Technology Matters: From innovation to implementation - Nationwide self-referral for digital mental healthcare is possible.
Digital mental health interventions for children are developing rapidly, yet a persistent gap remains between demonstrating that they work and making them available to families in routine care. This article describes Iceland's national rollout of the Online Support and Intervention for Child Anxiety (OSI) programme, a government-funded digital mental health intervention for parents of children aged 5-12 with common anxiety difficulties, adapted for Icelandic primary care. Its broader importance, we argue, rests not only on the intervention content but also on the service model through which it was delivered. We describe three features: a deliberately simple self-referral pathway that retains clinical oversight, delivery embedded within existing primary care services and national rollout achieved through collaboration across seven health institutions. We argue that scaling digital mental healthcare demands substantial organisational, technical and governance infrastructure and is rarely simpler than face-to-face provision. While Iceland's context may not be directly replicable in other countries, the implementation principles it illustrates may be informative for clinicians, service leaders and policymakers internationally. Improving access depends on implementation as much as innovation.