"Getting people access to services is also getting them access to a phone": Clarifying digital divide dynamics and their consequences in Community Mental Health Care.

Abstract

Access to mental healthcare is increasingly technologically-mediated. People with low socioeconomic status (SES) and serious mental illness (SMI) face lower rates of tech ownership and may lack technological skills, called "digital divides." Yet, little is known about how digital divides may impact mental healthcare access. Therefore, a qualitative study (ethnographic observations and interviews) was conducted with stakeholders working with low-SES SMI patients using community mental health care (CMH) (N=14). Findings showed that consumers struggled to maintain consistent internet-and thus mental healthcare-access despite owning smartphones. Consumers frequently faced care disruptions due to broken, lost, or uncharged phones. Staff and patients created effortful but ad-hoc workarounds to restore access during technological access disruptions. These solutions frequently occurred after healthcare appointments were missed. Digital divide concepts should accommodate the work necessary to maintain technology access even after ownership and its impact on care access-especially among low-SES SMI patients.