Putting Sustainability at the Front of Digital Mental Health

Sustainability & mental health: an overview

As people who work in mental healthcare and research, we need to be forthcoming: the climate crisis is also a mental health crisis. Beyond the mental health burden of ‘climate anxiety’ ¹, climate change is associated with environmental risk factors for mental disorder, such as increases in air pollution ² and heat ³. Environmental impacts of climate change are unequally distributed across the world ⁴, further entrenching existing global inequalities in mental health.

These issues have been gathering attention in the field of mental health; ACAMH has taken a lead in commissioning more pieces about the relationship between the climate crisis and mental health, which are available here. The Royal College of Psychiatrists recently produced guidance on Net Zero Mental Healthcare, which includes areas such as increasing nature-based interventions for intervention and prevention of mental illness.

Existing sustainable health frameworks^5,6 focus on areas such as reducing healthcare needs across populations and reducing the clinical waste and energy consumption associated with providing healthcare. Digital tools have also been proposed as a possible solution; from increasing the resource efficiency of existing processes to facilitating innovations that can change research and the provision of care, many digital tools have the potential to alleviate the climate impacts of traditional research and healthcare provision.

The climate crisis is also a mental health crisis.

How can digital innovation contribute to sustainable development in mental health research and healthcare?

Reducing paper-based methods of health monitoring. At the CAMHS Digital Lab, we have created myHealthE, an online platform for families accessing Child and Adolescent Mental Health Services where caregivers can upload questionnaire responses about their child’s mental health between appointments. Historically, these questionnaires were distributed via paper; not only did these paper-based methods typically receive low response rates, but they also contributed to a high degree of waste. Remote monitoring via myHealthE has positively impacted the mental healthcare we provide; rates of completion have increased approximately 12-fold, massively increasing the amount of data clinicians have to review treatment trajectories and make clinical decisions, in addition to eliminating paper-based waste. In addition, myHealthE enables families to access digital resources while waiting for treatment and to opt into research through Consent for Contact—supporting early engagement and advancing inclusive mental health research. In this way, digital tools can deliver multiple benefits to mental healthcare systems at the same time.

Evidence-Based Digital Interventions: Digital tools—like mobile apps and web-based platforms—can deliver evidence-based therapies such as Cognitive Behavioural Therapy in a scalable, accessible way. These interventions reduce the need for in-person appointments, which can lower the carbon footprint associated with frequent travel to clinics. They also reduce reliance on printed materials often distributed during therapy. For example, digital Cognitive Behavioural Therapy platforms can guide users through structured exercises, provide progress tracking, and offer feedback—all through their personal devices. This not only increases reach and flexibility but also decreases the environmental and administrative load of traditional therapy delivery, supporting a more sustainable model of care.

Mental Health Monitoring: Wearable devices can continuously monitor stress levels, sleep patterns, and mood; for example, we are currently working on a wearable device to track ADHD symptoms in young people helping individuals track their mental health and providing real-time feedback to both users and healthcare providers⁷. This increases the efficiency of monitoring health in the community, reducing journeys to healthcare facilities and thus energy consumption associated with those facilities, increasing their sustainability.

Evaluating the Sustainability of Digital Mental Health Tools

Digital tools are often assumed to be more sustainable than their ‘analogue’ counterparts: from reducing paper waste to decreasing emissions associated with travel to in-person appointments. However, to our knowledge, relatively few frameworks exist for evaluating the sustainability of novel mental health technologies, and these are not employed as standard practice in the evaluation of these technologies. Green DiSC is a Digital Sustainability Certification designed to train researchers to evaluate the climate impact of their digital research and computing activities. Few studies have formally compared the sustainability of digital mental health solutions across the key areas of carbon emissions, waste production, materials toxicity, and more. Below, we outline considerations for the evaluation of digital mental health products.

Key considerations

• Digital storage and servers. While they do not consume as much physical material as traditional methods, digital methods of storing data require the use of servers which consume energy. Healthcare systems can employ sustainable decision-making to manage this energy expenditure: for example, can some servers be turned off during non-peak usage hours?
• Energy consumption of devices. Digital tools rely on electronic devices that consume energy, which can contribute to carbon emissions. Healthcare systems should consider using energy-efficient devices and promote practices that reduce energy usage, such as optimising software and turning off unused devices. Reducing energy consumption helps lower costs and contributes to a more sustainable digital health ecosystem.
• Online working. While remote appointments and working may reduce the carbon footprint associated with travel to a physical space, online activities such as video calls are associated with carbon emissions⁸. Clinical teams should consider turning off video during routine online meetings. Clinicians may ask service users their preferences with regards to video in online appointments (e.g., therapy), but at the same time should consider the potential therapeutic benefits of video during online assessments and interventions.
• Data privacy and security. Protecting patient data is crucial in digital mental health tools, and maintaining secure systems can contribute to sustainability. Efficient data management practices, like using encrypted storage solutions and minimising data retention periods, reduce the amount of storage needed and lower energy consumption. Regularly updating security protocols ensures the system’s longevity and helps avoid unnecessary data duplication or system rework. By balancing privacy with efficiency, sustainable practices in data management can reduce both environmental impact and the risk of costly data breaches.
• Material lifecycle and e-waste. Every product has a lifecycle, and so healthcare systems that employ digital products need to consider how and when these will be disposed of. In some cases, products with a longer lifecycle may incur greater upfront costs, which should be accounted for in the decision-making process. Physical products made from recycled materials should be considered where possible.

Digital tools are often assumed to be more sustainable than their ‘analogue’ counterparts: from reducing paper waste to decreasing emissions associated with travel to in-person appointments.

What are we doing for sustainability?

This past academic year, we participated in the Sustainability Champions programme at King’s College London, a university-wide programme designed to engage teams in increasing sustainable practices within their departments. Teams participated across four levels: Foundation, Bronze, Silver, and Gold. We completed the Foundation and Bronze levels, which included actions across areas such as:

• Operations: creating materials for the rest of the Lab for job descriptions, job inductions, and leading events that promote sustainable practice.

• Travel: analysing departmental travel data and formulating an action plan for encouraging more sustainable travel across the department.
• Learning: taking the Climate & Sustainability module from King’s E-Learning and Teaching Service (KEATS) to learn more about the climate crisis and sustainable development.
• Networking: attending events put on by the King’s Climate Action Network (CAN) to learn about and engage with sustainable practice across the university.

These actions have supported our team in initiating our own work on sustainability. We hope to spend the coming months reviewing the relevant literature, attending courses such as Green Disc, and developing a plan to evaluate how our methods can be even more climate informed.

Conclusion

As digital tools become increasingly integrated into mental health care, it is essential that we adopt a sustainability-driven approach to their development and use. By reducing paper waste, improving energy efficiency, and promoting responsible data management, we can ensure these tools not only improve access and outcomes in mental health but also contribute to a more sustainable future. The next steps involve expanding frameworks for evaluating the environmental impact of digital health solutions and continuously refining our practices to align with climate-conscious goals.

As digital tools become increasingly integrated into mental health care, it is essential that we adopt a sustainability-driven approach to their development and use.

NB this blog has been peer-reviewed

References

1. Wu, J., Snell, G., & Samji, H. (2020). Climate anxiety in young people: a call to action. The Lancet Planetary Health, 4, e435–6.
2. Braithwaite, I., Zhang, S., Kirkbride, J.B., Osborn, D.P.J., & Hayes, J.F. (2019) Air pollution (Particulate matter) exposure and associations with depression, anxiety, bipolar, psychosis and suicide risk: A systematic review and meta-analysis. Environmental Health Perspectives, 127(12),
3. Niu, L., Girma, B., Liu, B., Schinasi, L.H., Clougherty, J.E., & Sheffield, P. (2023). Temperature and mental health-related emergency department and hospital encounters among children, adolescents and young adults. Epidemiology & Psychiatric Sciences, 17(32),
4. Zhang, S., Braithwaite, I., Bhavsar, V., & Das-Munshi, J. (2021). Unequal effects of climate change and pre-existing inequalities on the mental health of global populations. BJ Psych Bulletin, 45(4), 230–4.
5. Comment Planetary health care: a framework for sustainable health systems [Internet]. 2021. Available from: https://www.irena.org/-/media/Files/IRENA/Agency/Publication/2020/
6. Dion, H. & Evans, M. (2024). Strategic frameworks for sustainability and corporate governance in healthcare facilities; approaches to energy-efficient hospital management. Benchmarking: an International Journal, 31(2), 353–90.
7. Morris, A.C., Douch, S., Popnikolova, T., McGinley, C., Matcham, F., Sonuga-Barke, E. et al. (2024). A framework for remotely enabled co-design with young people: its development and application with neurodiverse children and their caregivers. Frontiers in Psychiatry, 15, 1432620.
8. Obringer, R., Rachunok, B., Maia-Silva, D., Arbabzadeh, M., Nateghi, R., & Madani, K. (2021). The overlooked environmental footprint of increasing Internet use. Resources, Conservation and Recycling, 167,

About the authors

Sarjhana Ragunathan Brindha and Zoë Firth are researchers at the CAMHS Digital Lab at King’s College London, a clinical research group using digital innovations to improve mental healthcare for children and young people. Sarjhana is a Clinical Informatician, and Zoë is a Research Assistant.

Sarjhana Ragunathan Brindha is a Clinical Informatician at the CAMHS Digital Lab. She focuses on producing clinically driven data extracts, developing reports and dashboards, and performing in-depth data analysis. She also facilitates and manages Natural Language Processing projects within the lab and supports various operational automation pipelines. Her interests include exploring the potential applications of artificial intelligence in clinical settings.

Zoë Firth is a Research Assistant at the CAMHS Digital Lab. With a research background in clinical linguistics and experience working in mental healthcare, she currently works on a variety of projects related to digital methods of researching, assessing, and treating mental illness in children and young people. Her research interests also include trauma-informed practice and sustainability in mental healthcare.