In our previous article, we looked at the stepped care model and e-mental health. In this, we understood that many young people, recognising the need for help, are turning to technology – smartphone apps, websites, and social media to manage their own mental well-being.
With such an evident skills shortage, it isn’t a huge leap to see how digital technology could offer a more structured clinical therapy, training, and provision for professionals in the early stages.
So, how can these budgets be more effectively utilised to solve this increasing problem and, with the increasing funding making little to no difference, how can we think differently around the problem? How can we work towards a place where the majority of families with children with treatable conditions receive the support they need?
Using digital technologies to support stepped care in youth mental health.
Until now we have looked at stepped care and e-mental health as separate topics. And while it doesn’t take a huge leap to understand how the two can work together, it is important to understand how and where they can intersect. Where can e-mental health solutions be used effectively in a stepped care environment? Where should it not be used. And what are the considerations for young people with mental health disorders?
According to the Royal Australian College of General Practitioners (RACGP)’s e-mental health guide:
“While evidence has yet to identify ideal candidates for e-mental health, it is likely that these interventions are an appropriate option for people who have an increased risk of developing mental illness, or who are already experiencing mild to moderate symptoms of mental illness. There is less evidence for the use of e-mental health interventions with people who have complex or severe mental illness, co-morbid personality disorders, substance dependence, or people who have an elevated risk of self-harm or suicide and require urgent clinical management.”
Based on the RACGP guide, this would mean e-mental health is suitable for treatment between steps 2 and 4 in the Australian stepped care model.
- Step 1: Well population
- Step 2: At risk groups
- Step 3: Mild mental illness
- Step 4: Moderate mental illness
- Step 5: Severe mental illness
The Black Dog Institute seem to share a similar view:
“e-Mental health treatments are an appropriate treatment option for many patients with mild to moderate conditions and in some cases may be the only treatment that a patient requires.”
In the UK, the National Institute for Health and Care Excellence (NICE) recommends Digital CBT (cognitive behavioural therapy) as a first-line treatment for 5-18-year-olds with mild depression, provided they do not have active suicidal thoughts. In contrast to Australian recommendations, NICE does not recommend digital CBT for moderate depression.
So in what capacity are e-Mental health solutions currently being used?
Some e-mental health solutions can simply be handy screeners for mental health issues. Rather than offering specific treatment, e-mental health can be used as a means to identify symptoms of common mental health disorders. Identification solutions exist for both clinicians and those seeking guidance and care.
Several solutions exist that not only enable young people to identify mental health symptoms, but also to administer their own self-care. As mentioned in part one of this series, there are over 10,000 mental health apps in existence, and Apple’s Best of 2018 report contained ‘self-care’ as the major trend of 2018.
In a clinician-assisted situation, a young person will use an e-mental health solution combined with more traditional (e.g. face-to-face) treatments. Most appropriate at the mild-moderate stages of the stepped care spectrum, a GP might assist patients by checking in with them on a regular basis to ensure they are sticking to the program, setting aside time for progress reviews, and sending SMS reminders where appropriate.
In certain situations, with the patient’s permission, clinicians are able to monitor patients’ progress within an e-mental health solution. New to this Australian e-mental health marketplace is the Innowell platform. Working as an extension to clinician-assisted care, this type of service offers live interactions and monitoring of results means clinicians can check-in on progress without the need to interrupt the patient.
What about the ‘Well population’?
Although RACGP and Black Dog Institute don’t specifically mention the ‘Well population’ in the links provided above, e-mental health solutions have a place at this step too. ‘Prevention is better than cure’ (so the saying goes) so it seems logical that digital technology can be used to help young people to maintain a healthy mental state.
E-mental health solutions are helping the ‘Well population’ in two ways:
1. Increasing access to information. Increased access leads to people being more informed and better educated, breaking down some of the stigma associated with mental health and helping people to understand how to handle a mental health issue, should the need arise.
2. Making ‘mindfulness’ more popular. Young people are becoming increasingly aware that a healthy mind is just as important as a healthy body, and mindfulness activities are not just about the treatment of mental health problems, but also a way to maintain a healthy mind.
E-mental health is still in its infancy in Australia and the UK. Today, most digital support tools are designed to assist people with mild to moderate symptoms, providing an early form of ‘triage’ by introducing people to helpful concepts like mindfulness and breathing techniques.
While this kind of low-burden intervention is valuable in early implementations of a stepped care model, there are even more exciting developments starting to pick up the pace.
Next week we will look at how the future offers huge opportunities to advance and engage with patients and practitioners. It’s not difficult to see how further technological advancements can develop to provide real opportunities to develop the quality and accessibility to care in the future.
Where to find more information.
Youth mental health apps.
The following links contain comprehensive lists of apps that are suitable alternatives to (or complementary to) face-to-face mental health counselling:
Youth mental health support services in Australia.
Youth mental health support services in the UK.
Is there a youth mental health support service that you think should be added to one of these lists? Let us know at firstname.lastname@example.org.