A Qualitative Study of Youth Mental Health Service Users’ Views on the Delivery of Psychological Interventions via Virtual Worlds

With origins in video gaming, 3D virtual worlds (VWs) are digital environments where people engage and interact synchronously using digital characters called avatars. VWs may have future potential for delivering youth mental health (YMH) services. Despite progress in developing VW-based YMH interventions, limited consultation with young people may be contributing to mixed uptake and engagement. This study aimed to understand how young people with experiences accessing YMH services view the potential (i.e., hypothetical) use of VWs for YMH service delivery to understand qualitative factors influencing uptake. Eleven 18–25-year-old consumers (M = 22.91 years; five women, five men, and one non-binary person) took part in one-on-one, semi-structured interviews via videoconferencing. Interviews explored anticipated ease of use, helpfulness, and perceived intention to use VW-based YMH interventions if they were made available. Interviews were analysed using reflexive thematic analysis. Four themes were produced: (1) VWs as unique therapeutic spaces; (2) creative engagement for therapy; (3) VW communication promoting both connection and distance; (4) flexible access. All participants expressed a level of openness towards the potential use of VWs for YMH interventions. Features such as creative world-building and avatar customisation, increased anonymity, and remote accessibility were seen as ways to improve access to convenient, personalised, and engaging mental healthcare. Concerns included technology misuse, privacy risks, and reduced physical and emotional presence. Future research and service development should test real-world outcomes to ensure clinical benefit and employ codesign approaches that leverage servicer-users’ expectations to ensure accessible and acceptable delivery.