By Dr Imogen Bell – Orygen, Centre for Youth Mental Health, University of Melbourne

Youth mental health services like headspace are the front door of support for young people struggling with mental ill-health. With over 150 centres across Australia, and a growing number internationally, these services offer effective, evidence-based care for young people. However, access barriers and wait lists are very long in over 90% of youth mental health services; a problem which has grown dramatically throughout the global pandemic. Indeed, demand for services is growing, with mental health problems increasing by up to 25% over the past two years and young people the most several impacted. With mental health problems worsening world-wide, we are now faced with a crisis where demand for services far outstrips supply.

Digital technologies like smartphone apps and online programs have been heralded as potential means of addressing the unmet demand for youth mental health care. A relatively new area of research and development, emerging research has found that these tools can provide effective and accessible treatment for a range of mental health conditions. However, despite widespread use of technologies in youth populations, very few evidence-based options exist for young people. Evidence from randomised controlled trials show that online platforms, particularly when combined with some form of human support like weekly emails or phone calls from a peer worker, can improve mental health outcomes. An online therapy platform called MOST, developed by researchers at Orygen Digital, was found to improve employment outcomes and reduced visits to emergency departments over 18-months compared to usual treatment. At the height of the pandemic in Victoria, these findings lead the Victorian Government to invest in rolling out MOST across youth mental health services, a move now followed by several other states.

Whilst online, computer-based therapies like MOST are being made available to young people in some Australian states, new digital technologies provide additional opportunities that could change the way young people receive treatment. For example, virtual reality (VR) has great potential for therapeutic impact owning to the immersive and engaging user experience, particularly for treatments such as exposure and cognitive behavioural therapy. As research and development continues to explore the various therapeutic applications of new technologies, it is imperative that the needs and preferences of the end users are used to inform and guide the field towards solutions that are engaging, effective and fit for purpose.

Capitalising on the rise in digital intervention use during the global pandemic, the BRACE survey was conducted to understand perspectives on the use of different digital technologies to support youth mental health. Five hundred and eighty-eight young people and 73 clinicians took part across Australia. Young people were recruited from within headspace services and the general population, to gain insights across a spectrum of care needs. The survey sought to capture access to, and use of, different digital technologies, like smartphone apps, computers and newer technologies like virtual reality, and levels of interest in their use for mental health support.

Findings from the survey showed that young people have access to and use technologies frequently, including those from within clinical services. Ninety nine percent had access to a smartphone, which most used several times an hour. Eighty percent of clinicians had used a smartphone app within their clinical care of young people. Comparatively and perhaps unsurprisingly given the recency of the technology, technologies like VR and wearables were less often used, with only around 5% of young people having access to a VR headset.

Clinician views towards digital technology were very positive, with 95% reporting that the technologies they had used in routine clinical work were at least somewhat helpful. Eighty five percent had recommended a smartphone app to a young person, with the most popular being mindfulness apps like Smiling Mind. There were optimistic views towards the use of technologies to support youth mental health generally, particularly for online therapy, smartphone apps, employment support, telephone and blended therapies (where a digital intervention is used within standard treatment). Comparatively, there was less interest in social media, text messaging and chat bot-based treatments.

Young people were mostly interested in self-help technologies, particularly smartphone apps and online therapy, although blended therapies were of particular interest to those already using services. Likely explained by a lack of familiarity with the technology, there was less interest in immersive therapies like VR, as well as chatbots.

These findings from the BRACE survey highlight the readiness and motivation amongst young people and clinicians to use digital mental health technologies to support youth mental health. Given the rising demand for youth mental health services and the growing crisis in access, it is critical that we think innovatively about possible solutions. Research and development are now needed to harness the unique capabilities of digital technology to provide new options for supporting young people with their mental health.

Source paper:

Bell, I. H., Thompson, A., Valentine, L., Adams, S., Alvarez-Jimenez, M., & Nicholas, J. (2022). Ownership, Use of, and Interest in Digital Mental Health Technologies Among Clinicians and Young People Across a Spectrum of Clinical Care Needs: Cross-sectional Survey. JMIR Mental Health, 9(5), e30716.

References:

Alvarez‐Jimenez, M., Koval, P., Schmaal, L., Bendall, S., O’Sullivan, S., Cagliarini, D., … & Gleeson, J. F. (2021). The Horyzons project: a randomized controlled trial of a novel online social therapy to maintain treatment effects from specialist first‐episode psychosis services. World Psychiatry, 20(2), 233-243.

Bell, I. H., Nicholas, J., Alvarez-Jimenez, M., Thompson, A., & Valmaggia, L. (2022). Virtual reality as a clinical tool in mental health research and practice. Dialogues in clinical neuroscience.

Bell, I. H., Thompson, A., Valentine, L., Adams, S., Alvarez-Jimenez, M., & Nicholas, J. (2022). Ownership, Use of, and Interest in Digital Mental Health Technologies Among Clinicians and Young People Across a Spectrum of Clinical Care Needs: Cross-sectional Survey. JMIR Mental Health, 9(5), e30716.

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Nicholas, J., Bell, I. H., Thompson, A., Valentine, L., Simsir, P., Sheppard, H., & Adams, S. (2021). Implementation lessons from the transition to telehealth during COVID-19: a survey of clinicians and young people from youth mental health services. Psychiatry Research, 299, 113848.

Torous, J., Bucci, S., Bell, I. H., Kessing, L. V., Faurholt‐Jepsen, M., Whelan, P., … & Firth, J. (2021). The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry, 20(3), 318-335.

About the Writer:

Dr Bell is an NHMRC Early Career Fellow and psychologist working on the development, evaluation and dissemination of novel digital interventions for youth mental health, with a focus on smartphone apps and virtual reality.