Over two days of discussions at San José State University’s Health TechQuity conference, a clear theme appeared: although decades of advancement in digital health have occurred, access to behavioral health care remains limited. Scaling these solutions at the population level remains difficult, including digital therapeutics, self-guided interventions, and AI-enabled approaches.
However, these advancements have not transformed into consistent real-world access. For most individuals, access to digital behavioral health services depends on system capacity, provider availability, and geography. Low-barrier interventions usually face the biggest barriers, whereas services are fragmented; populations that might benefit most from scalable and long waitlists remain the major problem. This highlights a shift from innovation challenges to implementation and access challenges.
At its core, the result is the gap between proven effectiveness and real-world delivery. Regardless of expectations, not all digital health interventions make it to research or pilot phases and maintain or achieve impact on target populations, which is more indicative of more structural and system-wide barriers than adoption barriers.
To analyze this gap, it’s important to understand three interconnected layers that include infrastructure, evidence, and innovation. The field has made substantial progress in innovation with an extensive array of tools available and in evidence with growing validation through research. However, the infrastructure that systems require to provide these tools at scale remains underdeveloped; the most effective interventions cannot have a significant impact on the population without strong infrastructure.
Digital behavioral health interventions are complex, with outcomes shaped by design, engagement, and personalization as important as clinical effectiveness that makes them harder to evaluate and scale. Even so, without systems for broad and sustained delivery, innovation itself is not sufficient to improve access. Misalignment of the structure of technology, healthcare, and funding creates significant challenges, with each sector having different priorities that comprise regulation, innovation, and short-term returns.
The result of such misalignment is fragmented work efforts in which definite efforts generate evidence yet are not adopted; others work on engagement but with lack of validation, and others develop infrastructure but fail to integrate effective interventions. Structural misalignment across key sectors hinders progress. Digital behavioral health spans funding, healthcare, and technology, each with different priorities that include regulation, innovation, and short-term returns.
In conclusion, the lack of innovation or evidence can no longer confine digital behavioral health. The primary issue is the development of coordinated systems that will facilitate scale delivery. This requires coordinated alignment across healthcare systems, funding models, and technology platforms. To improve access at the population level, it is fundamental to transition to implementation, systems, and impact rather than tools and knowledge.
Reference: van Mierlo T. From innovation to infrastructure: why digital behavioral health still struggles to scale. J Med Internet Res. 2026;28:e97118. doi:10.2196/97118
