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The role of technology in Australian mental health

22 million Australians

If every psychiatrist and every psychologist in Australia worked full time for 52 weeks of the year, without any holiday or sick leave, they could generate 8.3 million hours of patient contact.

Just two hours per affected person.

There is a huge disparity here. Who are the 1.7 million individuals who are affected by mental illness and not receiving subsidised help? And of those who do get in, is the few hours of contact they get enough? Is there another way of connecting with people that alleviates the public healthcare burden without compromising patient care?

The 1.7 Million young people

Whilst young people (<34yo) account for a large proportion of the burden of mental illness, they are underrepresented in the data of GP visits and are poor at accessing mental health services. When they do present, it is mostly with anxiety, depression and substance use.

The barriers for these vulnerable people seem to be vast and varied. They may not identify as needing mental health support, struggle to recognise the symptoms, or have no idea where to actually ask for help. And when they do reach out, the lack of service availability is a significant deterrent to future help-seeking behaviours. Aside from all this, mental illness remains hugely stigmatised socially, despite the great work of advocacy groups such as MindFrame: with movies like M Night Shyamalan’s “Split” still making their way onto our screens it’s no wonder people shy away from addressing their issues.

It is perhaps unsurprising that young people are more likely to seek help online.

A quick Google search is conveniently sitting in your pocket. It’s free, it’s available when you want it to be, and it is completely confidential.

 

A quick Google search is conveniently sitting in your pocket. It’s free, it’s available when you want it to be, and it is completely confidential.

Dr Jennifer Hazel

The anticipatory anxiety is removed, along with the pressure of telling your most intimate secrets to a complete stranger sitting right in front of you and all of the judgement that entails. A veil of anonymity allows users to connect with others who may share their experiences, without fear of being stigmatised or personally singled out.  

Ultimately about half of young people turn to the internet for help. Services they find online are well received by this demographic. 94% are satisfied with the information they get. Increasingly we are becoming aware of the vital role the internet has in mental health promotion, in providing education, resources and advice - even treatment.

Men

When it comes to mental health, the men in our society are hugely vulnerable. They have higher rates of suicide and substance use, but are significantly less likely to seek help. The social construct of “masculinity” discourages men not only from reaching out for support, but often prevents them from even recognising problems in the first place. They are taught from day dot that whilst girls are allowed to experience and express their emotions without ridicule, they must “man up”.

Even when concentrating on improving male mental health knowledge, service uptake has not improved, leading us to wonder how we can engage the crisis of the stoic and silent. A promising approach is the development of programs tailormade for men. BeyondBlue’s “Man Therapy”, MensLine and The Shed are examples of such initiatives: designed in aesthetics, attitude and language to appeal to men, normalising their experiences and allowing them to ask for the help they need without threat to their masculinity.

The use of technology in reaching these vulnerable guys is so important. Men who are feeling stressed out or distressed use their phones more often than those who aren’t - this is a critical access point we must use.

Rural and marginalised communities

Despite the best efforts of our public healthcare services, there are always going to be practical and cultural hurdles between the best care and the most separate communities. The more remote you get, the fewer mental health professionals exist. People must travel further to see them. Less appointments are available. Attitudes toward mental healthcare change, and must be adapted to. Stigma increases and privacy becomes more difficult.

Technology bridges a gap here that no government could ever fill with traditional services. Technology has been shown to allow people - particularly young people - from marginalised groups to engage with each other, with services, and to participate in a social role they otherwise had no access to. They feel safe and supported in this new community, and for the first time, they are accessible. The use of these techniques reduces costs too - meaning we can invest more in improving services.

The efficacy of online mental health services

None of this matters if internet based mental health services don’t work. Fortunately we are starting to see evidence of just how valuable they are.

In addition to providing information in an accessible format that users are familiar with, online mental health sites can be a source of social support and even an evidence-based treatment.

One such intervention is e-CBT (electronic cognitive behavioural therapy). This involves either a digital therapist or self-driven course of treatment. GPs can now even refer patients for a course of online therapy - an instant option for many, an adjunct for others whilst they wait for a psychologist to become available. Studies have shown that this can be effective for depression and anxiety. Other computer-assisted treatments, such as apps and gamified CBT have had similar success, particularly examples such as MoodGYM, Beating the Blues and Colour Your Life.

This approach has been very well received by the community - particularly the vulnerable youth. It is a medium they find familiar and they are comfortable with, whilst ensuring confidentiality and privacy. In fact, initial findings even show that these programs can help people to attend appointments with their psychologists.

Where to now?

Now that we know technological mental health care works, that people want it, and that it suits the public healthcare model financially, there is one final barrier - getting people involved. With education we can get the most out of the services available, and the future holds exciting prospects for further program development and outcomes measures of what already exists. Perhaps with time we can bridge the gap for the 1.7 million, and improve care for the 2.3 million others who need it.

 

Dr Jennifer Hazel is a psychiatry registrar and founder of the non profit organisation CheckPoint which connects mental health resources with video games and technology. You can find out more at checkpoint.org.au.

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