An Australian view of evidence and policy implications
Michelle Blanchard, Aram Hosie and Jane Burns
Adolescence and young adulthood are critical periods for the onset of mental health problems. Timely and appropriate help-seeking can reduce the enduring impact of many of these mental health problems; however, only 29 per cent of young people who require clinical care seek help. Of those who do receive care, many do not receive the most suitable evidence-based treatments at the most opportune time.
With 99 per cent of 15 to 16-year-olds and 76 per cent of 9 to 16-year-olds using the internet daily or almost daily, we have unprecedented opportunity to create new systems of e-mental health care – from promotion and prevention through to treatment and recovery – that bridge young people’s online and offline worlds, recognise the consumer as an expert, and embrace stepped and collaborative care. Such approaches provide a significant opportunity to mitigate young people’s aversions to seeking help as well as overcoming many other geographical, attitudinal and financial barriers.
“…we have unprecedented opportunity to create new systems of e-mental health care – from promotion and prevention through to treatment and recovery – that bridge young people’s online and offline worlds…”
Young people’s use of technologies
At a basic level, the internet can be conceived of as a broker of health information. However, as technology rapidly evolves, the internet of today is an interactive, participatory and collaborative space that encourages self expression through user-generated content and the building of online communities through social networking services.
Today’s young people are most likely to utilise the internet to connect with others and engage in activities such as social networking, messaging, playing online games and emailing. Over 95 per cent of Australian young people use the internet. A total of 3.9 million Australians aged over 14 went online via their mobiles in June 2011 alone, with recent data showing that young men access the internet on their mobiles twice as much than the average adult, and that 48 per cent of young men who own a smartphone download apps at least once a week. Around 90 per cent of young people aged 12 to 17 use social media, with 8.6 million Australians aged over 14 found to have accessed social networking sites from home in June 2011. For most Australian young people, the internet is a way of a life.
Working in partnership with young people
Young people have an important role to play in driving change and innovation in the area of youth mental health. Adopting a youth participation approach is an effective way of ensuring that organisations keep abreast of developments in the technological environment and develop a deep understanding of the ways in which young people engage with technologies. Moreover, in order to encourage and support adolescents and young adults to seek professional help early for emerging mental health problems, services must be informed and guided by the young people they serve.
Indeed, there is growing evidence that youth participation brings about benefits for the individual young person as well as the service being delivered.
Taking a participatory design approach to reforming mental health service delivery enables us to make mental health objectives meaningful and relevant to young people so that activities and interventions are more effective. It does this by providing a way for young people to participate meaningfully in the design process regardless of their prior expertise in design or mental health, and empowers them to take an active role in making decisions about their own care. A participatory design approach supports researchers and practitioners to develop empathy for, and connection to, the lives and lived experiences of young people, and then work together to identify and prioritise which issues young people think are most important.
With this understanding, service developers can create an intervention that draws on young people’s understanding of how to achieve maximum usability, impact and benefit to them in the context of young people’s lives.
The opportunities to use technologies to improve youth mental health
Consistent with the World Health Organization (WHO) and the Victorian Health Promotion Foundation’s (VicHealth) health promotion framework, we must engage with young people in environments where they interact – ie the internet and new media – and use the tools and networks with which they engage, including mobile phones, social networking sites, games and virtual worlds. Good evidence exists that technologies can be used effectively in improving mental health and well-being, especially among young people.
“…technologies can be used effectively in improving mental health and well-being, especially among young people.”
The internet can be seen as both a tool and a setting for action in improving the mental health and well-being of young people. The internet can be used as tool by young people to find information or access services, while also acting as a social setting within which young people establish and maintain relationships. The internet has been described as accessible, anonymous, engaging and informative, and as providing a space in which young people can feel empowered and confident to talk about sensitive issues such as depression; sexuality or sexually transmitted diseases and physical activity and nutrition.
“As the technical capacity of the internet grows with new services and Australia’s National Broadband platform, it becomes better able to offer a practical medium for health behaviour interventions.”
As the technical capacity of the internet grows with new services and Australia’s National Broadband platform, it becomes better able to offer a practical medium for health behaviour interventions. For example, social marketing campaigns can now be disseminated to a large population online via social networking services, at a fraction of the cost. There are a number of significant benefits associated with the use of social networking services, including: delivering educational outcomes; facilitating supportive relationships; identity formation; and promoting a sense of belonging and self-esteem. Furthermore, the strong sense of community and belonging fostered by social networking services has the potential to promote resilience, which helps young people to successfully adapt to change and stressful events.
Technologies in early intervention, treatment and recovery
Australia has been at the forefront of international innovations in its use of e-health platforms to promote better mental health and deliver enhanced mental health care. Given workforce shortages in mental health, the geographical and cost barriers to effective service provision, and the reluctance of key groups (such as young people and men) to use formal clinical services, e-health innovations will be central to real reforms.
Research indicates that information about depression and interventions that used cognitive behaviour therapy and were delivered via the internet were more effective than a credible control intervention in reducing symptoms of depression in a community sample. The result of the study revealed both cognitive behavioural therapy and psychoeducation delivered via the internet are effective in reducing symptoms of depression.
Online interventions for a range of mental disorders and problematic health behaviours (for example, depression, anxiety, smoking, weight) have demonstrated efficacy, and the number of programs available is growing rapidly. For those experiencing mental ill health, the strategic use of technologies can help to overcome barriers to help-seeking, such as physical access, confidentiality and stigma.
Engaging and supporting the youth health workforce
There is growing optimism in the Australian youth mental health sector regarding the opportunities to utilise technologies as an integral part of a mental health system. Recent Australian research found that a majority of youth health workers surveyed believed that using technologies would allow them to have a greater impact on young people’s mental health.They believed that technologies play a considerable role in the lives of most young people and that these technologies have the potential to influence mental health and well-being, both positively and negatively. However, participants in the study also felt that these technologies are poorly understood and underutilised in mental health promotion, as well as in the prevention, early intervention and treatment of mental ill health. The youth health workforce could use technologies more effectively if barriers to their use were overcome. Such barriers include poor infrastructure, lack of guidelines or policies to support safe and constructive use of technologies. and lack of awareness about which technology-based strategies or approaches are most effective and in which contexts.
“…a majority of youth health workers surveyed believed that using technologies would allow them to have a greater impact on young people’s mental health.”
Further investment needs to be made in securing appropriate technological infrastructure in youth mental health services and in training staff members to develop an adequate understanding of young people’s technology use and the range of strategies that can be applied to improve and promote young people’s well-being. Innovation in the online space is occurring rapidly and it is important that the youth health workforce is equipped to respond appropriately.
All indications are that technology is close to making it possible to deliver what are in fact ‘face-to-face services’ to people geographically distant from the service provider. Such services, however, will never be exactly the same as physical presence, and thus the challenge for service providers and policy-makers is to determine how best to gain value from technological developments.
However, as technology use evolves, the divide between the connectivity-rich and the connectivity-disadvantaged grows – both between and within nations. Such a divide cannot be ignored, especially as it is the poor, the already disadvantaged, and the Commonwealth Health residents of rural and regional areas who are most likely to experience the digital divide.
With so much work under way already within the community and corporate sectors, the challenge is to integrate those developments found to be effective into a new system of service delivery – one that blends the best of 20th-century models of care with innovative new technology-based approaches to deliver a high standard of mental health care and support to all, regardless of where they may live.
This is an edited excerpt of the whitepaper Embracing technologies to improve well-being for young people, published by the Young and Well Cooperative Research Centre. You can download the full version here.