A major project across California aimed at using digital tools to improve mental health care has revealed that technology alone cannot bridge the gap in services without meaningful support from individuals with lived experience. The Help@Hand initiative, which involved 11 county-level sites, was designed to bring digital mental health interventions into public services, with trained peers playing a central role. The findings were published in the journal Administration and Policy in Mental Health and Mental Health Services Research.
Although the project had an ambitious scope and was backed by over one hundred million dollars in funding, it encountered widespread difficulties. Peer workers were expected to provide both emotional support and technical help with apps, devices, and online systems. But finding individuals who were both digitally skilled and had experience of mental health challenges proved extremely difficult. Most sites reported that recruitment was a significant obstacle, with low pay and limited hours discouraging suitable candidates.
Even when peers were hired, many were not given clear roles or adequate training. Several reported feeling uncertain about their responsibilities or how their input would be used. This lack of clarity led to inconsistent peer involvement across sites. While some counties embraced their role in planning and delivery, others offered minimal support. These inconsistencies impacted the effectiveness of digital tools, particularly in communities that already faced barriers to care.
Further logistical issues emerged. Nearly half of the sites reported delays in distributing tablets and smartphones. Some communities lacked internet access or digital literacy, making it difficult for them to benefit from the new services. Peers often had to bridge these gaps by providing basic tech support and digital education, yet many were overstretched with additional work on unrelated projects.
Communication breakdowns added to the challenges. Delays in decision-making from the central project team left some sites uncertain about next steps. Internally, poor information flow hindered coordination between local staff. Staff turnover, particularly among peer workers and project leads, disrupted progress and made it difficult to maintain continuity.
The onset of the Covid pandemic made the situation worse. Services had to move online at a time when many sites were still waiting for vendor agreements and software rollouts. In some cases, the pandemic accelerated the need for digital tools, but in others it deepened existing inequalities in access.
One of the most pressing concerns was sustainability. Peers hired on short-term contracts were unsure about their future. Some sites were hesitant to invest in peer support if funding could not be guaranteed beyond the project’s timeline. This uncertainty limited the development of a stable peer workforce, undermining the project’s long-term impact.
