Technology transforming prevention and early intervention in mental health
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In 2014–15, more around 1.31 million Australians visited ReachOut.com. ReachOut is designed to act as a gateway to professional mental health support, by breaking down barriers to help-seeking and providing pathways to clinical or crisis support where required. After using ReachOut.com young people indicate they are more likely to seek professional help. This presentation gives an overview of the impact of ReachOut.com, and its interface with downstream clinical mental health services. Presented by Kerrie Buhagiar (Director of Service Delivery) at the National Suicide Prevention Conference 2015.
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Technology transforming prevention and early intervention in mental health
- 1. ReachOut Australia: Technology transforming prevention and early intervention in mental health Kerrie Buhagiar, Director – Service Delivery June 2015
- 4. 1998 2008 2014 World’s first online youth mental health service 3083 visitors per month First online game for mental health ReachOut embraces social media 113,435 visitors per month Established in Australia, Ireland and US Mobile-led strategy Suite of tools and apps Award-winning social media approach 154,166 visitors per month USING TECHNOLOGY TO REACH MORE PEOPLE
- 5. Innovation in Mental Health 1998 2005 2006 2007 2010-12 2017 2014 2015
- 6. Service Quality and Risk Management • Rigorous evaluation and research partnerships • Evidence reviews and content partnerships • Clinical Advisory Group • Duty of care – Staff moderation – Community and self-moderation – Technical
- 7. Results: Mental Health Status K10 Score ReachOut 2013 2007 NMHWB 16- 24 year olds Low (< 16) 7% 91% (low to moderate) Moderate (16-21) 16% High (22-29) 21% 9% (high to very high) Very high (>=30) 56% Most ReachOut users are currently experiencing high or very high levels of distress
- 8. Most RO users are currently experiencing symptoms of depression, anxiety and/or stress 19% 23% 23% 7% 11% 13% 18% 13% 20% 15% 12% 25% 41% 41% 18% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Depression Anxiety Stress DASS-21 Scores (%) Normal Mild Moderate Severe Extremely severe 89% met the cut-off for mild or above symptoms for at least one MHD (11% had no symptoms)
- 9. Young people report improved self-rated mental health after using ReachOut.com of study participants who rated their mental health as “fair” or “poor” at baseline, reported that it had gotten “better” after using ReachOut.com Poor 39% Fair 35% Good 17% Very Good 7% Excellent 2% How would you rate your mental health right now? (At baseline) 30%
- 10. Results: Main Reason for Visit 56% of users were going through a tough time and looking for help
- 11. Results: Help-seeking Intentions 52% of participants experiencing high levels of distress had not previously accessed professional help Previously accessed professional support Never accessed professional support 46% are more likely to seek help after using ReachOut
- 14. Stepped care Universal Selective Indicated Early Intervention / Treatment Continuing Care LOW Self-help LOW–MED Self-help/ Supported self- help MED Supported self-help HIGH Managed care LOW–MED Recovery MENTALHEALTH SPECTRUM STEPPEDCARE • Info + resources • Self-help apps/tools (generic) • Peer support • Info + resources • Self-help apps/tools (generic + targeted) • Peer support • Self-help apps/tools (targeted) • Online CBT • Crisis phone lines/chat • Online coaching • Peer support • Online counselling • Online clinics • Peer support • Self-help apps/tools FEATURES/FUNCTIONS
Editor's Notes
- The aim of the service is to improve mental wellbeing, as well as prevent and intervene early in the onset of mental health disorders in young people aged 14-25 years. Information, apps, tools and resources and peer support. Prevention and early intervention. We don’t offer a clinical or treatment service, but refer young people on to downstream clinical services if they require additional support.
- In addition to our program for young people we also offer a service for professionals that work with young people that may be experiencing MH difficulties, including teachers and other education professionals and health professionals. As of next year we’ll also be providing a service for parents and carers of young people experiencing mental health difficulties, to enhance support within the family environment. This will mirror the RO service with a website and peer support forums, and will also offer an online 1:1 intervention around parenting coaching. Currently doing some research with parents to understand the parameters of this service.
- SLIDE 3: History, details of our work and how it is delivered. [2 minutes] Established in 1998, ReachOut Australia was the world’s first online mental health service. We started in Australia and have rolled out to US and Ireland because of the success here. Technology is central to the content we create, and the way in which we can deliver support to those young people in need of help. As technology has advanced over the past decade and become better integrated into people’s lives, so too has demand for our service. In 1998 we had 3083 visitors per month. Today we have more than 154000 unique visitors each month, and it continues to grow quickly.
- Technology has always been at the heart of what we do, and ensuring that we use technology as a vehicle to engage and make services relevant and accessible to young people. Specifically, innovations in technology have allowed us to: Develop a range of wellbeing apps and games: we have new products being released in the next few months Conduct research more efficiently using online recruitment Better promote our service through digital channels Gone from: 1. Static information website (1998) 2. Online community forums (2005) 3. Develop online games and interventions (2006-7) 4. UX and codesign – marry user experience and action research approaches with evidence base - more interactive and personalised site; mobile led (2010-12) 5. Academic partnerships – interventions, personalised pathways (2014) 6. Interventions and gamification; wearables (2015)
- Service standards and risk management a little bit different to most organisations as we don’t offer any 1:1 intervention. As well as academic partnerships focusing on specific interventions or projects also undertake annual service evaluation to understand impact Annual user survey Cohort study Content partnerships allow us to keep up to date info and support – expert partners ensure reliable and credible information Written in strong brand voice (accessible, relatable, non judgemental) ad experts provide the scientific and clinical rigour. Clinical Advisory Group advise on projects, service developments and duty of care. DoC most relevant for forums: Staff moderation – professionals Community/self – Trained peer moderators; Community guidelines enforced Technical – trigger words; report function Advise other organisations and also learn from their experiences in this space.
- Small selection of findings from our 2013 user Profiling survey, that demonstrate some of the service impacts. Annual survey from 2013, cross-sectional design with ~1,600 participants collected over 2 month period. Who uses ReachOut? More detailed data on demographics etc can be found in our full report from the 2013 survey. K10 to assess psychological distress 77% scored high or very high on the K10 distress scale – much higher then the general population. Although focus on prevention and early intervention, by nature of what we do are reaching a significant number of people experiencing high distress.
- When we used the DASS-21 to look at depression, anxiety, stress we found that 89% of our service users met the cut off for mild or above symptoms for at least one mental health disorder (Reflected here by everything but the yellow bar). Only 11% of users were experiencing no symptoms. Significant proportion experiencing mood disorders and, for depression and anxiety, are skewed to the more severe end of the scale.
- When we lloked at self-reported mental health, and how young people rated their own mental health 74% said that at baseline (prior to using to RO) their MH was poor or fair. Of this group, 30% reported that they felt better after using RO. For a group of people, RO acts as an intervention in itself, whereby young people self-report a positive impact after using the service. Follow up work involves us understanding more about the characteristics of this group, and whether there are any specific components that are more likely to mediate this.
- Young people were asked to identify their main reason for visiting ReachOut, from a drop down list of responses. Over half of users reported they were going through a tough time and looking for help and support. Other reasons included looking for help for a friend. Analysis of the specific issues young people were coming to ReachOut seeking support for is reflected in this word cloud, with the larger font reflecting a higher frequency of the issue being reported. Demonstrates that specific concerns like depression, anxiety and self-harm were common issues where young people were online looking for support. This was followed by a long tail of concerns for issues such as eating disorders, bullying, alcohol and drugs and many more. Furthermore, many users indicated they were looking for support on more than one topic, suggesting young people are presenting at ReachOut with complex and nuanced issues.
- Studies suggest that 70-80% of young people experiencing psych distress do not seek any kind of professional support. A key objective of RO is to target YP experiencing distress that are not otherwise seeking help. Our data shows that a significant proportion of our users are experiencing distress or some kind of mental health problem, yet over half of these had not previously accessed any kind of support. Encouragingly however, of this group 46% indicate that they are more likely to seek help after using RO. Interestingly, repeat visitation was significantly associated with a higher likelihood of intention to seek help – suggesting a possible dose-response relationship whereby higher level of exposure to the program increases the likelihood of future intention to seek help. This could be important for future design and delivery of the service and warrants further investigation. Didn’t track longitudinally to see longer term impact on behaviours – cohort study will identify which services young people go on to use. Though analytics data suggest that helplines like Lifeline and Kidshelpline are a key pathway.
- This report is the third in a series in the partnership between ReachOut and EY with the aim to contribute to and change the national dialogue around mental health through reports such as this and the previous Counting the Cost and Crossroads. The reports examine the current and future states of mental health and mental health service provision in Australia and explore potential solutions to achieve a 21st Century model of mental health care. Explores the role of technology based services, such as ReachOut in delivering scaleable MH care at an earlier stage to relieve the pressure on traditional face to face and more intensive services. Not to replace these services but to balance the model of care so that intensive services are available for those that need them most, and people experiencing mild to moderate symptoms have access to a range of less intensive options as determined by clinical need. Looks at stepped care approaches: most effective but least resource intensive intervention, stepping up or down dependant on clinical need.
- Proposed solution draws on a stepped care model that integrates online and offline services. At the lower tiers drawing on more scalable interventions such as peer-support and online tools and therapies to provide support and manage demand higher population demand. From there, there would ideally be streamlined transitions to step up (or indeed down) into more appropriate tiers depending on clinical need. So moving right through from low intensity right through to complex care. Could in many ways map to the Mental Health Spectrum of Interventions, with your universal interventions at the lowest tier, moving up through selected and indicated at low tier, case identification and treatment and medium to high tiers. Recovery or continuing care would see stepped down approaches. The report is NOT advocating against on-going investment in specialist support and professionals, or for replacing them with e-MH, rather it's about making better use of what we have, integrating all components of the mental health spectrum from promotion and prevention through to treatment, and developing a system where professionals have the capacity to reach and support those who most need it.
- Very simplistic and subjective look at where stepped care could be applied to online and teleweb services more broadly. Not all inclusive, and haven’t included offline services, though they could be easily mapped in. Looks at a range of interventions targeting different segments of the MH spectrum and with different degrees of resourcing intensity. The challenge for us as a sector is to support people to get to the right level of care for their needs, - tapping into low and med intensity resurces where appropriate in order to free up higher intensity resources (treatment and complex care) for those that need it most. Also need to streamline transitions between all of our services so that people can step up or down into different levels of support as required. Starting to look at some of that through Link and WNSW projects … but more work to be done with partners to explore the opportunities.