Whether you are a consumer/user/patient, carer or family member, clinician, or a researcher… if you have some experience with mental health… you probably have some information that you have learned along the way about improving mental health opportunities for others in the future. And information from all of these sources contributes to the pot of all known knowledge about mental health. Sharing the gems of knowledge we have can be challenging (and a bit scary sometimes too!) But, sharing makes a useful contribution. This blog is about one way to contribute to the convincing tried and tested evidence end of the knowledge spectrum…
These days in mental health conferences in particular we are seeing more people with lived experience speaking, and being included in conference discussions and agendas – respect is growing, the environment is becoming more inclusive. Clinicians are also increasingly being included, and asked to share their practice rich knowledge. Meanwhile researchers and scholars have a long experience in speaking and writing about mental health topics, however, they are becoming increasingly challenged to do so using some co-design and co-creation principles. The collaborative and inclusive shared environment of knowledge production (evidence) to improve, prevent illness, promote health and well-being and to support recovery is slowly changing and hopefully becoming stronger and more informed as a result.
Some of the traditional formats for knowledge exchange have a procedure for selecting and screening information. The abstract, a very brief and concise overview that summarises a longer discussion, makes a first impression, and is the first hurdle you encounter if you want to present your ideas to mental health professionals, and have them taken seriously. The abstract is a hard hitting pitch to your reviewers who will ultimately decide if your argument is convincing enough, and accurate enough to be included in a peer reviewed context such as a scientific conference or a journal.
Peer review is widely considered to be the ‘gold standard’ of ensuring that ideas, have sufficient merit, have been obtained in an ethical fashion, are organised and analysed using a reliable, logical and trustworthy processes, and can be considered dependable and credible. Of course it has its limitations… but it is how the scientific world revolves at the moment, and if you want to add your voice and your ideas to the scientific mental health audience – this is the process your ideas must undergo to show they are indeed valid!
For conferences, a call for abstracts is sent out up to a year before the conference date. Three common conference presentation styles are: a Poster; an Oral paper; or as part of a Symposium.
For most journals you can submit a full manuscript anytime, and you will be asked to include an abstract. You will be asked to follow the authors instructions and these must be adhered to very closely – otherwise, your submission will simply be rejected – no one will read it at all. Don’t be overwhelmed though… just go through the step by step list, do as they ask… and things can proceed very smoothly.
When you submit your paper – your abstract is your ‘sales pitch’… Manuscripts and abstracts usually are sent to experts in the field – but only about 4 people in the first instance. You have to gain the interest of (usually) 3 peer reviewers and an editor or scientific chair person. The reviewers are called ‘blind’ – but only because they are not given your name or details, and theirs are not revealed to you! They are asked to critically analyse your submission and to make a judgement on whether it should be accepted and presented to the wider mental health audience (conference delegates or journal readership). It is complicated, and a big responsibility for the reviewers and editors – because they are to some extent the guardians of the evidence on which good practice is based. So – we want it to be a very rigorous, process so we can all trust it as much as possible, for the public good. It is a very serious business. What is more, is that reviewers don’t get paid for this work… it is volunteer on top of their other responsibilities, as a service to their discipline. So, don’t cheese them off with a half baked abstract!
So – here is the How To guide!
- You have 250 words (average) and that is all. Automated functions will only allow a certain number of words or characters and you simply can’t enter anymore than what the programmed file will allow. 250 words is common – you will soon find that when you start writing, they get get used up very quickly.
- Your 250 words must be captivating, interesting and thoughtful! (Remember your reviewers are volunteering to review your work… they have probably opened your file after dinner at night… after a long day at work… they are hoping to open something that will be inspirational – something new… now is not the time to let them down!)
- Make sure that you are reporting what you have actually done... not what you hope to do, unless you are presenting a protocol.
- Use key words that will help your work to be found in the literature searches of others in the future!
- Make sure you acknowledge your co authors and affiliations.
- Make sure your ideas are aligned to your audience – a good fit – you need to match the right audience, with the right time and the right ideas.
- Use a framework like this to organise your ideas and communicate them effectively (you don’t need to use heading but you can):
- Background/ Significance
- Make sure your work can be reviewed as recent, relevant, and reliable. (Don’t let it get too old… and don’t slice the salami too many times).
- Make sure the topic of your abstract matches the conference themes.
- Make sure you have a tight, concise and well argued discussion. Get a trusted mentor to read it through and critique prior to submitting.
Remember – if you get rejected – don’t lose heart… try again, look at the feedback, try to work on a new more convincing draft, seek feedback from someone with more experience than you, find a mentor… and of course – the reviewers aren’t infallible… sometimes they get it wrong, and you have to wear it. You will have to muster some resilience, be brave – refine… revise… rework... and try again another time.
A Christmas message for my mental health friends and colleagues... looking back with a grateful heart…
…looking forward in anticipation of more adventures, successes and exciting discoveries ahead!
What an amazing year 2017 has been from my perspective! With Christmas only a few days away… and a New Year about to dawn… I wanted to take a moment to reflect on my journey through 2017, and the companionship of the people who have journeyed with me! And, to pay respect…
This time last year, I was busy packing up our family home in Armidale, Australia… I was saying goodbye to my previous workplace, University of New England… farewelling my home town…
And, my husband, family and I were preparing for our usual big family Christmas traditions… the weather was hot… the days were long! There were plenty of mangoes…
Eleven and a half months ago (January 10) I arrived (with some of my family) in Odense, Denmark… to take up a new position at the University of Southern Denmark… about as far away from my home town as I could be, and still be on planet Earth! It was cold… dark… icy… People said it was brave… I think it was too… some times life requires that you step up to an uncomfortable plate… and be courageous. It is risky… but opportunities are!
It was hard to leave behind the old … and exciting to discover the new…
Milestones since leaving Australia:
- moved house 8 times
- emptied two precious jars of vegemite
- travelled to about 15 countries (some on repeat visits… and some in transit…)
- discovered the hygge phenomenon and acquired more candles than my husband approves of!
- published 9 book chapters/journal papers (that is my job!)
- learned to drive on the wrong side of the road
- there have been conferences, keynotes, grant proposals, reports… lots of successes… some near misses… and there are plenty of ‘ducks lined up’ for 2018 to look forward to!
There are many people to acknowledge and thank over the last year…
Always at the top of my list are my husband and family… but in my professional life, there are so many colleagues and old and new friends who have been such a great pleasure to work with this year.
I have throughly enjoyed working with every single one of my new Danish colleagues at the E Mental Health Research Unit and the Telepsychiatric Centre… Institute of Clinical Research in the Faculty of Health, University of Southern Denmark; the Region of Southern Denmark; and Odense University Hospital, and the Middelfart Psychiatric Hospital. Thank you to all for the wonderful welcome… kindness… and for the amazing work we have been able to contribute to the mental health discipline and the evidence-base for the care of people with mental health conditions this year!
To my colleagues in our various advisory committees, steering committees, and working groups, and partnership consortiums – it has been a tremendous year working with you also, and I am looking forward to continuing with you all in 2018.
All my co-authors and co-investigators… you are all amazing people and I value the work we have done in the past, and continue to do in 2018 immensely! We all need each other, and together we succeed, in the sometimes lonely and slow business of research. I absolutely love working with you all – and have the deepest respect for each of you and your skills, expertise and dedication to our collaborative work.
To my mental health and nursing colleagues and friends in Australia (and throughout the world…) thanks so much for your continued support and encouragement… some treasured mentors among you (especially Kim… Debra…)! Some have visited… (Cath & Eimear)… and more with plans to visit in 2018… and some I have been able to reconnect with in Europe (Kurt… Helen…) the world is actually a very small place! And the mental health research population, minuscule! The encouragement from colleagues and friends at the Australian College of Mental Health Nurses and the Congress of Aboriginal and Torres Strait Nurses and Midwives has been very warmly received as well. Mange tak! Many, many thanks… I am cushioned by such a fabulous network of mental health professional around me – and it is a source of strength and refreshment for me.
2017 has been fabulous, and if you are reading this blog – you probably played a part in making to so fabulous! Thank you!
There is a great deal more to be done in reducing the burden of world mental health problems… I am utterly convinced that technology has a very prominent place in delivery of safe, quality and effective mental health care of the future… and I am looking forward to working to increase the capacity we have further in 2018 along side my teams, students and collaborators.
I wish you all a very happy Christmas – God Jul til alle. Best wishes for 2018.
A short photo gallery 2017 in review:
Another hot off the press publication… in it we (Wilson & Usher) give some practical guidance about how to recruit using social media to ensure that mental health research is reaching the right informant audience to investigate mental health questions.
In this paper we argue that research protocols that engage only in traditional forms of media (eg newspaper, TV, radio) to recruit participants may in fact be missing an important informant group – those people who only use social media sources and no longer consume traditional media. We contend that there are ethical and practical implications if we miss these individuals in our samples … and that this might adversely impact our results…
This one has a paywall – so you need to use your library account to access a copy – but if you have trouble – message me and I will find a suitable solution for you to see a copy!
If you are a health or social researcher – you will be interested… if not… this one might be a little on the dull side… (boring disclaimer for the most of the world!) But – fascinating if you are into research and want to make sure we ask the right questions to the right people in the right way to answer our important research questions…
Click here to read the abstract/ summary and download if you can!
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
A new podcast discussing E Mental Health Research…
Getting your idea across to Your Reader is an art form!
Some days it can seem like just one paragraph is a mammoth effort… and that Your Reader is a million miles away!
The trick is to carefully determine who your audience is… and be mindful of preparing your writing specifically for them. Get to know Your Reader!
- What are the characteristics of Your Reader. Can you profile Your Reader? You will want to know exactly where your target lies and how to capture their literary attentions.
- Why would Your Reader be bothered to read your text? Communicating clearly and engagingly with Your Reader is your primary focus.
Short gripping and rich grabs are important handles for Your Reader
Your Reader probably reads in short grabs… most use the punctuation to guide them… but generally it is a grab of 5-10 words at a time…Then, Your Reader pauses to comprehend… and then they go on… and read a bit more… to the next few words… so every few words needs to be rich and meaningful.
Experiment: Pause for a moment now… reflect on how you read new text…? Will Your Reader have a reading pattern like you do… if so, write like you read! If not, adapt to match your writing style to suit Your Reader.
Aim for sentences with about 7 words or less! That way, Your Reader stays engaged, enthralled and most of all – awake!
- Use punctuation to guide Your Reader through the narrative pathway you have carefully designed.
- Make sure that your sentence construction is complete, and that you don’t leave the story line hanging… with an unfinished idea.
- Make sure that what you have written will convey the message you want it to convey, and that it is not possible to misconstrue the content.
- Don’t use sarcasm or double meanings in text… unless you are an expert story teller (most of us are not).
- Ideally a paragraph will be about 200- 300 words long, depending on Your Reader, and the complexity of the ideas, or depth of discussion in your paragraph. (Don’t worry – references are not included in the word count)!
- Use a referencing style that is acceptable to Your Reader. For example, a numbered referencing system might help to keep the text more readable for some audiences, while other readers want to see names and dates of references in text. Use some referencing software such as Endnote, so that your referencing is consistent throughout.
- Each paragraph needs to tell a concise and discreet part of the larger story that you are telling to Your Reader. Make sure your join the dots!
- Remember: The first sentence sets the scene for the paragraph. It indicates the big idea you are dealing with, and it outlines the topic or main theme for the discussion you are about to outline.
- Then, add one, two, three… (or reluctantly/ cautiously …maybe four) supporting sentences. Include evidence to back up your main topic/ main idea or main theme.
- The final sentence should conclude the paragraph. Summing-up the idea in a convincing crescendo. So Your Reader will have a ‘Arhhh’ moment, capturing the essence of message. Your Reader will want to feel as though they understand your idea. If Your Reader completes reading the text of your paragraph and then feels ‘dumb’, doesn’t get the gist of your idea… or is bored by it; then your haven’t conveyed a convincing message yet. Re draft, and try again!
- Each paragraph in the body of a piece of writing needs to contain three distinct elements: an idea, enough convincing evidence and a summary.
- And remember Your Reader is probably reading on an electronic device – computer, iPad, smartphone… so, write for the screen not the page!
Here are some two resources to help you structure a paragraph for your #300words this week!
- Paragraph-writing fact sheets for academic writing. Getting back to the basics.
- Writing a thesis – a great writing guide here: http://betterthesis.dk
Acknowledgement – The Burger Image for this blog is from the following writing resources team…. check it out – handy tips! http://www.readingrockets.org/strategies/paragraph_hamburger
Do you get stuck for words… or find that you are over using a word… however nice it sounds, or clever it seems?
Where can you find other words… when you need them. It can be especially challenging if you are writing in English language, but it is not your first language…Here are some websites to trigger your imagination and help you find the right word to describe the mental health phenomenon you are writing about!
- Dictionary… https://www.macquariedictionary.com.au/ http://www.webster-dictionary.org/
- Thesaurus… http://www.macmillandictionary.com/about_thesaurus.html
- Colour thesaurus… http://www.thesaurus.com/browse/color
- Number thesaurus… http://www.thesaurus.com/browse/number
- Emotions thesaurus… http://www.thesaurus.com/browse/emotion
- Bloom’s taxonomy… https://cft.vanderbilt.edu/guides-sub-pages/blooms-taxonomy/
- Medical dictionary of health terms… https://www.health.harvard.edu/a-through-c
- Mental health glossary… http://www.wamhinpc.org.uk/glossary-of-mental-health-terms
- WHO’s lexicon of mental health terms… http://apps.who.int/iris/bitstream/10665/39342/1/924154466X.pdf
- Glossary of psychological terms… http://www.apa.org/research/action/glossary.aspx
…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
Yesterday I was asked to discuss rural mental health with some other rural health colleagues in the rural and regional electoral seat of New England in Northern inland NSW on local ABC radio. With Federal Election 2016 bearing down on us (July 2, 2016) we looked at some of the pressure points for health in the electorate. Here is the audio from our discussion… hopefully this makes a useful contribution to the local debate, and advocates for fair and reasonable mental health service distribution in rural Australia – especially for our young people.
Click here to listen – happy to hear others views as well.
photo credit Above New England
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!
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