enhanced by involving individuals with lived experience to understand the most helpful and relevant options.
- Signpost to support in a range of formats, such as face to face, online, phone, email and text services. Age-appropriate formats are particularly important for younger users.
- Signpost to local support where possible, as well as national organisations.
- Be realistic about support options and how they can help.
How much information you can provide may depend on the space you have available, for example if you have a full webpage or an in-app pop up.
Risk Escalation Procedures
Manufacturers don’t always see themselves as responsible for direct communications from users, believing that this falls to the service provider. However, it’s not uncommon for users to reach out through manufacturer’s communication channels—like tech support for a bug report or general inquiry—and either unexpectedly disclose a mental health crisis or mistakenly seek mental health support there.
This means that any personnel who might receive user communications, regardless of their primary role, must be prepared to identify such disclosures and know how to escalate them.
Therefore, digital health product manufacturers should have established internal risk escalation policies and procedures in place. These procedures should ensure a defined pathway for escalating such disclosures to designated staff members who are trained to assess the risk and initiate an appropriate response.
International and Advanced Considerations
Further considerations include the use of support for a global user base and new technologies.
- International Users: For platforms with a global user base or UK based users accessing from abroad, providing access to international crisis support is a key consideration. This requires thoroughly vetting international services or partnering with reputable organisations. Resources such as https://findahelpline.com/ can be a good starting point.
- The Role of AI: While AI can help identify users in distress, it has limitations. Platforms should provide easily accessible links to human-led crisis helplines, not rely solely on automated responses, and be transparent about how AI is used. It’s also important to note that if your platform processes user data using AI, this functionality is generally considered ‘high functionality’ by the MHRA, which can be a key factor in its qualification as a Medical Device if it also serves a medical purpose.
The Regulatory Imperative
Making sure users are signposted to in person support in times of crisis is a key part of building a safe digital health product. Thinking through and documenting your approach to this risk can help support the content of your DCB0129 Hazard Log and Clinical Safety Case Report (CSCR).
The new MHRA guidance on Digital Mental Health Technology‘ also strongly reinforces the regulatory imperative for effective crisis signposting. It identifies the risk of a ‘patient crisis’ and provides examples where flagging concerns about a user’s mental health necessitates signposting to a healthcare professional.
However, it’s important to understand that simply providing crisis signposting to a lay user may not, by itself, make your product a medical device. If your digital mental health platform processes user data to assess risk, predict, treat, monitor, or make a diagnosis of mental health conditions and/or symptoms considered diagnosable or clinically relevant, it may qualify as a Medical Device (even if it’s purely software, known as Software as a Medical Device or SaMD). This distinction is critical for understanding regulatory obligations. If you need help defining whether your digital mental health tool may be entering Software as a Medical Device (SaMD) territory, get in touch with us about a Regulatory Review and Strategy.
Considering how to integrate effective crisis signposting within your digital health platform is crucial, with the goal of mitigating potential harm and promoting user well-being. The relevance of specific implementations may vary depending on the platform’s nature and risk profile. However, it is generally advisable to consider early in the product design process how you will manage any disclosures of mental health crises or significant distress, alongside the integration of crisis signposting, rather than treating these as an afterthought. This proactive approach promotes a safer and more responsive system for potentially vulnerable users.
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