The worsening mental health of the general population has left European countries struggling to meet the demand for mental health services and treatment (European Parliamentary Research Service, 2023) partly due to a lack of trained professionals and provider services (WHO, 2023). As health reforms take place across Europe, a common emergent theme has been promoting the use of digital technologies to help ease the demand/supply issue (e.g. WHO, 2024).

Research into digital mental health care is a growing but still developing area. The inevitable increase in the use of digital technologies in mental health care means more needs to be known about the use of digital components in real-life therapeutic practice. As digital therapy continues to be a new and innovative area, there is an understandable need to investigate the clinical safety of such technologies (Taher, et al., 2023, 2024), especially as regulation is still an emerging area (e.g. Hopkin, et al., 2024). Traditional safety research, often termed Safety I (focusing on what goes wrong), is insufficient for understanding complex systems like digital mental health care.

This presentation introduces the Safety II framework, which focuses on work-as-done -  what work looks like in everyday practice - to the digital mental healthcare field, an application currently lacking in published literature. The central aim is to explore how mental health clinicians use digital therapy components to develop and enhance the crucial therapeutic relationship, moving beyond written protocols ('work-as-imagined'). The study uses qualitative thematic analysis of semi-structured interviews with psychologists who regularly use components like video calls, automated outcome measures and iCBT programs in their practice.

The lecture will share the results of this research, offering insights into:

• Real-world clinical adaptations: The flexible ways clinicians use digital tools to suit individual patient needs.

• Best-practice workarounds: The informal but successful strategies clinicians deploy to overcome the limitations of technology or protocols in developing a therapeutic alliance.

• Safety implications: How recognising 'work-as-done' can help bridge the gap between policy/guidance and actual clinical practice, ultimately enhancing patient safety in digital settings.

The findings are highly topical and essential for anyone involved in developing, regulating, or providing digital mental health services, ensuring that technology implementation remains patient-centered and clinically safe.

At time of writing this proposal, the researchers are in the data collection stage. Results will be ready for presentation at Vitalis.