In Australia, as in many developed countries, the mental health care system is characterized by increasing fragmentation [1]. Responsibilities for mental health policy and services are split between our federal government, which funds primary mental health care services, and our eight state and territory governments which are responsible for hospital-based emergency, acute, and outpatient mental health care. Myriad state and national mental health plans and strategies have not fundamentally shifted a situation in which mental health care receives about 7% of the total national health spending [2] (a figure unchanged since 1992) while accounting for around 15% of the total burden of disease [3].

This mix of responsibilities has seen a withering of community mental health services over time, creating a “missing middle” in Australia’s mental health service landscape [4].

Fragmentation also arises through disconnection between public and private mental health sectors, very significant mental health workforce shortages, and a heavy reliance on the medical model, which favours clinical and hospital-based care over community and psychosocial mental health services. Psychosocial services have always been a peripheral element of Australia’s mental health service mix [5].

Australia’s recent implementation of its National Disability Insurance Scheme has also created a new funding and policy seam separating different mental health clients and systems.

At the same time, and in response to increasing recognition of the need for more services to respond to mental illness in Australia, funding has gone into a plethora of new programs. Often these programs are time-limited, operating in isolation from one another. Repeated inquiries and reports have found these issues and others combine to make mental health system integration very difficult in Australia [6,7].

New navigation tools offer some prospect of helping surmount this fragmentation. In doing so, they must fit into, or change the current model of primary mental health care provided in Australia, which sees the general practitioner (GP) operate as a gatekeeper to publicly subsidized, specialist mental health care, typically provided by either a psychologist or psychiatrist under Medicare.

Australians cannot directly book Medicare‐subsidized sessions with psychologists or other mental health care professionals without a referral from a primary care provider [8]. There is no suggestion (yet) that navigation tools should supplant the GP gatekeeper role in Australia. However, they can still play a valuable role, helping consumers and caregivers to find community mental health services or to advocate for a referral to specialist care. Additionally, health professionals, including primary care providers and mental health planners, can benefit from using these tools to support and streamline care pathways.

Navigation tools help health care service planners, health professionals, and health care consumers locate available services [5,9] and connect individuals and their families with the most suitable option for mental health treatment and support services. In the last few years, the number of Australian digital mental health care navigation tools has significantly increased from a handful in 2020 to currently over 100. This abundance of web-based and digital resources can be overwhelming and confusing to navigate due to the volume of information, variable levels of digital literacy, and uncertainty about which services are appropriate [10]. With growing demand for digital resources in mental health, it is crucial to gain a better understanding of current digital navigation tools.

In the context of this study, mental health care navigation tools are defined as digital or web-based resources designed to assist health professionals, consumers, and caregivers in locating and accessing mental health services, referral information, resources, and support. These tools can exist as stand-alone web-based systems or modules integrated with other web-based tools for assessment, diagnosis, and facilitation of appropriate treatment. Navigation tools commonly feature directories of mental health services and offer interactive, integrated, and user-friendly functions for locating resources and support. They may also provide estimated appointment waiting times, web-based booking services, telehealth platforms, relevant information pertaining to rules about clients or restrictions, and digital consultations.

Navigation tools are not “navigators” of the care system. There is a widespread interchangeability and confusion, even in the scientific literature, of navigation as a function or activity, the tools used for conducting navigation activities, and the specific occupation of “navigators” who perform care coordination activities using publicly or organizationally available tools. Studies seldom provide clear definitions of their operational use of the term navigation and often conflate navigation activities with the role of “navigators” [11,12].

In Australia, as with other developed nations, there are various ways to access the mental health care system. However, access often relies on individuals being aware of these options. Having all service choices available in one location can help overcome barriers related to lack of knowledge of available services and save consumers time in trying to determine what is accessible in their area [13]. One of the benefits of digital mental health care navigation tools is that they provide aggregated information about available resources in a centralized location to help navigate the complex mental health system. The tools are often stratified by geographic location, making it easier for health professionals and consumers to locate appropriate services [14].

Navigation tools can also be used by health care and support workers, care coordinators, and care navigators to provide recommendations about mental health care services and guide referrals. Digital mental health care navigation tools can offer insights into specific demographic needs by leveraging metric analytics to understand usage patterns and inform policy and program planning, ensuring that services are tailored to meet the specific needs of different populations [15].

However, access to and use of digital mental health care navigation tools depends on end user awareness and other factors such as their level of digital literacy. The use of digital supports may create additional challenges for those in most need of care due to issues such as limited technology access, unreliable internet, associated costs, and lack of digital and health literacy [16].

Currently, there is an absence of standardized evaluation criteria for conducting reviews and assessing the quality and accuracy of digital navigation tools. The National Safety and Quality Digital Mental Health Standards (NSQDMHS) are a set of guidelines developed in Australia to ensure high-quality mental health care across the country. Their purpose is to establish a benchmark for the quality and safety of mental health services and to guide service providers in delivering consistent and effective mental health care. The standards are organized into several core areas that outline the expectations for mental health services. These core areas are consumer rights and safety, access and engagement, treatment and support, service environment, continuity of care, and workforce. The NSQDMHS [17] provides voluntary standards for digital mental health services. These standards do not explicitly address mental health navigation tools, nor do they encompass principles of quality and accuracy for information within digital navigation tools. The standards suggest that service providers use quality improvement systems to identify quality measures, but do not offer guidance on definitions of quality or accuracy.

Infoveillance, a combination of information and surveillance, refers to the systematic collection, analysis, and monitoring of information from digital sources [18,19]. Infoveillance can also be used to take a snapshot of health system change by analyzing data from various web-based sources [20], allowing for repeated assessments at different time points. Infoveillance allows researchers and others to gather insights from digital data to gain a better understanding of various phenomena [21].

Analyzing existing mental health service navigation tools using the infoveillance method can help to identify availability gaps and access barriers to inform the development of more inclusive and accessible tools. Additionally, it can offer valuable insights for policymakers to comprehend the mental health landscape and address support gaps effectively [18].

The aim of this study was to identify and outline the primary features of existing Australian digital mental health care navigation tools while pinpointing gaps in availability and barriers to access.

The research team conducted an infoveillance study to identify Australian mental health care navigation tools. A comprehensive web search was conducted by 2 members of the research team (CEW and MAF). Primary Health Networks (PHNs), the 31 regional districts of primary health care in Australia, were used as the reference catchment areas. We conducted a literature search, reached out to key experts to identify available tools, and performed a comprehensive Google web search to locate mental health navigation tools at both the local and national levels. This involved reviewing the official web pages of the PHNs as well as any other available sources of regional-level information.

The web search was executed using Google, incorporating the name of the PHN along with the following search terms and Boolean operators: AND directory OR navigation. The search results initiated a snowball effect, with some PHNs providing links on their website to state-based or national navigation tools. Concurrently, a systematic scoping review search was conducted alongside the infoveillance search to identify literature pertaining to navigation tools. The scoping review was not part of our study, but it was instrumental in determining if any navigation tools were overlooked in the infoveillance search.

Inclusion criteria were specific mental health navigation tools, or general health navigation tools that contain mental health and related services such as those for people experiencing homelessness, financial crisis, substance use, and gambling. Exclusion criteria were tools that do not have any form of service directory, screening, pathways, or referral information on their website, and navigation services that are staffed by care navigators who screen and connect an individual to an appropriate support service.

The research team developed a framework with relevant domains and subdomains of navigation tool features and characteristics a priori, drawing on an author’s digital mental health expertise (LSC). This predetermined set of domains and subdomains, along with the definition of navigation tools, was assessed by a multidisciplinary expert panel (n=19), which met twice via video-conferencing and provided feedback and external validation. Experts were invited to participate in the expert panel via email. Invitations were sent to networks known to the authors and also to targeted experts in mental health services planning and PHNs, clinically experienced mental health practitioners (psychologists and psychiatrists), mental health community-based organization representatives, and an advocate with lived experience.

The expert panel consisted of representatives from peak mental health bodies, government health or mental health departments, consumer and lived experience advocacy, the PHN, and GPs, psychologists, psychiatrists, and community mental health care providers. Based on the feedback from the panel, additional domains and subdomains were added to the framework. The domain of service information (waiting time and accessibility), and the subdomain of quality—information update frequency—were added to the framework. The expert panel identified a set of key components of a navigation tool relevant to evaluate its usability. These components related to technical aspects (interactivity) and a glossary of terms.

An Excel (Microsoft Corp) data extraction spreadsheet was used as the data extraction tool, with each subdomain listed as a separate column heading. The validated domains and subdomains include the following (Table 1):

Each navigation tool was independently screened against the inclusion or exclusion criteria by two authors (CEW and MAF). Three authors (CEW, MAF, and MD) made an independent evaluation of the dataset and individually extracted data regarding the subdomains, features, and links (or a representative sample if there were many) of each navigation tool. Any additional relevant features or characteristics identified during the data extraction process, such as quick exit buttons or symptom checkers, were subsequently incorporated into the data extraction form.

This study was reviewed and approved by Australian Capital Territory Health Human Research Ethics Committee (2023.ETH.00112). Participants were provided with an information sheet and signed a consent form before taking part in the expert panels. No compensation was provided to participants. Expert panel data were deidentified.

The Google search identified 197 navigation tools in the 31 Australian PHNs. After removing duplicate national navigation tools that provide customized local navigation services to individual PHNs such as Head to Health, HealthPathways, and My Community Directory, 102 unique navigation tools remained. Table 2 shows the number of tools in each jurisdiction. The states with the highest population, namely New South Wales (PHN n=10) and Victoria (PHN n=6), have the largest quantity of navigation tools.

Seven navigation tools were developed by the Australian Government, 3 were developed by a combination of Australian and state or territory governments, 21 were developed by state or territory government, 7 by local government (councils), and 1 by a New Zealand district health board. Three navigation tools were developed by a local health district while 37 were developed by one or more PHNs. Other developers include charities (n=7), not-for-profit or nongovernment organizations (n=5), community organizations (n=3), and a social enterprise (n=1). Private sector organizations developed 4 navigation tools and 2 were developed by a university.

The majority of navigation tools are free to use although some do require registration. Two navigation tools provide a paid subscription service for health services or health care professionals that includes web-based service listings, web-based appointment bookings, digital advertising, and social media marketing, depending on the chosen subscription level. The use of one New Zealand–based navigation tool is funded by PHNs, and individual health care professionals or services are provided with access information. One navigation tool developed by large public corporations is free for consumers, caregivers, and health professionals to use, but fees are charged to provide anonymous search or usage data.

Sixteen navigation tools include a glossary or similar, such as a list of terms with descriptions, explanations, or information about mental health conditions, AOD, or dementia (n=4). One navigation tool contains a list of acronyms or abbreviations but limited definitions, and one provides a glossary for rating IAR-DST domain impact. Three navigation tools provide a nonstigmatizing language guide (n=2) or a directory of language guides (n=1). Six navigation tools provide a glossary of mental health terms or conditions, and two provide a glossary of AOD with one including a drug information directory.

Australian privacy legislation mandates that websites display a privacy statement or privacy policy if they collect any information from consumers or visitors. Seventy-six percent (77/101) of navigation tools comply with this requirement by providing a privacy policy or statement on their website. Among the 24 navigation tools without such information available on the web, 10 are static navigation tools that do not collect any data, 11 provide privacy details through their developers’ websites (eg, PHNs), and the remaining three do not offer any privacy information on their websites.

To our knowledge, this is the first study of Australian digital mental health navigation tools and their characteristics. The quantity and accessibility of mental health care navigation tools, or those encompassing mental health care services, has exponentially increased in recent years, from just a handful of tools in 2020 to more than 100 available in 2024. The large majority of these tools have been built with the consumer in mind. The research team was unable to locate or access any navigation tools specifically designed for planners.

Mental health care navigation tools are constantly and rapidly evolving with technological advances improving access to information and support. Despite this progress, there are persistent gaps and challenges that could be addressed to enhance their usefulness. These include varying quality in existing mental health care navigation tools, and a lack of standardization and definitions, leading to ambiguity about the type of care provided. This uncertainty affects individuals when choosing a service provider and health care professionals when referring consumers to service providers [22,23]. Tools ostensibly designed to facilitate access in fact could perpetuate further confusion.

Previous research indicates that individuals can find it challenging to access and use appropriate navigation tools, with the process being overwhelming and confusing [10]. To reduce this confusion, a system for navigating navigation tools appears to be necessary, akin to the Transcultural Mental Health Centre Directory of Directories in New South Wales, Australia.

The lack of accuracy or of tailored support in existing navigation tools remains a major challenge in accessing timely and appropriate mental health treatment and support [10]. Of the identified navigation tools, only 6 included a self-assessment screening tool capable of recommending services based on an individual’s mental health condition and required level of care. Improving the accuracy of navigation tools and information regarding types of service provision can significantly impact the effective linkage of individuals to suitable treatment and support services.

Locating information is a significant challenge in contemporary information systems [24]. The user interface of navigation tools can act as a barrier or facilitator to accessing information. Dieberger and Frank [24] argue that navigation is difficult unless the information space is designed in an understandable manner. Currently, Australian digital mental health directories are not easily navigable. Many of the navigation tools required significant searching and digital searching skills to locate required information, or to access a map of services and locations, and would benefit from a more user-friendly and intuitive design [13]. The three-click rule is an informal guideline in web design that pertains to the navigation of a website. According to this rule, users should be able to locate any desired information on a website within 3 mouse clicks [25]. The rationale is that users tend to experience frustration and often abandon a site and are unlikely to return if they are unable to find the information they are looking for within three clicks [25-27].

Only 30% (n=31) of navigation tools provided options such as language translation, or assistance with screen reading. Equitable access to mental health care service information is crucial for individuals who have low digital or health literacy, have a disability, or are from culturally and linguistically diverse backgrounds. Therefore, the design of the navigation tool and accessibility options such as language translation, large print, and screen reader functionality are paramount in addressing their needs [28,29].

The usefulness of existing navigation tools is further hindered by the limited availability of information about waiting times to access support and treatment from mental health care services [13]. Fewer than half of the navigation tools provided this information. Previous reviews have identified extensive waiting lists as a barrier for individuals seeking mental health support [30-33]. The estimated waiting time to access a service and the availability of services for new patients are crucial pieces of information for individuals seeking support and for health professionals referring individuals to services. The absence of information about available services, wait times, and client entry requirements is a major barrier to timely access to appropriate mental health services [30].

According to De Croon et al [34], health recommender systems represent a specialized application of recommender systems, using medical data, user input, and advanced algorithms to offer customized suggestions for improving health outcomes and wellness. One notable category of health recommender systems is the treatment recommender system, which furnishes specific recommendations for medical treatments, therapies, or interventions based on an individual’s health condition and medical history. Incorporating a health recommender system in navigation tools can help to address the challenges associated with varying health or digital literacy, information overload, and uncertainty about the quality of available information by providing personalized and tailored navigation tool recommendations. By leveraging these capabilities, health recommender systems hold the potential to significantly enhance personalized health care navigation, ensuring that recommendations align with each individual’s unique health profile and needs.

A systematic web search was conducted to identify navigation tools. Although the search methods identified a large number of navigation tools, there may be other navigation tools that were missed. Only Australian navigation tools that are available and accessible on the web were included in the infoveillance study. There are potentially paper-based or private digital navigation tools that are used by health care professionals or care navigators of which the research team did not have knowledge or to which they lacked access.

As stated, there are no standardized evaluation criteria for conducting reviews and assessment of the quality and accuracy of navigation tools, or the domains for different user groups. For example, the characteristics of a useful navigation tool for planners are different from the characteristics that are important for mental health care consumers. Therefore, a quality appraisal of navigation tools was not undertaken.

The risk of bias with an expert panel lies in the potential for subjective judgments or preferences of individual panel members to influence the group’s conclusions or recommendations. This bias can occur due to factors such as personal opinions, conflicts of interest, or professional affiliations that may sway the panel’s collective decision-making process. To mitigate this risk, composition of the panel was carefully considered to include diversity in perspectives or expertise, to reduce the risk of overlooking of alternative viewpoints or relevant evidence.

Navigation tools have become seen as the solution to the complexity and fragmentation of Australia’s mental health system. Paradoxically, exponential growth in these tools risks perpetuating confusion over clarity. It is critical to address the limitations of existing tools to enhance quality and provide a level of standardization across all mental health system navigation tools. The current focus on mental health care reform in Australia is centered around the challenge of access to care for individuals with mental health concerns and strengthening services’ capacity to deliver appropriate, quality care across Australia [35]. Enhanced digital navigation tools possess a distinct capacity to influence this setting, with the aim of enhancing the accessibility of the health care system, minimizing care wastage, and promoting the well-being of individuals in need.

This study findings’ suggest a need for quality standards in digital mental health care navigation tools. These standards would enhance quality and accuracy and aim to eliminate ambiguity. Users would have increased confidence in selecting service providers. Additionally, it would aid health professionals in referring individuals to mental health care services.

The Australian Commission on Safety and Quality in Health Care and authors of the NSQDMHSs, which aim to improve the quality of digital mental health service provision, would be well placed to introduce these standards.

A potential next step includes compiling a national directory of mental health care navigation tools and their domains which will have the following benefits: