My latest publication with my Australian computing science colleagues is about using gamification (an app game on a smart phone) to address the problems of Metabolic Syndrome associated with medication taking to treat some severe mental health conditions. In this paper we describe some of the computing science considerations for testing a new health app, and particularly … the way we included clinicians in our testing to check that the way we developed the lifestyle modification interventions in a game format that retained the integrity of the face-to-face as usual treatment for this condition. The good news is – it did… So, the next phase will be to test a new edition of the app in a clinical population.
Research – it is SO exciting…. creating the evidence for future practice… designed to help real people, with real mental health challenges. It is all about the people, people!
PS – and bonus… it includes pictures!
Pass it around! Available in full at this link: https://www.researchgate.net/publication/321938987_GAMIFICATION_IN_E-MENTAL_HEALTH_DEVELOPMENT_OF_A_DIGITAL_INTERVENTION_ADDRESSING_SEVERE_MENTAL_ILLNESS_AND_METABOLIC_SYNDROME
…what is E Mental Health?
E Mental Health has been around for the last 50 years, perhaps more, in a rudimentary fashion using two-way radio and landline telephones. The idea of consulting with, and supporting, patients (and their families) using communication technology is well established. We have been using telephone services in mental health for many years, but in recent times, E Mental Health has snowballed to include a wide range of electronic and digital technologies enabling mental health promotion, early intervention and longer-term treatments in both stand-alone and blended care formats.
Increasingly, it is seen as a viable and cost effective strategy to integrate or blend care within a comprehensive suite of mental health service delivery options, making it possible to help more people at a time and place of convenience to them (Wilson R. L. & Usher, 2015). A wide range of digital interventions are emerging, however not all of them has been validated for safety and efficacy in clinical trials. Never-the-less, it is known that positive engagement in mental health interventions (especially where behaviour change is required) is improved where technology-based strategies are included in either standalone or blended therapies (Alkhaldi et al., 2016). Digital interventions can be described as “programs that provide information and support – emotional, decisional and/or behavioural – for physical and/or mental health problems via a digital platform” (Alkhaldi et al., 2016; Bailey et al., 2010).
E Mental Health is expanding into new and exciting areas of practice, and for clinicians and health researchers, this is a particularly dynamic time. The general community are engaged and ready to use E Mental Health innovation (Fox & Duggan, 2012). More than that… people now expect to find useful mental health information, support and even treatment in digital formats (Fraser, Randell, DeSilva, & Parker, 2016). People expect to access E Mental Health in a range of forms as simply and quickly as pulling their smart phones out of their pockets. Increasingly, a ground swell exists for self-care E Mental Health and this is gaining widespread popularity (Alkhaldi et al., 2016). Many people prefer to receive, information, guidance and even treatment in the privacy, and comfort of their own homes where they remain connected to their place and daily practical life competencies that underpin their optimal wellbeing (Bissell, 2013).
The 21st Century E Mental Health reality is that health care professionals can deploy a virtual mental health clinic in the pocket, handbag, or backpack of the majority of people in the developed world, and for many people in developing countries also (Brusse, Gardner, McAullay, & Dowden, 2014; Wilson, Ranse, Cashin, & McNamara, 2013). The global opportunity that is available by using the personal Internet connected smart devices of individuals everywhere has enormous potential and capacity to promote mental health, and to reduce the burden of global mental illness (ICT Data and Statistics Division Telecommunication Development Bureau Geneva Switzerland International Telecommunications Union., 2012; Proudfoot, 2013). These are exciting times.
3 main categories for E Mental Health services:
- Web 1 & 2.
voice & text…
- Two-way radio UHF services where mobile or cell phone coverage is poor (for example, Royal Flying Doctors Service in remote regions of Australia).
- Call centre-based services to triage and arrange intake or referral to individuals seeking entry to mental health care services (for example NSW Health free call numbers in Australia) (Elsom, Sands, Roper, Hoppner, & Gerdtz, 2013).
- Call centre-based services to crisis mental health help lines (for example Australian services such as: Lifeline, Suicide Call Back Service, Kids Help Line). Similar services are available in most countries where free public mental health care services/insurance also exist.
- Most countries have an emergency service free call telephone number such as 000 in Australia, 911 in USA, 112 in Europe and 999 (or 112) in the UK.
- Mobile/cell phone SMS or text-based services (“Nancy Lublin: Texting that saves lives,” 2012).
- Telepsychiatry – frequently refered to as video links between health services where the consumer or patient and/or carer is in one location, while the specialist mental health clinician/s are in a separate location. A synchronised time is arranged to make a private video consultation link-up. This allows people to receive specialist care without the need to travel to a far away appointment in a distant location (for example Queensland Health (Queensland Health., 2013; Statewide telehealth services., 2013) and )
- More recently Skype has provided a platform that enables flexible video based consultation and added an element of convenience and simplified technology.
web 1 & web 2…
- Email usage and web browser literacy is now generally considered to be a basic life skill for adults, where an integration of web literacy develops as people are able to explore, build and connect relevant information that is useful to them and for solving a range of problems from a self help perspective. For example: Browser search engines such as Google and associated free email host services such as gmail have provided a virtual and digital context where people are more able to search for health information aligned with their health needs and specific health question.
- Web 1 has provided a platform for health care professionals to develop static information and education resources for the general public (for example: beyond blue, black dog), and also website based intervention tools. For example Cognitive Behavioural Therapy (“myCompass. Introductory video,” 2010) and Mindfulness Based Therapy.
- E Mental Health electronic patient records such as the European E health action plans and in Australia (Australian Commission on Safety and Quality in Healthcare., 2016).
- Call centre-based services have been able to add value to their telephone services, by providing extra general information on website connected to their services so that they can support callers further. (For example: Lifeline)
- Web 2 has expanded the options available even further by integrating all other options with a synchronous real time, and asynchronous convenient times, social media enhanced interactive experience that is particularly convenient to the general population, and it is this element of E Mental Health that offers particular promise as new service and interventions are developed.
- Smart devices, and especially smart phones, facilitate the opportunity to utilise apps to enhance the mental health service portfolio, with many apps currently available as information or treatment services.
- Personal electronic accessories such as fitness monitoring devices (eg fitbit or the apple watch) that sync activity levels, such as heart rate, calorie consumption, with smart device diary tools to monitor health characteristics and behavioural change. Fitbit has demonstrated effectiveness as a monitoring tool to enhance engagement in self-care and promoting health and wellbeing generally. The integration of these personal monitors into health care is gradually occurring.
- Gamification in E Mental Health, enhancing engagement in mental health self-care, and gaming-based interventions is an area of particular growth. Gamification introduces a fun and engaging way to interact with health promotion, digital intervention and to foster behavioural change with the added incentives and motivation of providing rewards for efforts. Some gamification is simple and brief such as gif files that prompt and guide breathing to assist in reducing the experience of panic or anxiety.
- More advanced gamification is used to connect with various populations, for example, young people. Integrating gamification software strategies into mental health promotion and strategies will target at risk populations.
- Social media is a useful platform for teaching the public, student health professionals and less engaged experienced clinicians about mental health information and clinical skill development. We know that many health professions students prefer to gain their discipline information for social media such as Facebook (Usher et al., 2014). We also know that a growing number of health professionals are using social media to create virtual communities for research, practice, knowledge exchange and mentoring purposes.
The common usage of personal smart phones and access to computers and other smart devices has driven a level of integration so that we are now in an era where voice, video and web-based resources are available, and often in a blended format so that all three can be use simultaneously and either in synchronous or asynchronous formats. This provides service users and service providers with a level of flexibility and convenience not seen previously.
commercial & social enterprise influence in the E Mental Health arena…
Plenty of innovation in the field of E Mental Health is occurring at a rapid pace, with commercial and social enterprises quick to respond to the global appetite to address mental health problems generally. There are many apps and websites to choose from – some with costs, others free to access. This dynamic has both risks and benefits associated with it.
- A general population wide awareness and expectation about accessing mental health information and support in an electronic environment.
- Populations skilled and literate in the use of electronic devices and digital technologies such as apps, web site navigation, email and social media.
risks and limitations…
- The trustworthiness, reliability, dependability and credibility of many E Mental Health activities in the commercial and social zones are not known because E Mental Health research and development occur at a slower pace than the commercial and social environment, and with a rigorous process to demonstrate efficacy and patient safety. Thus, health service providers and clinicians are reluctant to engage in E Mental Health initiatives with out best practice rigour to support their practice.
- Clinical trials take a significant amount of time, planning, design and testing to underpin evidence to support safe practice. In the context of the rapid pace of change in the E environment generally, this poses a challenge.
- Not all clinicians are keen adopters of social media generally. Thus a digital literacy and skills base has not dominated the health environment generally to date. The mental health workforce is aging in the international sphere, and as younger and digitally literate workforce enter the mental health professions they will bring with them the ease and comfort of existing and operating in the various web environments (Wilson et al., 2013).
opportunities for safe E Mental Health development…
E Mental Health holds great promise for mental health care now, and into the future. There are some gaps at present, and there is a significant need for ongoing research to develop practice-ready tools to contribute to a blended care delivery system (Fraser et al., 2016). Blended care includes elements of face-to-face and online or electronic components of clinical mental health care.
Mental health clinicians and researchers need to develop and refine their skills in the use of e health care technologies – especially in regard to web-based tools, apps and social media (Wilson et al., 2013). Encouragingly, students in the health professions indicate that they are likely to have a strong grasp of electronic health care and information transfer because they bring pre-existing web-savvy skills to their pre-qualification studies (Usher et al., 2014).
Governments and funding bodies increasingly anticipate the incorporation of strategic E Mental Health care into health service delivery systems, because it aligns with economic business plans and population distribution plans (Department of Health., 2015; E-mental health strategy for Australia, 2012; European Commission, 2012).
- E Mental Health is not new, but it is expanding at a rapid pace, driven by consumer demand and heath service financial constraints to deliver more services with limited budgets
- Three main avenues exist for E Mental health: Voice/ text; video; and Web 1 & 2.
- Opportunities exist to build safe E Mental Health into the future as research and development collaborate with willing practitioners to create a evidence base to support best practice in the E Mental Health field.
Alkhaldi, G., Hamilton, F. L., Lau, R., Webster, R., Michie, S., & Murray, E. (2016). The effectiveness of prompts to promote engagement with digital interventions: a systematic review. Journal of Medical Internet Research, 18(1), e6. doi:10.2196/jmir.4790
Australian Commission on Safety and Quality in Healthcare. (2016). Safety in E Health. Retrieved from http://www.safetyandquality.gov.au/our-work/safety-in-e-health/
Bailey, J., Murray, E., Rait, G., Mercer, C., Morris, R., Peacock, R., . . . Nazareth, I. (2010). Interactive computer-based interventions for sexual health promotion. Cochrane Database of Systematic Reviews, 9(CD006483). doi:10.1002/14651858.CD006483.pub2.
Bissell, D. (2013). Virtual infrastructures of habit; the changing intensities of habit through gracefulness, restlessness and clumsiness. Cultural Geographies, 0(0), 1-20.
Brusse, C., Gardner, K., McAullay, D., & Dowden, M. (2014). Social Media and Mobile Apps for Health Promotion in Australian Indigenous Populations: Scoping Review. J Med Internet Res, 16(12), e280. doi:10.2196/jmir.3614
Department of Health. (2015). e-Health. Retrieved from http://www.ehealth.gov.au/internet/ehealth/publishing.nsf/content/home
E-mental health strategy for Australia. (2012). Canberra: Commonwealth of Australia Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/D67E137E77F0CE90CA257A2F0007736A/$File/emstrat.pdf.
Elsom, S., Sands, N., Roper, C., Hoppner, C., & Gerdtz, M. (2013). Telephone survey of service-user experiences of a telephone-based mental health triage service. International Journal of Mental Health Nursing, 22, 437-443.
European Commission. (2012). eHealth Action Plan 2012-2020 – Innovative healthcare for the 21st century. Retrieved from Brussels: file:///Users/rhondawilson/Downloads/eHealthActionPlan2012-2020.pdf
Fox, S., & Duggan, M. (2012). Mobile Health 2012: Half of smartphone owners use their devices to get health information and one-fifth of smartphone owners have health apps Retrieved from California Health Care Foundation: E Mental Health.docx
Fraser, S., Randell, A., DeSilva, S., & Parker, A. (2016). Research Bulletin: E-mental health: the future of youth mental health? Retrieved from Orygen Youth Health: https://orygen.org.au/Our-Research/Research-Areas/Online-Interventions-and-Innovation/Orygen-Research-Bulletin-E-Mental-Health.aspx
ICT Data and Statistics Division Telecommunication Development Bureau Geneva Switzerland International Telecommunications Union. (2012). Mobile cellular subscriptions per 100 inhabitants, 2001-2011 (Excel Spreadsheet) Retrieved from http://www.itu.int/ITU-D/ict/statistics/material/excel/2011/Mobile_cellular_01-11.xls.
. from Telecommunication Development Bureau Geneva, Switzerland: International Telecommunications Union. http://www.itu.int/ITU-D/ict/statistics/material/excel/2011/Mobile_cellular_01-11.xls.
. myCompass. Introductory video. (2010). In B. D. I. m. program (Producer). Australia: Black Dog Institute.
Nancy Lublin: Texting that saves lives. (2012, April 2012). TED talks. Ideas worth spreading. Retrieved from http://www.ted.com/talks/nancy_lublin_texting_that_saves_lives.html
Proudfoot, J. (2013). The future is in our hands: The role of mobile phones in the prevention and management of mental disorders. Australian and New Zealand Journal of Psychiatry, 47(2), 111-113.
Queensland Health. (Producer). (2013, 7 March 2013). Telehealth. Retrieved from https://www.facebook.com/notes/queensland-health/telehealth/379845328790222
Statewide telehealth services. (Writer). (2013). Extending the reach of clinical health services throughout Queensland . In Q. health (Producer). Australia: Queensland health.
Usher, K., Woods, C., Casella, E., Glass, N., Wilson R. L., Mayner, L., . . . P., I. (2014). Australian health professions student use of social media. Collegian, 21(2), 95-101. doi:10.1016/j.colegn.2014.02.004
Wilson R. L., & Usher, K. (2015). Rural nurses: A convenient co-location strategy for rural mental health care of young people. Journal of Clinical Nursing, 1-11. doi:DOI: 10.1111/jocn.12882
Wilson, R. L., Ranse, J., Cashin, A., & McNamara, P. (2013). Nurses and Twitter: The good, the bad, and the reluctant. Collegian(0). doi:http://dx.doi.org/10.1016/j.colegn.2013.09.003
Practice-informed nursing: The future of transformative nursing education and research in a technological context
Three significant factors will impact on the future of nursing education and research in Australia
- Entrenchment of a culture of patient safety among practice-ready graduates while offering transformative educational experiences to nursing students and building resilient communities. Rural and regional communities, Indigenous people, and international inclusiveness and connectivity will be particularly important.
- Entrepreneurial nursing academics will be pivotal in developing innovative ways to fund practice and research projects; deliver quality-learning programs; and produce a strategic mix of research outputs. This is critical because of cuts to funding across the higher education sector and increasing competition for research grants.
- Capitalising on E Health – using the term broadly to cover not only storing, retrieving, maintaining and sharing patient records safely and effectively, but also electronic health service delivery assisted by communications technologies, such as web-conferencing, internet-based interventions, and the use of apps and social media. And there’s also E Health in academia – the way that the technologies are revolutionising the teaching, learning and research environment for nursing. Nursing academics’ expertise in E Health technologies will undoubtedly need to expand in the future.
transformative practice informed patient safety
The health industry expects universities to produce nursing graduates who are practice-ready and proficient in delivering quality health care where patients are safe, health risk is reduced, and deterioration is detected and responded to quickly. The graduates must be prepared for the high acuity of workplaces in the health sector, and must possess the indispensable attribute of resilience. Industry also expects graduates to be skilled in collaborative teamwork and capable of leadership and supervision early in their careers (Australian Commission on Safety and Quality in Health Care, 2010; Australian Institute of Health and Welfare, 2014; NSW Health, 2013).
A new era in the nursing discipline is dawning where transformative models of service and care are prioritised. The transformative process surpasses the traditions of ‘evidence-based practice’ and ‘life-long learning’, which frequently uses ‘time-spent’ as a metric to determine learning outcome.
Instead, future nursing needs contemporary continuous transformative learning, and practice-informed research using continuous models that are more flexible and nimble, in order to enhance capacity to adapt to rapid changes. Preparing students to be practice-ready has become increasingly challenging within the traditional three-year degree program, where specialty themes compete for inclusion. There is a need for innovative and entrepreneurial practice-informed teaching and learning to invigorate future curriculums, in conjunction with a balanced approach to practice-informed research agendas.
Postgraduate courseware will need to align with, and adapt to, market forces. In Australia, this includes addressing the changes announced by government to create Primary Health Networks and Health Care Homes, and ensuring the supply of qualified nurses to fill posts in these national centres (for example, Credentialed Mental Health Nurses). Advocating for appropriate reimbursement of specialist nurses will be a critical driver of postgraduate education (Australian College of Mental Health Nurses, 2013).
nurse entrepreneurialism in higher education
Funding for the higher education sector has been dwindling in recent years leading to major budgetary challenges, particularly for regional universities. Popular, high-enrolment courses like Bachelor of Nursing will continue to be important and strategic contributors to the overall university budgets.
International university ranking analysts suggest that “strongly motivated academics can offset to some degree limited funding” (Williams, Leahy, de Rassenfosse, & Jensen, 2016). Actively seeking collaborations will be vital to ensuring research funding success at the highest level, and so will serious attention to grantsmanship.
Nursing curriculum, with its expensive practicums, will undergo closer fiscal scrutiny in the future. So will other teaching related expenditure, with imperatives to maintain industry accreditation, to provide quality educational experiences for students, to have genuine consumer participation in curriculum design, and to incorporate digital and simulated pedagogies while managing cost effectiveness.
A particular challenge for nursing is to improve the impact of nursing research generally. Co-investigative nurse membership of collaborative interdisciplinary research teams has been important. A newer challenge is to move towards a position of excellence in nurse-led health research. New opportunity exists to do this, with the Australian Research Council looking to widen the definition of measurable impact to include category 2 and 3 grants, and with impact metrics increasingly linked to Google open access outputs, and international linkages including co-authorship (Williams et al., 2016).
Nurse researchers will need to be grant-ready and this includes building track record in grant success, and generating publications from their research. Concurrently, nursing scholars will need to develop industry and research linkages (including international higher degree research student intakes), together with the technological skills to generate outputs in digital domains.
safe and effective e health innovations
State and Federal governments are turning their service delivery focus and funding streams toward E Health services to meet growing expectations across the Australian consumer population (Australian Bureau of Statistics, 2013; Australian Commission on Safety and Quality in Health Care, 2015). For example: digital gateways for triaging and accessing health care service provision (Department of Health, 2015), managing patient health records, and delivering, monitoring and evaluating health interventions (Christenson & Petrie, 2013; Department of Health, 2016; Department of Health, 2015; E Mental health strategy for Australia, 2012; Keast, 2016).
E Health skills will need to be recognised as a core competence in future nursing curriculums (Australian Commission on Safety and Quality in Health Care, 2015). The rise of E Health presents opportunities for nursing with improved digital pedagogy learning design systems to produce nursing graduates who are practice-ready for the new and evolving practice domain of safe E Health. This has particular relevance for including and servicing rural and regional communities.
The nursing academy in Australia is trending against the odds. Nationally, enrolments are high, outputs and impact are strengthening despite dwindling higher education budgets for the discipline. Nursing academics will continue to drive the Australian nursing discipline into the future as they transform their focus towards practice-informed teaching and learning, practice-informed research integrated with international connectivity, and stronger collaborative relationships with the health sector and wider society.
- Australian Bureau of Statistics. (2013). Internet Activity, Australia, December 2012. (8153.0). Canberra: Australian Bureau of Statistics. Retrieved from http://www.abs.gov.au/
- Australian College of Mental Health Nurses. (2013). A Survey of Credentialed Mental Health Nurses working in the Mental Health Nursing Incentive Program.
- Australian Commission on Safety and Quality in Health Care. (2015). Australian Commission on Safety and Quality in Health Care Annual Report 2014/15. Retrieved from http://www.safetyandquality.gov.au/
- Australian Commission on Safety and Quality in Health Care. (2010). National Consensus Statement: Essential Elements for Recognising and Responding to Clinical Deterioration. (pp. 1-24). Sydney: Australian Commission on Safety and Quality in Health Care (ACSQHC).
- Australian Commission on Safety and Quality in Healthcare. (2016). Safety in E Health. Retrieved from http://www.safetyandquality.gov.au/
- Australian Institute of Health and Welfare. (2016). Primary Health Network (PHN) data. Retrieved from http://www.aihw.gov.au/
- Australian Institute of Health and Welfare. (2014). Australia’s Hospitals 2013-14. Retrieved from Australian Institute of Health and Welfare:http://www.aihw.gov.au/
- Australian Research Council. (2016). 2015-2016 State of Australian University Research ERA National Report. Retrieved from: http://www.arc.gov.au/
- Best, O. (2015). The cultural safety journey: An Australian nursing context. In O. Best & B. Fredericks (Eds.), Yardjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care (pp. 51-73). Port Melbourne: Cambridge University Press.
- Christenson, H., & Petrie, K. (2013). Information technology as the key to accelerating advances in mental health care. Australian and New Zealand Journal of Psychiatry, 47(2), 114-116.
- Department of Health. (2015). Australian Government Response to Contributing Lives, Thriving Communities – Review of Mental Health Programmes and Services. Canberra: Australian Government Retrieved from http://www.health.gov.au/
- Department of Health. (2016). Health Budget 2016–17. Retrieved from http://www.health.gov.au/
- Department of Health. (2015). e-Health. Retrieved from http://www.ehealth.gov.au/
- E-mental health strategy for Australia. (2012). Canberra: Commonwealth of Australia Retrieved from http://www.health.gov.au/
- Godbold, N., & McCaffery, K. (2015). Improving care by listening: care communication and shared decsion-making Communicating quality and safety in health care (pp. 164-175). Port Melbourne: Cambridge University Press.
- Keast, K. (2016). How technology will advance nursing practice. Retrieved from http://healthtimes.com.au/
- Little, F., O’Brien, A., Gray, M., Wilson R. L., & Finn, A. (2015). Scoping novel rural mental health clinical placements for undergraduate nursing and social work students in Northern NSW. Final Report: 20th November 2015. Retrieved from Hunter & Central Coast Interdisciplinary Clinical Training Network:
- NSW Health. (2013). Policy Directive: Recognition and Management of Patients who are Clinically Deteriorating. (PD2013_049). Sydney: NSW Ministry of Health.
- Usher, K., Woods, C., Casella, E., Glass, N., Wilson R. L., Mayner, L., . . . P., I. (2014). Australian health professions student use of social media. Collegian, 21(2), 95-101. doi:10.1016/j.colegn.2014.02.004
- Williams, R., Leahy, A., de Rassenfosse, G., & Jensen, P. (2016). U21 Ranking of National Higher Education Systems 2016. Retrieved from http://www.universitas21.com/
- Wilson, R. L., Ranse, J., Cashin, A., & McNamara, P. (2013). Nurses and Twitter: The good, the bad, and the reluctant. Collegian(0). doi:http://dx.doi.org/10.1016/j.colegn.2013.09.003
In Australia, moves are afoot to review and implement changes to the mental health services and programs on offer – including those offered to young people. Change always produces some tensions, and that will be the case again in this situation… but something had to give… change was needed to see equitable improvements, and none more obvious than for rural young people with mental health problems. So here we go – join me on the slippery slope of mental health care reform roller coaster!
The media have labelled the staged funding reductions to early psychosis services as “Futures will be lost. Health fears as youth pychosis program dropped” Read about it here: http://www.smh.com.au/federal-politics/political-news/futures-will-be-lost-health-fears-as-youth-psychosis-program-dropped-20160429-goi1hu.html
This begs more questions: The future of who…? Who will be advantaged…? And, who will be disadvantaged…? How do we achieve fairer and more equitable care for all of our young people throughout Australia? There are no easy answers or solutions… to suggest there are is to reveal a flippant disregard for the complexity of meeting the mental health needs of young people today.
I’m an optimist…
I hope that the government have got this right… and that a redistribution of youth psychosis program money will benefit young rural people more equitably as a result… Of course, advocating for the equitable mental health needs of young rural people has been my long-term professional activity of mine! So, I can only hope that this new direction to send funds to the primary health networks – will in fact work for rural and regional young people where the gaps are larger! There are some risks to note. For example, how will people be mobilised from their comfort zones to take up work in new geographical regions…? Will this be supported in the recruitment of appropriate servicing of populations? Will it really be equitable? Or just equal? Will health professionals be contracted using brokerage models as they are ‘commissioned’ for services? And, if they are, how will this new model ensure that health professionals are able to be fully employed at reasonable pay rates, in keeping with their level of expertise? How will we mitigate the risk of under-employment of people in low population communities yet maintain equitable service levels? How will the ‘gaps be filled’? Has this been fully considered?
I don’t think that the new approach to funding of youth mental health care this is such a bad thing for rural and regional young people. I have been calling for a more equitable and inclusive distribution of the mental health dollar for many years now… (eg https://www.researchgate.net/publication/275340216_Rural_nurses_A_convenient_co-location_strategy_for_rural_mental_health_care_of_young_people )
… it has not always made me popular…
The harsh reality is that rural youth often have much longer durations of untreated mental illness, poorer access to mental health services and poorer prognosis as a result… And, the largely urban-centric models of specialist youth mental health care have not met the demands for rural youth with mental health care needs. Something needs to give a little… perhaps this new funding model will be it… But – it needs to explain how it will include nursing expertise to promote mental health among young people at its core… Because, nurses are already there in all communities… and they represent a present resource that can be better engaged in primary care.
How will nurses be engaged in the primary mental health care of young rural people? The role of nursing in the models of care continues to be vaguely described at best in current strategy offerings… Only using nurses for managing chronic care (ie the Mental Health Nurse Incentive Program) is a sure-fire for short-changing the mental health of young people… becasue… young people have simply not lived long enough to have ‘achieved’ chronic mental illness status… rendering them ineligible for government supported nursing care in the main! Thus, how will this new model of funding utilise the expertise of nurses to deliver primary mental health care to young people and mitigate the early identification and intervention end of the care spectrum problems? Remembering of course that nurses make up the largest proportion of health professionals representing and the largest proportion of human resource for mental health service delivery throughout the country? Nurses need to be a large chunk of the journey towards successful new models of care – yet they seem to be overlooked in the latest iteration of change. Why?
I am not yet convinced the the Primary Health Networks will be the solution… but I am prepared to be open-minded about the possibilities… I hope we are seeing the beginnings of something substantially more useful than reshuffling deck chairs. I think closer federal collaboration with state health, education, family and community services and police/ justice services will bring more profitable benefits. But, while a two tier government approach persists in mental health service delivery (Federal and State/s), problems in administering equitable services will also persist with bureaucratic double-ups inevitable, ultimately soaking up some of the direct clinical and research spend potentials.
I agree with McGorry, that many gains have been achieved through the concentrating of specialist expertise in a small number of specialist services, and that it would be a shame to lose this. But, having built this considerable national human resource – if it were mobilised and dispersed across the country (for example, the experts geographically relocated) this have a benefit of authentically redistributing the talent and in doing so benefit more people over time. Is it time to mobilise the specialist population for greater good in health service delivery? A question for health geographers and health ecologists to ponder. Will redistribution of funding trigger a wider set of conditions in communities such that mental health is more effectively promoted? I think that this is possible: https://www.researchgate.net/publication/280134451_Rural_Mental_Health_Ecology_A_Framework_for_Engaging_with_Mental_Health_Social_Capital_in_Rural_Communities
It is not all bad news, a new model could bring with it ‘catch-up’ conditions to more vulnerable and harder to reach young populations who should have convenient access to local mental health support where and when they require it. The challenge is for mental health professionals to work together using digital technologies to bring us together, it is after all what we expect of our clients these days! That is, to be satisfied with e mental health/ telehealth and digital gateway (triage) delivery….
Perhaps health professionals will also need to adapt our practices in the ways that we work and collaborate with each other – building virtual centres of excellence rather than geographical catchments of excellence. In doing so, some castles will be dismantled – and new ones will emerge… shifts in the sands of time across the landscape of mental health service and evidence development and delivery are inevitable.
It is clear that the health budget in Australia will never be able to fund sufficient levels of mental health service delivery for Australian young people – our present budgets don’t go near sufficiency. Finding ways to squeeze a few extra drops of oil out of the rag are always going to be critical… the challenge is out for mental health researchers to be prudent in devising ways in which we can continue to do more, with less, and for politicians and policy makers to take heed of evidence as it emerges… And finally, for clinicians to be ready to adapt to the changing times as they evolve. None of that is easy!
Relevant other links:
The latest in my Bush Remedies ABC radio (ABC New England North West NSW, Australia) series about Rural Mental Health goes to air tomorrow morning on the Morning Show with presenter Kelly Fuller (about 0930 live on air) but- you can hear the podcast here sometime tomorrow afternoon…and listen at your leisure.
This time we are talking about how social media can support rural mental health, and in the spirit of rural innovation and modern social media, I thought I would integrate it all throughout a number of social media platforms to demonstrate how useful social media can be in the future as we work towards using e-mental health strategies more to positively promote mental health and well-being and encourage recovery… Below are some of the topics discussed in the radio podcast link above… As I hit the ‘publish’ button for this blog – it will also feed into my facebook page Rural Mental Health Nurse and to my Twitter feed – @RhondaWilsonMHN and also to my Linkedin social media newsfeed…. and travel well beyond my immediate small scope of ‘friends and followers’ towards a wider and unknown audience. In doing this – I am practicing what I preach…that is being a rural mental health nurse dedicated to promoting mental health well-being and recovery and building a community conversation about rural mental health…. hopefully my little bit contributes usefully to rural communities and rural people 🙂
I also encourage rural people to give social media a go and see if it is useful… it does reduce the travel miles when it comes to finding help, and there are some very good mental health resources on line.
So – here it is:
The iPhone has a lot to answer for – it has changed our world! And for the better when it comes to promoting mental health. Even it’s predecessors of regular old mobile phones have the capacity to do more for the health of the world than anything else ever has before! Bold claim… perhaps – but mobile phones and smart phones have the capacity to put a life saving mental health intervention in the pockets of most people in the world….The potential to save more lives than penicillin.
Mental health distress can be fatal – it is called suicide…. it is preventable. The burden of mental-ill health is fast looming as the next biggest cause of world-wide health burden. By 2020 health researchers predict depression will be the biggest health problem in the world. Depression is a risk factor for suicide. Suicide rates are higher in rural communities.
Mobile phones and smart phones may hold some hope in helping to reduce the impacts of mental-ill health & depression.
Why? How? Because they have the capacity to link people with other people to communicate anywhere, anytime – at the moment and instance of greatest risk, vulnerability and need. There is a hint of protection in that – and that level of protection can be worked in to safety plans for individuals….
Mental health services and clinicians can talk directly to clients; can set up scheduled messages or texts to promote mental health to vulnerable people. People can access facebook, twitter and other apps, and websites to enhance their mental health and even participate in therapy (eg Cognitive Behavioural Therapy) using app downloads. The convenience and privacy of social media and mobile phone mental health promotion is extremely appealing to many people, and it is located a time and place that suit the individual person. So much good is at hand!
What it isn’t.… social media and mobile/ smart phones are not a substitute for face to face mental health clinical help and services – but they are (increasingly) an adjunct to it.
Twitter, facebook and texting are fast becoming the ONLY way to communicate…. so it is important that mental health professionals keep up with the favoured communication pathways for people (and especially young people) and learn how to use social media to clinical effect – the world is changing! Our clients will expect us to change with it!
Twitter and Facebook are popular social media platforms – both have a great deal of positive mental health traffic – which rural people can tap into to build strength, resilience and protection in regard to being mentally healthy and encouraging others to do the same.
Social media and mental health
Nurses are already active in Twitter as mental health advocates for community mental health promotion, and as mental health communicators in both public and nursing conversations in the twitter environment. eg @jamieranse @meta4RN @ACMHN @Patbradley @hollynortham @thenursepath the list could go on and on… you can see many nurses who follow me – or I follow on my Twitter feed if you want to follow some! I am not promoting any particular nurse really – just the nursing conversation that is out there and happening in the public arena for anyone else to see and follow… (Obviously I follow a lot of nurses and vice verse – because I am pretty passionate about nursing generally – so my feeds are full of nursing talk!) The point is that nurses are some of the leaders in advocating for health and well-being across the social media platforms, and leading the way in many cases, a shift in health conversation and advocacy is in swing.
The use of mobile phones with the ability to connect to the internet (smart phones) is expanding rapidly – 75% of the developed world population has a smart phone.
We now use the internet across an increasing range of mobile devices including smart phones, tablets, and laptop computers we have the internet in own pockets, handbags, wherever we go…. On our lounge chairs when we watch TV, and on our bedside tables at night. Many people are never far away from the internet…. There are some down sides of this, but like all things it is a case of getting the balance right in life. There is a lot of good being spread in cyberspace as well – and especially in regard to promoting mental health.
In Australia there are about 12.2 million internet service provider subscriptions and half of those are wireless, while three quarters are household subscriptions (Australian Bureau of Statistics., 2013).
In Australia, there are 17.4 million smart phone subscriptions & a continuing rapid upward rise in this trend (Australian Bureau of Statistics., 2013). A specific shift in digital communication occurred around 2004 with the development of web 2.0, and a further shift towards social media utilisation with the advent of mobile web technology (such as the iPhone) in 2007!
Applications (apps) are readily available for all of these devices.
In Australia, Facebook is used for social networking with 11.5 million Australian users.
Half of Facebook users log on at least daily.
The flexibility of social media participation is entirely at the convenience and control of the user.
Four out of five professionals now use some form of social media and further adoption of this communication style is inevitable.
Social media represents the beginnings of a new era of communication and offers a platform from which health interventions and health communication can develop in the future
There are new potentials for e-health practice which have already commenced and will further develop in the future.
For example, the Suicide Call Back Service (@SuicideCallBack) is a free counseling service for people thinking about suicide or bereaved by suicide.
Many mental health organizations for people what mental health problems, people who care about someone else’s mental health, and have a facebook presence. I counted up how many I like ( I may be a biased example!!) = 23 +….. But once they are ‘liked’ you receive plenty of positive mental health updates in a newsfeed – every day. Sometimes I share them with my friends or various other facebook groups that I am part of…. It all builds the mental health conversation….. I would encourage everyone using facebook to ‘like’ at least one mental health promotion page…..
Here is some of my ‘like’ list:
· Walking feat – Sarah Mcfarlane-Eagle – advocate mental health awareness local champion. www.facebook.com/WalkingFeat
· Mental health council of Australia www.facebook.com/TheMHCA
· Suicide prevention Australia www.facebook.com/SuicidePreventionAustralia
· Mental Health Association NSW www.facebook.com/mentalhealthnsw
· RUOK day www.facebook.com/ruokday
· Children of Parents with Mental Illness www.facebook.com/COPMIorg
· Reachout.com Australia www.facebook.com/ReachOutAUS
· Mental Health Awareness Australia www.facebook.com/pages/Mental-Health-Awareness-Australia
· Single Mothers Who Have Children with Autism www.facebook.com/singlemotherswhohavechildrenwithautism
· Lifeline www.facebook.com/LifelineAustralia
· Anxiety on line www.facebook.com/AnxietyOnline
· Suicide call back service www.facebook.com/suicidecallbackservice (The Twitter presence of this service provides a convenient access to counseling and health promotion commencing in the social media environment as well).
· Carly Fleischmann www.facebook.com/carlysvoice
· Headspace www.facebook.com/headspaceAustralia
· E-hub self-help for mental health and well-being www.facebook.com/ehub.selfhelp
· Schizophrenia Fellowship of NSW www.facebook.com/SFNSW
· Rural Mental Health Australia www.facebook.com/RuralMH
And some more mental health professional pages that I ‘like’:
· International Journal of Mental Health Nursing www.facebook.com/pages/International-Journal-of-Mental-Health-Nursing
· Australian College of Mental Health Nurses www.facebook.com/AustCollMHNs
· National Drugs Sector Information Service www.facebook.com/NDSIS
· AFFIRM Australian Foundation for Mental Health Research www.facebook.com/pages/AFFIRM-The-Australian-Foundation-for-Mental-Health-Research
· Mental health foundation of Ghana www.facebook.com/MentalHealthFoundationGhana
· World Federation for Mental Health www.facebook.com/WFMH1
There is a robust facebook mental health promotion conversation to tap into where ever you live (as long as you have internet!)
Social media is here now; it will continue to evolve – need to make good use of this iteration of social media to positively influence the health and well-being of individuals and communities.
The general nature of social media has expanded to include professional conversations and while social media has a number of limitations, it also represents extraordinary capacity to do some good, especially in regard to the development of timely clinical conversations and the development of professional networks.
By using these #mentalhealth #rural –you will find there is a frequent stream of information – positive mental health conversations, links to information about specific issues, and some of the tweeters are mental health professionals.
Twitter is convenient because you can follow anyone you want to…. and the conversations are brief (just 140 characters) so you don’t get overwhelmed by long wordy blogs…. (like this!) Messages are straight to the point – nice and time efficient!. Tweeters tend to link to further information that is of interest – so if the tweet sparks your interest you can follow-up and go on to view any links.
Navigate Twitter by following people or organisations with a @ symbol, and by following # themes. Both ways will help you to build a community of interest about topics. I use #RuralMH #Rural #Mentalhealth #nurses #youngpeople #youth mostly in my tweets – because I Tweet mostly about those topics! I will be tweeting next week from the International National Conference for Australian College of Mental Health Nurses using #ACMHN2013 – you may want to follow on the hashtag and see what are the latest developments in mental health nursing…..!
Some Twitter mental health handles to follow:
E-self-help mental health
There have been significant developments in e-mental health, and especially with self-help e-mental health interventions such as cognitive behavioural therapy, many of which have been developed in Australia. Beacon at the Australian National University (ANU) host a controlled data base which contains about 62 web-based and 11 mobile applications for mental health and physical health self-help interventions listed on an open access website which addressed mood and anxiety disorders.
Most are designed for adults and were based on cognitive behavioural therapy principles. One third of the interventions have been evaluated by at least one randomised control trial, which shows some promise for the developing body of evidence emerging around the use of e-mental health in the future, however more research needs to be done in the future to understand the effectiveness and implications for e-mental health delivery to rural young people
Here are some examples of places to start to search for quality and reliable (evidence-based) mental health help and self-help therapy.