Audio transcript (edited)

Webinar facilitated and speakers introduced by Elly Robinson.

ROBINSON

Good afternoon everyone, and welcome to today's webinar Logging in: Using technology in practice to improve young people's mental health. My name is Elly Robinson, and I'm the Executive Manager of Practice Evidence and Engagement here at the Australian Institute of Family Studies. In today's webinar, we will hear about the role of technologies in young people's lives and how they might be used to support young people's mental health.

Before I introduce our speaker today, I would like to acknowledge the traditional custodians of the lands on which we're meeting. In Melbourne, the traditional custodians are the Wurundjeri people of the Kulin Nation. I pay my respects to their elders, past and present, and to the elders from other communities who may be participating today.

Before we begin, I need to alert you to some brief housekeeping details. One of the core functions of the CFCA information exchange is to share knowledge. So I'd like to remind everyone that you can submit questions via the chat box at any time during the webinar. There will be a limited amount of time for questions at the end of today's presentation. And we will try to respond to as many as possible.

We'd also like you to continue the conversation we begin here today. To facilitate this, we've set up a forum on the CFCA website where you can discuss the ideas and issues raised, and submit additional questions. We will send you a link to the forum at the conclusion of today's presentation. Please remember that this webinar is being recorded and the audio, transcript and presentation slides will be made available on our website and YouTube channel in due course. Accessible versions will also be available.

It is now my pleasure to introduce today's presenter. Dr Michael Carr-Gregg is one of Australia's most prominent child and adolescent psychologists. He is the author of nine books, and has worked as an academic, researcher and political lobbyist. As Managing Director at the Young and Well Cooperative Research Centre, Michael plays a key role in leading and implementing the digital education program both in Australia and internationally, and works to extend the reach and impact of the Young and Well Cooperative Research Centre's initiatives.

Michael's extensive use of technology in his clinical practice gives him particular insight into the valuable role that technology can play in the diagnosis, treatment and prevention of mental health problems. Michael has also recently been appointed to the board of the Australian Psychological Society. So without further ado, please join me in giving our presenter a very warm, virtual welcome.

CARR-GREGG

Thank you very much, Elly. Over the past century, we have split the atom, we've spliced genes, we've sequenced the human genome and even roamed Tranquillity Base. And in July this year, a piano-sized probe called New Horizons showed us, with unprecedented clarity, a range of majestic mountains under endless plains on the planet Pluto, six billion kilometres from our Sun. My love of technology began as an 11-year-old. And I remember watching in awe as Neil Armstrong and Buzz Aldrin walked on the Moon.

I remember being mesmerised by the launch of Voyager 1, a little space probe launched on September 5 1977. And its mission was to study the outer solar system. I especially loved the fact that Voyager, in case it ever encounters aliens, is carrying photos of life on Earth, greetings in 55 languages and a collection of music from Gregorian chants to Chuck Berry, including a song by 20 blues man, Blind Willie Johnson, whose stepmother blinded him at the age of seven by throwing caustic soda in his eyes. And he died alone and penniless of pneumonia after sleeping in the ruins of his house that burnt down.

But thanks to this amazing technology, on August 25 2012, his music left the solar system. Fortunately for me, my love of technology is now combined with my love of, essentially, adolescent mental health. I work for the Young and Well Cooperative Research Centre. We're based in Victoria, and essentially work in very close partnership with young people. Participatory design is very important in the work that we do. We have 75 plus partner organisations, including governments and a plethora of universities.

We look at the exploration of new and emerging technologies to promote mental health and wellbeing, but also to diagnose and treat it in young people. We work with researchers, practitioners, policymakers and innovators across the academic, not-for-profit, government and corporate sectors, and we have just developed the world's first online certificate in young people's mental health and technology.

This goes live in November and we have very fortunately partnered with Orygen, the National Centre for Excellence in Youth Mental Health. If you are at all interested in doing this online course, and if by the end of this webinar you are really interested, just log on to the Young and Well Cooperative Research Centre and register an expression of interest and we'll be in touch with you. So the current situation, when it comes to young people's mental health, is that there would appear to be several, really quite significant risk factors that are impacting adversely on young people.

They might be family breakdown, sleep deprivation, obesity, early sexualisation. But what we do know is that mental health problems are really quite common in young people. One in four young people have a DSM-IV, V criteria mental illness, and one in seven children. In fact, it would seem that being a young person in 2015 is more complex than it has been previously. Twenty-eight per cent report moderate psychological distress, and suicide sadly is still the leading cause of death for young people aged 15 to 24. Later on, in this broadcast, we'll talk about how technology might be used in the prevention of youth suicide.

The latest research, completed by the Telethon Kids Institute in collaboration with the University of Western Australia, released just in August really did reveal the nature and extent of the problems young people face. In what is now the largest ever survey of youth mental health, this two-year study looked at 6,300 families, and found not just that one in seven children experienced a mental disorder, but one in ten were self-harming.

Fifteen per cent of the 16 to 17 year-old girls had suicidal ideation and one in forty had actually attempted suicide. What we do know is that a relatively small number of people actively manage their wellbeing. They seem to know relatively little about a healthy diet, exercise, mindfulness or the all important sleep hygiene. To provide evidence for this assumption that young people aren't doing very well, we need only look at the Mission Australia annual youth survey.

The nation's largest survey online, which takes, if you like, the temperature of young people's mental health between 15 and 19. It's been run every year since 2002. If you just look at the results for two years ago, you can see that over 50 per cent are either extremely concerned, very concerned or somewhat concerned about coping with stress, school and study problems, body image and depression. And in 2014, the same issues, same order, but greater percentage.

So whatever we're doing doesn't seem to be working. We need to get better, we need to get more efficient. What we do know is that if we look at the healthcare system, it is struggling. We know that it costs over $140b a year or 9.5 per cent of GDP. And with the aging population, the increased prevalence of chronic disease and the increased numbers of risk factors, it's quite clear that the current system will be unable to meet the demand. On the other hand, the really good news is that Australia leads the world in evidence-based mental health services. Many of which are targeting young people. And these services have been shown to encourage wellbeing and increase help-seeking.

So what are e-mental health programs? Well, it's long been recognised that the internet has been used by young people. And it's long been recognised that we, as mental health professionals, can put programs on that make a difference. The first e-mental health program was put online 25 years ago. The first study was done in 1990, a trial of cognitive behavioural therapy delivered by computer and tested against a therapist. And even back in 1990, both were found to be equally effective, particularly for mild to moderate depression and anxiety.

There's now been over 40 different studies that show that e-mental health is better than placebo. And in fact, a number of studies have shown they are as good as therapist intervention, which has enormous implications for our rural and remote people. But clearly, one size doesn't fit all and not all consumers necessarily like e-mental health interventions.

But if they do suit a particular person's way of getting information, they can be highly effective. E-interventions have been applied to a vast selection of mental health conditions. In effect, e-interventions now exist for depression, anxiety, alcohol, eating disorders, as well, of course, as the enhancement of wellbeing. We know that young people are, in fact, almost always online. Ninety per cent of them have internet access at home. Almost 70 per cent use a smartphone. And almost 60 per cent use their mobile phone to go online everyday.

There are now more mobile phones in the world than people. Smartphone use accounts for the majority of the recent growth in global mobile devices and they are clearly advantageous when it comes to young people because they're anonymous, confidential, cheap and of course very appealing. Associate Professor Leanne Hides highlighted this when she talked about the fact that we now have, as psychologists, an unprecedented opportunity to provide real-time, standardised health information and treatment direct to young people in their natural environment.

It's estimated that there are now more than 100,000 health-related apps. Most of these target exercise, diet and weight loss. And these are the most popular. Interestingly, there are about 700 mental health apps. But at the moment, they're not used extensively by young people. This is a shame, because it's quite clear that technology has afforded mental health professionals the potential to rapidly increase access to treatment. This could potentially result in population level improvements in mental health and wellbeing.

I use apps, web-based programs in my clinical practice and have done so for five years, particularly around psycho-education. I use apps on my iPad for screening and getting feedback from my clients. I have web-based programs that can teach young people social and emotional competencies like anger management, problem solving and decision-making. Apps enable my clients to self-monitor and track, allow me to track their treatment progress. I even have apps that I can give my clients who are on medication to make sure that they're compliant.

I use apps to give my clients homework, to train them up in particular skills, to manage their own anxiety and depression. And of course there are now a plethora of web-based programs that encourage help-seeking behaviour. The bottom line is that we can now help the 70 per cent of girls and the 80 per cent of boys with mental health problems who just don't seek help. We have got the potential to develop accessible, empowering and sustainable models of mental health care through technology.

This, of course, will result in lower overall delivery costs, less demand on the clinical workforce and of course overcomes a lot of the problems with stigma. Of course, with young people, their desire to be anonymous and to have confidentiality can be assured. Not only that, but in my psycho-education efforts, they can learn at their own pace. Programs such as Livewire, programs such as what now for CanTeen allow young people with chronic illness, for example, to collaborate with peers.

There's a particularly fantastic eating disorders app called Recovery Record and many of my clients with eating disorders love the opportunity to collaborate with similarly affected peers on a mediated website. And, of course, it is cheap for consumers who are traditionally very price sensitive. Many of these programs are simple, easy to use and require no particular skill. They're easy to access, anonymous and free. For clinical professionals such as myself, we can get reports, which can guide us in the treatment of our clients and with the overall treatment plan.

There is no doubt, in my mind, that technology can and is improving and augmenting existing assessment, diagnosis and treatment for young people. There is a fear by some in the sector that this will, in some way, takeover from them or make them obsolete. These are all used in conjunction with face-to-face treatment. A really good example of this is the Headspace psychosocial assessment interview. Now, this was developed many, many years ago, 1988. Goldenring and Cohen came up with a way of interviewing young people. It was called the HEADSS analysis.

H stood for home, E for education and activities. D, depression, drug use, suicidality and sexuality. Interestingly, this particular format of interviewing young people has taken on great currency and is used, for example, at all Headspace centres across Australia. One of the great things about this is that the Centre of Excellence adapted the original HEADSS assessment interview and changed it to the Australian context. It extended the domains covered to allow the detection of more serious mental health problems.

The Headspace psychosocial assessment interview consists of screening and probing questions. It's particularly good for younger practitioners who perhaps don't feel confident to conduct the full interview. They can just basically complete the screening questions they feel competent to address and if those questions suggest the need, they can refer on to another, more experienced practitioner.

What's particularly interesting is that Sally Bradford, a provisional psychologist and PhD candidate at the University of Canberra, decided to take the HEADSS screen and to put it on an iPad. What she wanted to do was see whether or not, in fact, if you create this in a digital format, whether or not it made any difference. So her PhD looked at giving a number of young people the HEADSS assessment through the iPad compared to a similar HEADSS assessment delivered face-to-face with a clinician.

What she discovered was quite extraordinary. She actually was awarded a prize from the former Prime Minister as a result of this amazing research. What she discovered was that young people were much happier to disclose information to the iPad than to a clinician. And this particular slide shows the really quite staggering increase in disclosure, particularly over traditionally, shall we say, sensitive areas like substance abuse, sexual orientation, self-harm and unsafe sex.

Her research showed at least 10 times, up to 10 times, the rates of disclosure over and above face-to-face interviews. So the idea behind this is that it will be developed by the CRC into an app sometime next year. And workers with young people, in health, education and welfare will be able to use this particular app to gain valuable information from their clients, which hopefully will result in the greater potential for prevention and early intervention, improved help-seeking and self-disclosure, reduced costs and a reduction, hopefully, in suicide, self-harm and accidental death.

This is one really concrete example of how brilliant the technology is and the sort of advantages that can accrue with its judicious use. Of course, it's not just about apps. Australia has an enviable number of e-mental health portals. And these are really wonderful for clients to get more in-depth information about mental health issues. They can learn about specific information on signs, symptoms and diagnosis. They can learn about the various services and programs that are available to them, what the problems might be, advantages and disadvantages with various medications that they get. Of course, the other thing is it allows them access to other people's experiences of mental health issues or services on moderated websites, a validation of their experience and concerns, and provides them with a range of strategies to guide their own recovery and to learn from other people's journeys. It also encourages help-seeking and increases mental health literacy.

And of course, there's no stigma with this whatsoever. The major Australian mental health portals, which I encourage all of you to visit, are listed here. One of the great things about these is that they're constantly being updated. mindhealthconnect is a website which aggregates mental health resources and content from the leading health-focused organisations in Australia. It includes fact sheets, audio and video content.

It was launched in July 2012 and focuses primarily on the high prevalence disorders of depression, anxiety, stress, eating disorders. The other website that I strongly recommend to all workers with young people and health education and welfare is the Beacon website. This is your portal to online apps and web-based programs for mental and physical disease. It's part of a suite of self-help programs developed and delivered by the National Institute of Mental Health Research Centre at the Australian National University.

One of the things I love about this as a practitioner is that I can go to this website and I can click on a particular button which relates to which particular condition a young person might have. And one of the amazing things, as you can see, is the vast array of conditions that I can check: alcohol, depression, phobias, sleep problems, smoking and substance abuse are just a few.

The idea being that as you click on these, you get a range of different apps and web-based programs. But more importantly, they are rated in terms of the evidence base. So if you were to go to the depression one, the first web-based program you see is, in fact, MoodGym, developed by Professor Helen Christensen at the ANU. And what that will tell you straight off is that there have been no less than seven randomised controlled trials showing the efficacy of this particular program for mild to moderate depression and anxiety.

So it is with a great sense of confidence that I can use MoodGym with my clients, particularly as homework or even in session for explaining the fundamentals of cognitive behavioural therapy. This is going to ruin your weekend if you go through every single one of these and go through it. But really, if you're going to be as interested in e-mental health as I am, you'll happily give up your weekend. MoodGym, in particular, is a cognitive behavioural therapy-based intervention designed to prevent and treat depression.

It helps my clients identify and overcome problem emotions and develop really good coping skills. It consists of five different modules and they take about 20 to 40 minutes to complete. You'll also see a range of other programs there, all of which have similar evidence bases. And really, it's a matter of you exploring them before you suggest them to a client. There are also some fantastic resources now to help young people with anxiety. One of my favourites is ReachOut Breathe.

This actually helps my clients reduce the physical symptoms of stress and anxiety simply by slowing down their heart rate using a mobile phone or, believe it or not, your Apple Watch. It measures their heart rate using the camera in their phone. This is really wonderful technology. And once you demonstrated this in session, my experience is that young people will basically use this. There is a really fundamental principle here, and that is that I cannot be with my clients when they're having an anxiety attack.

But in 2015, you can bet your bottom dollar that they'll have a mobile phone with them and therefore they can be trained to use these particular apps when they need it. Another really interesting set of apps and web-based programs are designed to assist with wellbeing. I'd encourage you to go through these slides once the webinar is over and actually have a look at some of these.

They are brilliant. Balanced, for example, is an interactive goal-setting app which I use to help my clients develop healthy habits. And it seems to motivate and support them to achieve positive and healthy goals in their life. So you can also have a look at some of the other ones as well. Some of them are based on positive psychology such as Happify, but they really are, I think, excellent. And if you go to the Beacon website, you'll see that they're all listed there as well.

Of course, generally speaking, they're apps designed to assist with wellbeing. And I have to disclose my conflict of interest here.I am on the board of Smiling Mind. But this is an app which has now had over 800,000 downloads across Australia. It is modern meditation for young people, a very simple tool that gives a sense of calm and clarity and contentment. One of the really special things about Smiling Mind is that it's one of the only apps which is divided up by age.

So there's a particular section in the apps for 7 to 11 year olds, another one for 12 to 15 year olds, another one for 16 to 22 year olds and of course there is one for adults as well. Now, when we talk about high prevalence disorders, of course, we can't move away from the issue of substance abuse. So I thought I'd give a little example of how I might use some of the programs that are available with a client. And I'd like to introduce you to Toby.

He's 19, he's been smoking cannabis and drinking alcohol since he was in Year 9. He lives at home with mum, dad and the sister. He dropped out of school after Year 10, now periodically attends TAFE because he has the goal of completing Year 12. Both of his parents are unemployed. His new friends at TAFE are, I'm afraid, not necessarily what we would call pro-social peers. They're heavy drinkers. They use quite a bit of cannabis and ecstasy. And his use of alcohol and cannabis seems to be on the up just lately.

His parents suspect episodes of injecting other drugs, but he doesn't want to talk about that to them. He's been missing classes, his motivation to study is approaching zero and there is a lot of conflict at home. He's been interviewed by the police. He's now on a caution. Things are not looking good for him. What sort of options are there for me?

Well, apart from seeing him and talking to him, and trying to get his point of view, one of the things that I can do with Toby is I can sit in my office with two iPads and I can download a free web-based program called Clear Your Vision. Clear Your Vision involves, essentially, 19 specific steps. Starting with him choosing which of the four characters you can see on the screen that he most closely identifies with and moving through to the changes he wants to make and how. In between that, he actually gets to sit the SDS, which is the substance abuse scale – substance dependant scale.

And he actually can see, objectively, whether or not in fact he does have a dependence problem. It's quite amazing, the number of times I've used this, parents might've told the kids they're dependent on cannabis but they only really truly believe it when an iPad tells them. It's really quite bizarre. So one of the things that we can do with this is there's a degree of motivational interviewing. And what I've actually found is that going through this, allowing him to set a quick date or a date at which he can reduce his use is an incredibly powerful tool. But it's not just Clear Your Vision.

The Victorian Youth Drug and Alcohol Advice Service has actually gone virtual. This is just the most amazing web-based program and smartphone app designed to help young people like Toby reflect on their drug and alcohol-related needs. It really plays the role of a digital drug and alcohol counsellor, encouraging help-seeking and offering next steps. This is really quite a brilliant construct and I am sad that it currently only applies to Victorians. But if you do live in Victoria and you do have contact with young people who have substance abuse problems, this would be a fantastic first step. There are other just generic apps around alcohol.

Ray's Night Out was developed at the Queensland University of Technology. And this is a really clever idea. The app can be downloaded for free and users can take Ray the Panda out on a night, for a night out basically. They can buy Ray drinks and they can buy him food, they can even make him dance and they can even make him flirt and play bar trivia. You can collect good vibe points to unlock rewards and essentially even take selfies. The idea behind this is to take good care of Ray. He is in fact a virtual friend.

And it's all about not letting him cross his stupid line for drinking where, essentially, a good night turns bad. I would encourage you to download this app not because I'm suggesting for one moment that you have a substance abuse problem, but I just think this might be useful to some of your clients who might be able to make some use of this particularly. And it just shows how you can gameify some of these apps and really make them quite interactive. I think this has huge utility from an education point of view as well.

So, on to, finally, the issue of suicide and suicide prevention. Many of you would be aware of the fact that suicide is the 13th leading cause of death worldwide and is the leading cause of death among those aged between 15 and 39. One of the sad things is that Australia actually lacks an agreed upon national program of action on suicide. What we know is that the most effective way to combat this issue really involves a simultaneous system-based approach that includes medical, health and community agencies within a region.

All of who implement a specific set of evidence-based procedures. Now, many people have talked about the role of social media in suicide. And as Jo Robinson from Orygen, the National Centre for Excellence in Young People's Mental Health often says, social media often gets quite demonised when it comes to suicide. The reality is that we need to acknowledge the ubiquitousness of social media and ask whether or not it's possible to transform social media into a therapeutic tool to provide services, and connect and empower young people who might be at risk.

There's an excellent report on the Young and Well website written by Jo and her colleagues on suicide and social media. And I'd encourage you, if you don't download anything else, this is just a brilliant, brilliant publication. So, why is social media demonised regarding suicide? Well, very often it is the case that in the wake of a suicide, particularly one that receives a lot of publicity in the media, online memorial pages, photos and comments often spring up and can normalise, sanitise and often glamourise the incident in a way that is thought to be really quite counterproductive and could, in fact, cause this contagious effect.

There are any number of examples you can find on the internet, and I just put one example here. We also know, though, that social media isn't going anywhere. It has a role. And it's particularly interesting to look at cases like this one where a group of Melbourne young people were extremely disappointed in local professional responses to a particularly suicide, and as a result, created their own suicide prevention group on Facebook.

Within a very short period of time, it had more than 20,000 members and the group became so large so quickly that mental health professionals were enlisted to monitor the pages, with about 1,000 referrals to outside services made in just about three months. So this, I think, is a really stark example of how we can't ignore social media. We can sit around saying how dreadful it is, but we really need to use it. As I said, it's not going anywhere and the truth is, young people very often prefer using social media than seeing professionals.

They're not particularly sophisticated consumers of healthcare, let alone mental healthcare, so that's very understandable. So the question is, how might we be able to engage in a positive and constructive way using social media to work with young people and provide a meaningful service to them? Well, internet-based treatment, as I've already said through CBT, has become a very common way to treat adolescents with depression, anxiety and suicidal ideation.

And no one's suggesting this should replace face-to-face treatment. But there's a lot of evidence that it can be beneficial. One of the things that I don't think is clearly understood is that about 90 per cent of young people who take their own lives actually have a mental illness. And by far away, the most common mental illness is depression. Therefore virtually any program, any web-based program, any app that addresses depression in terms of helping people understand it, gets treatment is in fact, I believe, should be considered part of suicide prevention.

We also know that text-only hotlines, which are very, very popular in the United States, play an important role in helping people in distress. There are any number of social media prevention and anti-stigma campaigns like R U OK that have been found to be very useful. In fact, the United States is trialling, as we speak, a new feature on Facebook that allows users to report suicidal posts or content.

And that is hopefully going to come to Australia quite soon. But are there specific apps that can help when it comes to suicide prevention? Well, there are currently quite a few suicide prevention apps and many of them being created for specific populations. MY3, which I'll explain in a second, is a general app. There's Ask, another one. Guard Your Buddy, which is one of a number of military suicide prevention apps for people who are currently serving and people who have served. And iBobbly, which is one of the only apps that particularly target our Indigenous young people. And that was developed by the Black Dog Institute in Sydney.

The problem with all of these apps is that there's a paucity of good evaluation and this is something that the Young and Well CRC and of course organisations like the Australian Institute of Family Studies are already concerned about. Part of the problem of course with evaluating apps is that by the time you get an evaluation up, quite often the app has moved on. It is redundant and it has been replaced by another one. So, trying to keep up to speed in this space is not always easy.

So let me tell you about the app that I'm using in clinical practice as part of my work, particularly with suicidal and depressed young people. This particular app was developed in California. I do use it here in Australia only because there's nothing like it, but I really have to caution young people that the telephone numbers that it sometimes mentions are American helplines, not Australian. So this particular app is superb. I'm sitting with a client who I may believe to be somewhat suicidal and I can simply ask him or her to bring out their mobile phone, I can get them to download this app in my office.

And what we can do is together complete, essentially, a digital safety plan. They can actually send it to me, but they've always got it on their phone and they can send it to whomever else that they like. It's basically divided up into six key areas. The first is we can sit together and record what might be the warning signs that they are perhaps going downhill.

And we can customise these to the young person's particular situation. But there are also some generic warning signs that I would encourage the young person to consider putting in there. The second part is coping strategies. And again, I have my list but what we can do is perhaps take a list of 10 and whittle it down to the top three that they really, really like, and that's what goes into the coping strategy plan. Distractions, we know, are a very, very effective way and in fact I will often recommend specific apps that will help them distract themselves.

There's one particular one called FocusUp Pro, which I haven't mentioned in any of the slides, but it's a particularly good way of occupying the young person for quite a prolonged period of time. The other thing that I will encourage them to do is to establish a network. And the network really relates to the name of the app, MY3. So I encourage them to download photographs of the three people who they would most want to talk to if they were beginning to feel down. The way it works is as their photos are downloaded onto this app, so will the phone numbers.

So, in a moment of particular bleakness, they can just press on the photo of the person and their phone rings right away through. They're also in, section five, a number of strategies around keeping themselves safe. And of course, we also list my reasons to live. So this, I think, is a very clever app. I've just put some examples there of people one might put in. And I think you can see underneath there what I said about the American, "Call 911". Someone told me recently in Australia that if you do dial 911, it does still go through to 000. I don't know. I've never tried it.

But I've been told that that is, in fact, the case. And of course, the problem is that the, "Get help now" puts you through to the National Suicide Prevention Line in the United States. So you do have to warn people that. Now, the good news is that there are, as we speak, several organisations actively building very similar apps here in Australia.

And with a little bit of luck, they should be available. Some are being trialled as we speak. They should be available to workers with young people in health, education and welfare about halfway through next year. Certainly, if you log on to the Young and Well website, we would keep you up to date and informed as to what is going on. So, what this particular website does, what this particular app does is it allows you to help your clients create their own support system, literally build a safety plan. There is a good deal of data to show that building safety plans work and is one of the most important components of helping young people who have suicidal ideation, or particularly those who you feel are tremendously at risk.

It enables them to access the important resources to get support at a time of greatest risk. And I'm very impressed with the way in which this has been put together. So, to end, I just want to tell you a little bit more about the Young and Well's Certificate in Young People's Mental Health and Technology. Look, this is, as I said, a world first. It's in conjunction with Orygen, the National Centre for Youth Mental Health at Melbourne University.

And what we've done is we've put it online. There are four distinct modules: an introductory module, a module that looks at how one can integrate technology into clinical practice, one that looks specifically at suicide and self-harm prevention, and one that looks at the legal, ethical and moral dilemmas working with this. Each module is just seven hours. There are four of them. So, all up it's 28 hours of online learning. And it contains readings, a whole vast amount of resources for you to use.

One of the most exciting things about this is if you complete this – and it costs $250 per module – if you complete this you'll then be eligible to do the graduate diploma, which we're writing at the moment. And then on to the diploma and the graduate diploma. As I said, this is a world first. We literally have first-mover advantage. No one else has developed this particular type of course. We have two streams: one for clinicians and one for people who are just interested in the general welfare of young people.

So all you have to do is log on to the Young and Well website, click on the blue section there where it says, "Certificate in Young People's Mental Health and Technology", make your expression of interest and we will be in touch with you. Well, I've gone to my allocated time. I'm now going to hand back to my friend and colleague, Elly Robinson.

END OF WEBINAR

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CFCA webinar - 20 October 2015

1. Using technology to improve young people's mental health
   • Dr Michael Carr-Gregg PhD MAPS Managing Director, Young and Well CRC
   • Australian Department of Industry and Science
   • Business Cooperative Research Centres Programme
2. Image: Thank You Road sign
3. Image: Astronaut on the moon with USA flag
4. Voyager 1
5. Blind Willie Johnson
6. The Young and Well CRC
   • Victorian-based, international research centre
   • Working in very close partnership with young people
   • 75+ partner organisations, including governments & universities
   • Exploring new technologies to promote mental health and wellbeing
   • Researchers, practitioners, policy-makers and innovators across the academic, non-for-profit, government and corporate sectors
7. Image: Young and Well website
8. Current situation
   • Mental health problems are common in young people. There is evidence that the current generation has more difficulties than previous generations in coping, resilience and wellbeing.
9. 28 per cent report "moderate" psychological distress, despite reporting generally good health (Burns, Davenport, Christensen et al., 2013)
   • Suicide is the leading cause of death for young people aged 15 to 24 (Australian Bureau of Statistics [ABS], 2009)
10. The Mental Health of Children and Adolescents
    • Report on the second Australian child and adolescent survey of mental healh and wellbeing
11. Current situation
    • Webpage with headine: Quarter of teen girls self-harm: study
12. Current situation
    • Only a small number of young people actively manage their wellbeing or engage in early help-seeking behaviour.
13. Youth Survey 2014, Mission Australia
14. Results: Issues of personal concern to young people 2013
    • Diagram: More than 50 per cent of young people are either extremely concerned, very concerned or somewhat concerned about coping with stress, school and study problems, body image and depression
15. Results: Issues of personal concern to young people 2014
    • Diagram: A higher percentage of young people in 2014 were either extremely concerned, very concerned or somewhat concerned about coping with stress, school and study problems, body image and depression than in 2013.
16. Current situation
    • The not so good news: The healthcare system is under strain and youth mental health services are unable to meet the demand.
    • The good news: Australia is a world leader in developing online, evidence-based mental health services, many of which are available for young people. These services aim to encourage wellbeing and help-seeking.
17. What are e-mental health programs?
    • It has long been recognised that the internet provides enormous potential for health care delivery – particularly mental health care resources
18. E-mental health – research evidence
    • Over 40 studies show e-mental health interventions are better than placebo
    • Many studies show that they are as good as therapist intervention
    • One size does not fit all, but many consumers like e-mental health interventions
    • If they suit a particular person’s way of getting information they can be highly effective
19. Image: Time magazine cover with Headline: Never offline
    • 90% of yp have internet access in the home
    • 69% of yp use a smartphone
    • 56% use their mobile phone to go online
    • Diagram: The frequency of teenagers going online is increasing... 72% go online more than once daily
    • Source: 15 July 2014
20. Technology such as smartphone apps, web-based programs and wearable devices are an effective way of engaging young people, because they are anonymous, confidential, cheap and appealing.
21. Associate Professor Leanne Hides
    • "…The sheer penetration of smartphone use and apps provides an unprecedented opportunity to provide real-time standardised health information and treatment directly to young people in their natural environment."
22. Uses of mobile apps in practice with young people
    • Psychoeducation
    • Screening and feedback
    • Decision making, problem solving and goal setting
    • Self monitoring and tracking of treatment progress,
    • Medication adherence
    • Homework
    • Skills training
    • Self-management
    • Help seeking
23. Advantages of technology in mental health
    • Can help the 70% of Australians with mental health problems who do not seek help (McGorry 2012)
    • A need to develop more accessible, empowering and sustainable models of mental health care. (Christensen 2009)
    • E-health technologies have potential efficiencies and advantages in the domains of health promotion, prevention, early intervention and prolonged treatment.
    • Lower overall delivery costs
    • Reduce demands on the clinical workforce
    • Allows people to avoid stigma
    • Allows people to be anonymous & what they do is confidential
    • Self-paced learning
    • Opportunities to collaborate with peers
    • Cheap for consumers who are price sensitive
24. Why recommend e-Mental Health programs to young people?
    • Simple, easy to use and require no particular expertise.
    • Easy to access, and most are anonymous and free.
    • For clinical professionals, provide content and reports which can guide sessions with patients and the overall treatment plan.
25. Technology can improve and augment existing assessment, diagnosis and treatment for young people.
26. The headspace psychosocial assessment interview
27. The Centre of Excellence adapted the American HEEADSSS assessment interview.
    • This included:
      • changing the language to suit the Australian context
      • extending the domains covered to allow the detection of more serious mental disorders.
28. The headspace psychosocial assessment interview
    • The tool consists of a set of 'screening' and 'probing' questions.
    • Practitioners who do not feel confident to conduct the full interview with a young person should choose only to complete the screening questions they feel competent to address.  If these screening questions suggest the need, refer on to another experienced practitioner for a full assessment.
29. Sally Bradford…
30. A solution: MyAssessment
31. Results: Increased disclosure
    • Diagram: In the current study, young people were much happier to disclose information via the iPad than to directly to a clinician. The rates of disclosure via iPad were up to 10 times higher than face-to-face interviews.
32. Potential outcomes
    • Greater potential for prevention and early intervention
    • Improved help-seeking and self-disclosure
    • Reduced medical, carer and welfare costs
    • Reduction in suicide, self-harm and accidental death
33. E-mental health portals
34. Advantages of mental health websites
    • Initial or more in-depth information about mental health issues
    • Specific information on signs, symptoms and diagnosis
    • Information about services and programs
    • Information about medication and potential side effects
35. Advantages of mental health websites
    • Access to other people’s experiences of mental health issues or services
    • Validation of experiences and concerns
    • Strategies for young people to guide their own recovery
    • Encouragement for further help seeking
    • Mental health literacy
    • Anonymity
36. Major Australian Mental Health Portals
    • www.mindhealthconnect.org.au
    • https://beacon.anu.edu.au
    • http://au.reachout.comu
    • https://www.healthonnet.org
37. Image: Mindhealthconnect website
38. Image: Mindhealthconnect website
39. Image: Beacon website
40. Image: Beacon website
41. Apps and online tools are designed to assist with depression
42. Apps and online tools are designed to assist with anxiety
43. Apps and online tools are designed to assist with wellbeing
44. Apps and online tools are designed to assist with wellbeing
45. Case study - Toby

Toby, 19, has been smoking cannabis and drinking alcohol since he was in Year 9. He lives at home with his mother, father and sister. He dropped out of school after Year 10 but is now attending TAFE to complete Year 12. Both of his parents are unemployed.

Toby’s new friends at TAFE are heavy drinkers and users of cannabis and ‘‘ecstasy’’, and his use of alcohol and cannabis has increased lately. His parents suspect episodes of injecting other drugs, but Toby refuses to confirm this. He has been missing classes and his motivation to study has decreased rapidly. There is conflict at home and Toby has been interviewed by the police, and issued with a caution

1. Case study - Toby
   • Web-based intervention: Clear Your Vision
   • Involves 19 steps, commencing with him choosing which of four characters he most closely identifies with, and moving through to changes he wants to make and how
2. Case Study - Toby
   • YoDAA is a smartphone app designed to help Toby reflect on drug- and alcohol-related needs. It plays the role of a digital drug and alcohol counsellor, encouraging help-seeking and offering next steps
3. Case Study - Toby
   • Ray’s night out smartphone app is designed to increase the knowledge of harm minimisation strategies for alcohol consumption among people aged 16-25.
   • Participatory workshops with young people were used in design phase
4. The World Health Organization states that suicide is the 13th leading cause of death world- wide, and is the leading cause of death among those aged between 15 and 39.
   • Image: Cover of WHO report - Preventing suicide: A global imperative, Executive summary
5. Current situation
   • Australia lacks an agreed national program of action on suicide.
   • Evidence suggests that the most effective suicide prevention response involves:
     • a simultaneous systems-based approach that includes all relevant medical, health and community agencies within a region
     • all of whom implement a specific set of evidence-based procedures.
6. The role of social media in suicide
   • "…Social media gets demonized quite a lot when it comes to suicide." Dr Jo Robinson, Orygen
7. Question…
   • Is it possible to transform social media into a therapeutic tool to provide services and connect and empower teens?
8. The role of social media in suicide
   • Suicide and Social Media paper: http://www.youngandwellcrc.org.au/wp-content/uploads/2014/07/Robinson_2014_Suicide-and-Social-Media_Findings-from-the-Literature-Review.pdf
9. Why is social media demonized regarding suicide?
   • In the wake of suicides, online memorial pages, photos and comments often spring up and can glorify the incident in a way that is thought to contribute to a contagion.
   • Image: Webpage with heading - Tormented by trolling: The vile web craze that taunted family of bullied Natasha even after her suicide.
10. Proof that social media has a role
    • Image: Webpage with heading - Facebook youth suicide prevention group needs government funding.
11. The reality is:
    • Social media is not going anywhere
    • Young people actually prefer using social media than seeing professionals
    • How can we actually engage in a positive and constructive way with social media to work with young people and provide a service to them?
12. Why use e-mental health strategies in suicide prevention?
    • Internet-based treatment has become an increasingly popular way to deliver health programs across the board,
    • Cognitive behavioral therapy (CBT), a method considered one of the most effective ways to treat adolescents with depression, anxiety or suicidal ideation.
    • Online program shouldn't replace face-to-face treatment, but can be a beneficial "adjunct" treatment for teenagers in particular.
13. New media and suicide prevention
    • Text only hotlines
    • Social media prevention and Anti-stigma campaigns
    • New feature on Facebook that allows users to report suicidal posts or content
14. What about smart phone apps?
    • There are currently hundreds of suicide prevention apps that have been created for specific populations, such as:
      • My3
      • Ask
      • Guard Your Buddy
      • iBobbly
    • There is a paucity of appropriately designed, properly evaluated smartphone apps or web-based programs to address issues of suicide
15. My3
    • http://www.my3app.org
    • Image of My3 app: My3 lets you stay connected when you are having thoughts of suicide
16. My3
    • Your safety plan
17. My3
    • Get help now, Call 911
18. My3
    • Create your support system
    • Build your safety plan
    • Access Important Resources
    • Get support at times of greatest risk
    • Access the National Suicide Prevention Lifeline 24/7
19. Young and well webpage
    • Our tools and insights