Concerns about the mental health and well-being of children and young people remain pressing, with increasing demand placed on services and widening recognition of the complexity of need (NHS Digital, 2023). In the first part of this special edition, digital mental health was framed through the lens of “ecosystems of support and learning”, emphasising how technologies sit alongside families, schools, communities and services as part of interconnected pathways of care (Hanley, 2025).
If the first editorial focused on how this terrain is configured, this second part turns to what happens within it: the processes, mechanisms and moments through which change is experienced. Rather than revisiting where digital tools sit, the papers across both sections collectively examine how they function in practice – how they support young people to manage distress, make sense of experience, and move towards support in ways that feel usable and meaningful. In doing so, the collection reflects a broader shift in the field. The central questions are no longer solely whether digital mental health support is accessible and helpful, but how it contributes to change, for whom and under what conditions.
From access to process
Early developments in digital mental health were often concerned with access: extending reach, reducing barriers and offering timely support. While these remain important, access alone does not guarantee benefit. Engagement is not the same as meaningful use. A key development in the field is the increasing attention to mechanisms of change – the processes through which support becomes active and impactful. These include managing overwhelm in the moment, structuring daily activity, recognising patterns over time, strengthening coping, and increasing willingness to seek further support (Kazdin, 2007). Crucially, these mechanisms do not sit neatly within digital platforms. They are enacted in everyday life and unfold through interaction with context, routine and need.
Meaningful use
Alongside mechanisms of change, this collection highlights the importance of meaningful use as a guiding concept for the field. Meaningful use is not defined by frequency, duration or sustained engagement. Instead, it is defined by fit. It refers to whether digital support is used in ways that are timely, purposeful and aligned with a young person’s needs in a given moment. In some cases, this may involve brief interactions at key points – managing a surge in anxiety, preparing for a difficult conversation, or taking a step towards further support. In other cases, meaningful use may involve stepping away from a platform when it has served its purpose, as attention returns to offline relationships, environments and activities.
This framing also highlights a design tension within the field. Many digital platforms are optimised for engagement, yet mental health support may require forms of bounded, intentional and sometimes minimal use. This is particularly important given ongoing concerns about patterns of excessive or dysregulated digital engagement and their association with distress (Keles et al., 2020; Odgers and Jensen, 2020). From this perspective, value is not located in sustained platform use, but in whether digital tools support movement towards well-being in contextually appropriate ways.
This special edition (part 2)
The papers in this second part of the special edition reflect these developments, offering insights into mechanisms and meaningful use across a range of contexts.
The first paper, The psychological and social impact of the digital self-support system ‘Brain in Hand’ on autistic people: prospective cohort study in England and Wales, examines Brain in Hand (BiH), a hybrid human–digital support tool, in relation to anxiety among university students, with a focus on autistic and ADHD populations. Using a mixed-methods approach, the study identifies mechanisms associated with change, including improved coping, reduced cognitive load and enhanced social participation. Qualitative findings illustrate how the tool supports both in-the-moment responses and longer-term pattern recognition, as well as planning and help-seeking.
The second paper, Using the Session Wants and Needs Outcome Measure (SWAN-OM) in single-session web-based support for children and young people: a mixed-methods evaluation, explores the SWAN-OM within single-session, web-based support for children and young people. Drawing on a large mixed-methods data set, the study demonstrates consistent improvements in outcomes while highlighting the richness of young people’s self-defined goals. Themes of emotional regulation, interpersonal concerns and problem-solving emerge, illustrating the value of combining structured and personalised approaches to outcome measurement.
The third paper, Gamified mental health: digital therapeutic alliance and mental well-being, examines the effectiveness of the gamified mental health app SuperBetter in supporting mental well-being among young adults in India. Using a two-week intervention design, the study found significant improvements in mental well-being following app use. Importantly, digital therapeutic alliance (DTA) emerged as a significant predictor of outcomes, outperforming simple engagement metrics such as logged activity. This highlights the importance of relational and experiential qualities in shaping the effectiveness of unguided digital interventions. While limited by a small sample size and lack of a control group, the study contributes to emerging discussions about how connection to a digital tool itself may function as a mechanism of meaningful use in digital mental health.
The fourth paper, “Apart of Me”: a digital therapeutic game for bereaved young people – supporting loneliness, emotional regulation and connection, focuses on loneliness among bereaved young people, using the Apart of Me (AoM) therapeutic game as a case example. Adopting a conceptual and practitioner perspective, the authors outline how features such as quests, voice integration, adaptive chatbot support and community elements can support emotional regulation and connection. A central contribution of the paper is its emphasis on how digital engagement can scaffold reconnection with offline relationships.
The fifth paper, Digital media use and mental health in adolescents and emerging adults: a narrative review through an ecological systems lens, presents a narrative theoretical review of digital media use and mental health among adolescents and emerging adults, guided by ecological systems theory. The review highlights both potential benefits (e.g. social connection, identity exploration) and risks (e.g. anxiety, depression, problematic use), while identifying moderating factors such as digital literacy, parental mediation and sociodemographic influences.
The final paper, The Digital Platform Assessment Matrix (DPAM): a framework for evaluating digital mental health platforms for children and young people, introduces a comprehensive framework for evaluating digital platforms designed to support children and young people’s mental health. Developed through literature review, stakeholder consultation and pilot testing, the DPAM provides a practical tool for assessing quality, usability and sustainability across a rapidly expanding digital landscape.
Conclusion
Taken together, the papers in this issue reflect a field moving beyond questions of access and innovation towards a more detailed understanding of process and impact. By focusing on mechanisms and meaningful use, they offer a nuanced account of how digital mental health can support children and young people in practice.
Building on the ecosystem perspective outlined in the first editorial (Hanley, 2025), this collection suggests that future developments will depend not only on expanding provision but on refining how digital supports are used within those systems. This includes attending to developmental differences, supporting intentional and context-sensitive use, and designing interventions that connect meaningfully with young people’s everyday lives.
Digital mental health is therefore best understood not as an endpoint, but as part of an ongoing process – one that supports young people to manage distress, seek connection and navigate the complexities of their worlds in ways that are both supported and sustainable.
