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Digital care: Treating mental health online

Friday 12th February 2016

In need of a pocket counsellor? Ellen Falconer and Mava Moayyed take a look at the burgeoning industry for mental health apps

Maram Abomaray and Salma Salat
Maram Abomaray and Salma Salat

Luke McPake

With internet trolls, cyberbullies and general keyboard ragers, it often seems unlikely that going online could actually improve your state of mind.

But two Kiwis are looking to change that by making the internet a safe place for young people to get help. Maram Abomaray and Salma Salat are building a mental health app for New Zealanders who might otherwise have little access to support thanks to barriers like cost, availability and fear.

According to the latest Youth2000 survey, 24 per cent of students reported self-harming, 12.8 per cent percent reported depressive symptoms, and 15.7 percent reported having suicidal thoughts.

When it comes to youth suicide,  New Zealand  is among the top in the developed world in suicides amongst 15–19 year olds, according to OECD figures.

“I feel like if we don’t do anything now, in 10 or 20 years’ time, we’re going to have a huge crisis,” says Maram.

“Physical health is something that’s accepted in our society but there’s a stigma attached to mental health and that really got me.”

After meeting at a women’s conference, the pair decided to team up and create something that tackled the problem they saw growing around them.

SocialCloud is a platform that gives young people the opportunity to voice and explore solutions to pressing personal problems. Targeted at 12- to 24-year-olds, it’s a safe online environment that stands in stark contrast to much of social media.

“I find with social media, if you do voice your problems, there is a high chance you’re going to get some kind of backlash and there’s a lot of cyber bullying going around at the moment. With our business, the whole idea is tackling that issue and creating a safe environment for people to voice their problems,” says Salma.

Users will be able join support chat groups, enter one-on-one discussion, or get professional advice from therapists right at their fingertips.

***

As of June 2015, there are 1.5 million apps available for download in Apple’s App Store. A quick search for ‘mental health’ brings up an endless stream of results, making the choice of best fit overwhelming.

Dr Robyn Whittaker works in e-health at the National Institute for Health Innovation. She recommends reading app reviews to see if they worked for other users before downloading. It is also important to consider who developed the app and what research went into it.

“You might want to look at where they come from, and if they are a reputable group. Obviously something that was developed by a university or a health service, particularly a local one, is more likely to be aligned with guidelines for treatment in New Zealand, than an app that was developed overseas. You don’t know whether they are an expert in that area or not.”

***

You don’t want to be out in the mall and somebody’s made you angry and you don’t want to pull out a sheet of paper and fill it out or whatever.

Kim, 30, has been using mental health apps for two years and has noticed an improvement to her overall mood.

She started using apps to assist with her mental health issues after moving countries and a break up with her long-term partner seriously affected her existing conditions.

She says that because there is still a stigma attached to mental illness, it has been a huge benefit to be able to monitor her anxiety discreetly from her mobile phone.

“I’ve been to a psychologist over the last couple of years just to sort out some stuff. They give you worksheets and introduce you to the ideas of reframing thoughts and other things that come with CBT, like mindfulness and staying present in the moment. You get worksheets, but then it’s kind of annoying and you have all of these bits of paper.

“You don’t want to be out in the mall and somebody’s made you angry and you don’t want to pull out a sheet of paper and fill it out or whatever.”

Her favourite app at the moment is one called MoodKit, which is designed to help the user to improve their mood by identifying negative thoughts and then reframing them. It comes with a mood tracker and a journal.

“You can put a journal entry in to say what was good about that day and you can start to see what your triggers are and how to deal with them, which I found really good too.

“You can also set your own goals and it will send you a reminder, like, ‘Hey you were going to go for a walk this morning, do you still want to go for a walk? How do you feel after the walk?’”

***

Whittaker believes apps based on the practice of cognitive behavioural therapy are most effective for addressing mental health issues. Cognitive behavioural therapy, or CBT, is a form of modern psychotherapy that can help manage mental disorders by changing thought patterns and behaviour.

“A lot of those strategies and techniques that are recommended in cognitive behavioural therapy are just really good disciplinary things to do anyway. Learning how to recognise negative thoughts and turning them into positive thoughts… keeping a gratitude journal.”

Robyn says the apps are an important part of the health care system, as they provide support for a large number of people who need less intensive care for their mental health.

With an estimated 70 per cent of New Zealanders now owning a smart phone, they are an accessible option for getting mental health care as and when needed.

Users can access an app to follow a self-help programme and be given some direction around strategy and techniques.

Many of the apps have a self-assessment to get started, or open with a question as simple as ‘How are you feeling today?’, so a familiarity with CBT or psychology is not essential.

***

At the moment, the telehealth industry is growing exponentially throughout the world because there’s definitely a need for remote care.

Salma says app-based care allows people to access help who would otherwise be isolated.

“At the moment, the telehealth industry – so that’s health communication applications or software – is growing exponentially throughout the world because there’s definitely a need for remote care,” says Salma.

Maram says in New Zealand, mental health funding is being put in all the wrong places and even when there is money, and the quality of care is low.

“To add to all of that, it’s really expensive. If you want to go to counselling, you’re looking at around $80 per session. That’s a lot of money,” she says.

They want Socialcloud to eventually have a paid feature where subscribers can get professional counselling for about $50-$60 each month. “We’ve worked out the costs and it’s completely possible.”

***

Kim also recommends the other mood-monitoring apps Happify and TracknShare, and Headspace and Simply Being for mindfulness and meditation.

The new trend in mental health apps are ones that are built around a community and offer peer-to-peer support, such as Kindly, TalkLife and KoKo.

“I think they are kind of nice and you do get to practice the skills you’ve learnt [reframing thoughts], but I think if you’re feeling really low or something, it’s not good to read everyone else’s intensely low situations too.”

Whittaker says using mobile apps is an effective treatment for low-level mental health issues.

“They’re based on what we know works, they’re based on the evidence of what works, they’ve proved that they have an impact and they have a definite place in the health service.”

Kim is keen to emphasise that a mobile application could never replace a personal session with a doctor, but having a daily practice does help to keep underlying negative thoughts at bay.

“I think that everybody can benefit from learning how to work their brains in a better way, because that’s essentially what you’re doing: understanding yourself.”

***

Woman uses the Headspace app on her mobile phone.
Headspace app

RNZ / Justin Gregory

Maram is Palestinian and moved to New Zealand when she was six. Her parents left their home on the Gaza strip to make sure she got a good education.For Maram and Salat, mental health apps are a way to give something positive, accessible and cheap to their peers, clients and communities.

Being a young Muslim gives her to drive to do sometime positive her community, says Maram, something she thinks is hidden under mounds of negative media attention.

“I think there are a lot of Muslims out there who do great things. We really need to look at those people.”

The 26-year-old studied psychology and is now a school guidance counsellor and master’s student. On a daily basis she sees the lack of mental health services for young people.

“The issue is there is a really big gap between those who need treatment and those who are actively in that treatment,” she says.

Her co-founder Salma Salat agrees. Working as a registered nurse in Auckland, the 22-year-old says she’s often around refugee-background youth and sees firsthand the prevalence of psychological hardship.

When Salma was five, she had moved to New Zealand with her family as a refugee herself.

“I’ve seen a lot of situations where they’ve been affected by mental health in a bad way and there haven’t been the services available to help them through it.”

Maram and Salma are currently at the prototype stage, collecting result from a survey to see exactly what their users want and need. They have also secured some funding from YouthLine and hope to launch the app later this year.

Want to talk?

Youthline - 0800 376 633, free text 234 or email talk@youthline.co.nz



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