van Mierlo T. From Innovation to Infrastructure: Why Digital Behavioral Health Still Struggles to Scale. J Med Internet Res. 2026;28:e97118
This summary reflects discussions held over two days at San José State University’s Health TechQuity conference. Participants examined why access to behavioral health care remains limited despite decades of progress in digital health technologies. The conversations focused on the gap between developing effective digital tools and making them widely available to the people who need them. One central theme was that digital behavioral health interventions are more than simple ways to deliver treatment. Their success depends on factors such as how people interact with them, how easy they are to use, and how well they are tailored to individual needs. These features can influence outcomes independently of the intervention itself, making it more challenging to evaluate and compare different approaches. Key takeaways also highlighted the importance of building systems that can deliver proven digital interventions at a population level. Without this infrastructure, effective tools remain available only to limited groups, such as people connected to research institutions or well-resourced health systems. Participants suggested that validated, self-guided digital interventions could help address long waitlists by providing support while people wait for care or by reaching individuals who might not otherwise access the healthcare system. Overall, the resounding sentiment from the conference is that digital behavioral health interventions are no longer primarily limited by a lack of innovation or evidence that they can work. Instead, the main challenge is creating the technology, health care, and funding systems needed to deliver these interventions at scale. Participants emphasized that broader collaboration, improved integration across systems, and new approaches to implementation will be essential to ensure that effective digital behavioral health tools can improve access to care for larger and more diverse populations.