Online help for real-life issues
Author: Amanda Lyons
e-Mental health can be an extremely effective tool for GPs when consulting with young people in distress.
Adolescence is an exciting time, when we stretch our wings and begin to learn who we are as individuals. It can also be a time of pain, loneliness and confusion for many.
Beck,* a 15-year-old girl living in a small town in rural Australia, contacted eheadspace, an online mental health service for young people.
She disclosed in her online intake questionnaire that she identifies as a lesbian and during her assessment, which takes place in an online chat with a psychologist, she described her family and school environment as homophobic.
Beck feels alone and hopeless, but does not want to discuss her sexual identity face to face with anyone, including her local health service. She is afraid of how people will react – and of who could find out.
Beck’s story captures a typical presentation to eheadspace, the online service offered by headspace, the National Youth Mental Health Foundation that provides early intervention mental health services to people aged 12–25 across Australia.
Since its launch as a pilot in 2010, there has been a strong demand for what eheadspace offers, with it reporting more than 4.5 million messages exchanged and 215,637 chat sessions conducted among 80,550 young people.
Given the internet is the first place to turn for many in this age group when seeking entertainment, information, resources and social connection, it makes sense that it is also where young people often turn for help when faced with an issue of mental health.
Dr Claudio Villella, GP advisor for headspace, acknowledges that the internet can contain some mental health risks for young people, such as cyber-bullying; however, he believes it can also be extremely beneficial for young people who have limited options in terms of people with whom to discuss their issues.
‘There’s a lot of support that happens online, and I think organisations that work to assist young people are aware of that and are increasingly engaging young people in the social media space,’ he told Good Practice.
‘It’s certainly a platform that headspace engages very directly, supporting and connecting with young people.’
Overcoming real world barriers
Young people (in a surprise to no one) love to spend time online, not least for the relative anonymity and safety this world offers.
‘Young people like technology, they use it in their daily lives,’ Dr Bridianne O’Dea, Research Fellow at the Black Dog Institute, told Good Practice. ‘They associate a certain level of privacy and relationship with technology that perhaps older adults don’t.’
Dr O’Dea has spent her research career investigating the question of how to harness the appeal of the internet to help young people experiencing mental health issues.
This work has seen her identify a range of barriers that young people often face in accessing appropriate mental health care.
‘Things like accessibility, not living close to a mental health service, not having the financial resources to access mental health services, or a lack of clinical expertise in child and adolescent mental health in their area,’ she said.
‘They also face other barriers such as stigma, a fear of being judged, feeling ashamed or embarrassed about what they’re experiencing. In addition, young people have a strong preference for seeking informal help, so support from family and friends rather than professionals.
‘Lastly, young people have a really strong desire to solve problems on their own, so they want to retain as much autonomy over their care as possible as they are developing their adult independence and decision-making.’
Beck’s experience as a young person living in a rural community mirrors many of these barriers and, in this context, it is clear that online mental health services can offer a way to transcend a number of obstacles.
‘Many eHealth programs are available at no cost,’ Dr O’Dea said. ‘Also, they can be accessed in private and at any time of the day, so they offer an element of convenience that doesn’t occur in face-to-face healthcare.
‘Because of the nature of eHealth programs, they’re self-directed; they do try to encourage shared autonomy and involvement in care.’
These factors offer a very strong argument for using e-mental health programs for young people, especially as this age group can often be hard to engage in a face-to-face manner.
Anecdotal evidence suggest some practitioners may be wary of e-mental health initiatives for young people, fearing that they could replace in-person treatment and discussion. Dr Villella argues that the intrinsic value of e-mental health services lies in the fact they offer an avenue of access for people such as Beck, who would otherwise be unlikely to seek help at all.
‘You’ve got a whole group of young people who are not ready, or are not willing, to see someone to talk about their issues face-to-face, but who are really good at engaging online,’ he said.
It is also important to consider that face-to-face mental health services are not currently sufficient to meet the demand in the area of youth mental health.
‘We know that Australia doesn’t have the clinical capacity to see everybody who needs care for mental health,’ Dr O’Dea said. ‘So eHealth can play a role in tackling the workforce issues that we have around clinical care for mental health issues in youth.’
Additionally, some e-mental health interventions, such as eheadspace, employ the services of health professionals, using technology to bring their expertise to the patients rather than the other way around. Online services can also be used to funnel people into ‘real world’ care, an aspect of e-mental health for young people that Dr O’Dea is keen to emphasise.
‘I think in the future we’re going to see more integration of online care with face-to-face care, making those links much clearer for young people, and access to face-to-face care more streamlined,’ she said.
Dr O’Dea has been working with the Black Dog Institute for the past two years on a mobile web service called ‘Smooth Sailing’, which she hopes will help to bridge many of the mental health service gaps identified in her research.
‘[Smooth Sailing] combines online care with face-to-face care,’ she said. ‘It uses a digital platform to screen an adolescent’s mental health, allocate them to a step of care and then, where appropriate, link them in with the school counsellor.’
Smooth Sailing has been developed in consultation with young people, schools, including counsellors, and parents. In addition, Dr O’Dea has consulted with GPs during the development process, as she is keen to educate and encourage young people to connect with primary healthcare professionals.
‘We often find in adolescents a general fear or reluctance to seek professional help,’ she said. ‘That tends to be due to some misunderstanding of what’s involved in seeking help from a GP, and also a lack of knowledge of which GP they should go to and where it’s located.
‘So we have built a lot of information into the service about how to build and sustain a healthy relationship with your GP, because it’s beneficial not only for short-term, but also long-term physical and mental health.’
Smooth Sailing has been piloted in four high schools and will undergo modifications before being rolled out again to greater numbers. Dr O’Dea and the Black Dog Institute believe the online service will have a lot to offer GPs and hope to trial it in general practices in 2018.
‘GPs are very pressed for time and they want to be able to offer something to young people that can provide evidence-based quality care and also monitor them, because sustaining contact with a young person can sometimes be difficult,’ Dr O’Dea said.
‘So having a service that GPs can refer young people to and that’s going to link them in with their feedback and follow them up, would really assist the clinical practice of GPs.’
Black Swan Health (BSH), an independent, not-for-profit company based in Western Australia that focuses on the provision of primary and mental health services for the community, is another health service looking to innovate in the field of e-mental health.
BSH runs a range of mental health services for young people, which has given it insight into the challenges many of them face, including balancing mental health problems with the demands of work.
Gordon Shymko, Consultant Psychiatrist and Clinical Director at BSH, believes this is a vital time to intervene for young people experiencing mental health issues.
‘The importance of establishing and maintaining employment is significant for people with mental health issues,’ he told Good Practice. ‘If they can establish and maintain employment, their likelihood of having a good recovery from mental illness increases significantly.
‘It’s a massive issue and something that’s very important to get right for young people with mental health illness.’
BSH has been developing its own app, YAppEE – Youth App Empowering Employment – with a view to helping young people balance work and mental health.
YAppEE is designed to monitor the mood of the user during their employment. When a user signs up and downloads the app, they commit to ‘checking in’ with it regularly for a six-month period. This is done by opening the app each working day and selecting from a number of options to indicate their mood.
The app responds in various ways, from supportive text messages and links to helpful articles, right through to a phone call from a team of mental health professionals based in a call centre.
BSH has also made sure to consult with young people, gathering feedback from youth reference groups across the country. This helped to ensure a more user-friendly, youth-oriented product.
‘I think it’s highly accessible and technologically relevant for this particular target group, which is important if people are going to find it useful in their day-to-day life,’ Terina Grace, Chief Executive Officer of BSH, told Good Practice. ‘It’s cost-effective as well, and it enables quite good access and reach.
‘A lot of the app is based on the young person being enabled to self-manage and making them feel that they’re in control. It’s non-intrusive, but easy for users to maintain a regular contact.
‘Users can easily and quickly report, “I’m doing okay”, or “Actually, I need help – please call”. And then the call centre kicks in very responsively with our clinical psychologists, social workers and psychiatrists to provide counselling to the extent needed.’
* Not her real name.
After three online sessions, Beck accessed a support group in a neighbouring larger town, reporting a positive experience. She decided to attend a youth service in the larger town that had been recommended by the support group, and this service offered psychological therapies. Beck found face-to-face support very helpful and began to feel more hopeful about her future, ultimately deciding she no longer needed to access e-mental health services.