Integrating eHealth tools into mental health and substance use treatment
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This document discusses the potential for eHealth tools to improve access to and engagement with treatment for mental health and substance use disorders in Australia. It notes that currently only a small percentage of people seek treatment, often many years after the onset of their disorder. Barriers include a lack of services, stigma, and individual attitudes. eHealth shows promise as a way to overcome these barriers by increasing access through mobile and online platforms. Studies have found eHealth tools are as effective as in-person treatment and may improve outcomes for some individuals. The document highlights several Australian eHealth programs and their ability to engage hard-to-reach groups. It concludes that eHealth represents an opportunity to transform mental health services and better support the community.
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Integrating eHealth tools into mental health and substance use treatment
- 1. Integration eHealth tools into the treatment of mental health and alcohol/other drug use problems An overview of work at the CBMHR Frances Kay-Lambkin PhD National Health and Medical Research Council Senior Research Fellow
- 2. 2 The mental health of Australians NSMHWB (2007)
- 3. 3 In Australia, the proportion of adults with current mental disorders (incl. substance use disorder) using traditional services has not increased: o 38% in 1997 vs. 35% in 2007. o Physical disorders = 80%. Despite government initiatives o Estimated annual investment $3.2 billion. o Australia – BOiMHC – 10 sessions with psychologist. Treatment access is poor
- 4. 4 Treatment for alcohol disorders? 0.000.250.500.751.00 0 20 40 60 Years Since Onset Abuse Dependence Cumulative Probability of Treatment Contact 14 years 23 years • On average, Australians seek treatment 18 years after onset • Lifetime treatment rate is 34.6% • Current treatment coverage is 11% Alcohol Dependence Alcohol Abuse Chapman et al. (in submission) Andrews et al. (2004) British Journal of Psychiatry 184: 526-533
- 5. 5 Why don’t people seek treatment? Individual determinants Structural determinants •Mental health literacy •Support systems •Attitudes to services •Referral pathways •Attitudes to conditions •Payment systems •Perceived stigma •Geographical isolation •Time commitments •Lack of relevant services •Reliance on self (Barker, et al., 2005; Rickwood, et al., 2007)
- 6. Australian Institute of Health and Welfare (2008) “Increased health care service demands, costs and complexities are already testing the limits of the financial, physical and human resources of the Australian Health System...These challenges will not be solved by doing more of the same, particularly given the limits of available human and financial resources...”
- 7. 7 How do we overcome these barriers?
- 8. 8 E-health = rapidly expanding field of health information and communication technology. Widespread recognition within health sector that better use of e-health initiatives should play a critical role in improving the healthcare system. Increasing acceptance for individuals to take a more active role in protecting their health and participating in their own health care. The potential of e-health to respond...
- 9. 9 Access to technology 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Gen Pop Mild Dep Mod-Sev Dep Risky Drink Harmful Drink Psychosis PTSD + AOD Mobile Mobile with Internet Internet
- 10. 10 Does eHealth deliver for mental health and alochol/other drug use problems?
- 11. Self-Help for Alcohol/other drugs and DEpression 10 modules of CBT/MI and mindfulness o Behavioural activation o Managing thoughts o Problem solving o Drink/drug refusal o Coping with cravings o Relapse prevention SHADE (www.shadetreatment.com)
- 12. 12
- 13. 13
- 14. Serious game for depression and alcohol misuse o See links between mood and drinking Pilot testing underway o Engagement of young people o Effective in translating key CBT messages to real life SHADoW
- 15. 15 Funded by the Commonwealth Department of Health and Ageing (AUSTRALIA) Adapt face-to-face ATS interventions Randomised controlled trial Breaking the Ice…
- 16. 16
- 17. 17 Will populations with addictive disorders, who are typically low-treatment seeking access eHealth to support their concerns? o ?pride, ?fear of stigma, ?manage on their own Will eHealth overcome attitudinal barriers?
- 18. 18 What do the end users think? • One client who presented with ongoing depression and alcohol dependence has logged on 663 times in 28 days (23 times a day). • Even clients who don’t post very often are logging in and “lurking” • “I just wanted to thank you having been around. I know your research project is coming to an end for me, and I haven't been specially active on this platform (if at all!) - but I went through some very dark times last year and it's been good knowing you were around, receiving sporadic emails from iTreAD and knowing I could reach out to you if needed.”
- 19. 19 Consider using the Internet… Gen Pop Mild Dep Mod-Sev Dep Risky Drink Harmful Drink Psychosis PTSD + AOD M Health Treatment 17% 28% 39% 21% 45% 33% 55% AOD Treatment 7% 10% 7% 11% 36% 20% 62% Gen Pop=General Population (N=894) – no MH/AOD Mild Dep=PHQ-9 score 5-9 (N=188 Mod-Sev Dep=PHQ-9 score ≥ 10 (N=67 Risky Drink=AUDIT score 8-15 (N=135) Harmful Drink=AUDIT score ≥ 16 (N=22) Psychosis=Current diagnosis (N=115) PTSD+AOD=Current AOD treatment (N=29)
- 20. 20 SHADE study ◉ No differences in therapeutic alliance or treatment satisfaction for therapist-delivered versus SHADE treatment. ◉ No relationship between treatment preference and retention, alliance or perceptions. ◉ If no preference, significantly greater benefit for alcohol use from SHADE. ◉ If high on perfectionism, better outcomes for depression and alcohol use from SHADE. Kay-Lambkin et al. (2012), J Dual Diagnosis 8(4):262-276
- 21. Kavanagh, D (2014) Six reasons to integrate e-health into psychological practice. InPscyh. June, 2014 “There is a quiet revolution going on. E-health is rapidly changing psychology practice, just as it is affecting every other area of our lives. It is a revolution that is here to stay. It presents challenges for psychological training and practice, but we need not be afraid. If we fully embrace e-health’s opportunities, we can offer the community a level of service and everyday support that has never before been possible”
- 22. 22 Acknowledgements Collaborators Amanda Baker Maree Teesson David Kavanagh Brian Kelly Terry Lewin Vaughan Carr Global eHealth Research & Innovation Cluster, UoN f.kaylambkin@unsw.edu.au @FranKayLamb Funding AERF NHMRC HMRI DoHA
Editor's Notes
- 16 millions Australians aged 18-85, almost half had a lifetime mental disorder – 1 in 5 in the past 12 months 14% had a 12-month anxiety disorder 6% had a 12-month depression 5% had a 12-month substance use disorder
- The length of delay in Australia (18yrs) is long It is similar to estimates from NZ (17yrs) but longer than those from the UK and USA Those with longer treatment delays were less likely to ever seek treatment from traditional services.
- The reasons for this discrepancy between need for and receipt of treatment are complex. And its probably easiest to split into individual components such as recognition of problems, attitudes toward the problem and services, and perceived stigma associated with treatment and time commitments; and structural determinants include things such as family and community support systems, referral pathways, financial cost of treatment, geographical barriers and a lack of relevant services.
- For all of the advantages of the Australian Healthcare system, like systems in other developed countries, our health system is under increasing pressure due to a shortage of trained healthcare professionals, suboptimal distribution of services and the increasing demand for care. Limits of financial, structural and human resources, whilst experiencing an Increasing demand for services Real risk that by 2020, the majority of those in need will not receive appropriate care, and that this will be disproportionately borne by people with addictions and other mental disorders This leads to high levels of frustration amongst healthcare providers and clients - particularly disadvantaged groups, including homeless, incarcerated, low SES, who are over-represented in populations reporting addictions.
- Australia was one of the first nations to recognise the potential and benefits of e-health, leading to a number of initiatives in the 1990s aimed at better integrating technology into practice. E-health approaches have been recommended in the newly released Guidelines on the management of co-occurring alcohol and other drug and mental health conditions (led by Kath Mills) and on the NSW Health Professional Practice Guidelines for Psychosocial Interventions in Drug and Alcohol Services.
- So they found that in terms of access to technology there didn’t appear to be a digital divide between the general population and people with a range or mental health and substance use issues. Consider that, on average,87% of Aust population report Internet usage … Gen Pop=General Population (N=894) – no MH/AOD Mild Dep=PHQ-9 score 5-9 (N=188) Mod-Sev Dep=PHQ-9 score ≥ 10 (N=67) Risky Drink=AUDIT score 8-15 (N=135) Harmful Drink=AUDIT score ≥ 16 (N=22) Psychosis=Current diagnosis (N=115) PTSD+AOD=Current AOD treatment (N=29)
- Across two RCTs among people with severe depression and concurrent alcohol or cannabis dependence, Evidence that SHADE, with brief assistance from a clinician, is associated with significant improvements in depression, and significant reductions in alcohol use and cannabis use that are equivalent in magnitude to that associated with a face-to-face psychologist-delivered treatment.
- The DEAL Project was associated with significant reductions in both: Depression symptoms Alcohol use frequency and quantity Despite this though at post treatment the program was associated with a significant drop in phq-9 depression scores from 16 (classed as Moderately severe depression) to 10 (just outside the mild depression cut off). This was also significantly different to control. The program was associated with a rather steep drop in the number of standard drinks consumed in the past week. No change was seen in the control group. compared to the control, the intervention group reported a three-fold greater reduction in standard drinks per week over time. At post treatment, the intervention group reported drinking half as many standard drinks as controls and 66.8% fewer standard drinks compared to baseline Again a significant drop in drinking days per week from approximately 3 to 1.5. While the control group showed no change Compared to the control, at post treatment, the intervention group reported an 88% greater reduction in drinking days. The intervention group reported drinking on 39.5% fewer days than controls and half as many drinking days compared to baseline
- New Social Networking site – partnered with Cobalt to access and develop this site…and we have gone onto win just under $1 million in NHMRC (Australian) funding to run the first randomised trial of social networking for binge drinking and depression in young people.
- Adapt existing face-to-face psychological approaches (CBT and MI) for delivery via the internet to reduce the use of ATS and associated problems, plus improve motivation to reduce ATS.
- Addresses smoking, diet and exercise- Therapist support via email, phone-based assessment/monitoring 100s of wellbeing programs now available - online, phone-based support…not all have been evaluated for efficacy, and even fewer have been evaluated for people with mental illnesses. So, we came up with our own program, based on our successful face-to-face and telephone-based lifestyle interventions in people with mental illness to address this gap.
- More severe, more open