intervention

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Using e-Mental Health to Help Our Clients

by Dr Tania McMahon

As part of the Australian Government’s recommended stepped care model of mental healthcare, ‘e-Mental Health’ services (low-intensity online mental health interventions and resources) are becoming a much more important part of our mental health system.

With 1 in 5 Australians experiencing mental health difficulties, low intensity interventions can provide an ideal option for individuals with mild-moderate mental health symptoms where other options (e.g. psychologist referral, medication) might not be suitable. However, e-Mental Health services need not be an either-or choice when compared with face-to-face treatment. In fact, e-Mental Health services can fill multiple roles in the space between an individual seeking help from their GP and accessing treatment with a Psychologist, from initial psychoeducation and increasing acceptability of face-to-face services for first-time help-seekers, to crisis support between appointments, to providing interim support and brief intervention for busy periods where they may be on a waitlist.

Below is a brief guide to the range of e-Mental Health services available (Table 1), as well as an outline of the various roles e-Mental Health can play, and which services are most appropriate.

All listed programs have been developed by credible sources, such as the Australian Government, universities, and national nongovernment organisations.

Table 1. e-Mental Health Service categoriesHere is an outline of some of the ways e-Mental Health can be used to help our clients:

 

Head to Health
(https://headtohealth.gov.au/)

Previously ‘mindhealthconnect’, this is the Australian Government’s portal to mental health information and e-Mental Health services. It enables consumers to search for information and receive advice about their mental health needs.

 

Telephone and Webchat Telephone and online chat services, most often free and used for crisis support, information-seeking, or brief counselling.
  • Lifeline
  • Kids Helpline
  • eHeadspace
  • Suicide Callback Service
  • Beyond Blue Support Service
Psychoeducation Websites Freely accessible websites providing mental health information, and often general tips and strategies for wellbeing.
Online programs Online self-guided courses that are either transdiagnostic (i.e. targeting common core mental health symptoms), or address a specific problem (e.g. Social Anxiety, PTSD). Some programs offer limited guidance from a therapist via phone or email. The majority of programs are free, with a few being low-cost.
Apps Easy and convenient to use (as they are mobile- or tablet-based). However, due to the number of apps available on the market and the relative ease in creating them (compared to the more comprehensive online programs), many do not have experimental validation. As such, it is important to thoroughly check the content and credentials of any app before referring to it.
  • BeyondNow Suicide Safety Planning app (developed by Beyondblue)
  • MoodPrism and MoodMission (developed by Monash University)
  •  AIMhi Stay Strong App (developed by Menzies School of Health Research for practitioners developing a mental health plan with ATSI clients)

 

1. As crisis support:

  • Telephone and webchat services are a great option for clients to contact if they need immediate support out of hours or between appointments with their healthcare professional.
  • Apps such as the BeyondNow Suicide Safety Planning app can help clients and their healthcare professional create a strong, structured plan for dealing with ongoing crises and distress.

2.     Psychoeducation for first-time or hesitant help-seekers:

  • Head to Health, the government’s mental health information portal, is a great place to direct clients to in the first instance.
  • Psychoeducation websites are fantastic tool for providing information about general stress and wellbeing, specific diagnoses (e.g. generalised anxiety, eating disorders), or specific problem areas (e.g. parenting, relationship issues, work stress) to first time help-seekers.
  • Online programs (particularly the transdiagnostic programs that don’t focus on a specific diagnosis, such as myCompass) are a great option for help-seekers who are hesitant or uncertain about face-to-face mental health intervention.

3.     Interim support:

  • If clients are on a waitlist or aren’t able to access timely support due to situational circumstances, online programs and apps can provide a great option to help them start working on their wellbeing in the meantime (which also means they can hit the ground running when they are able to commence face-to-face intervention).

4.     To complement face-to-face treatment:

  • Online programs and apps can help build on the skills being taught in therapy, such as CBT strategies, mindfulness and positive psychology. Whilst using these resources as a complementary tool can involve a little extra work on the part of the clinician (i.e. to be able to get to know the programs available and find ones that complement their work), it can really help to strengthen and reinforce the work done in session.
Using e-Mental Health to Help Our Clients2019-03-27T13:59:30+10:00

Freeing Ourselves From Avoidance

By Dr Jasmine Pang

As human beings, we are encoded to survive by avoiding things that are likely to cause us pain, which we have learnt in the past to induce pain or which is stressful or unpleasant: be it that giant spider sitting on the clothing line, that shoulder pain that has been ongoing for a while, or an article that you have promised to write for your upcoming practice newsletter.

In the initial phases, avoidance can work very well. By just using the part of the clothes line that the spider has not occupied, by not thinking about the article I need to write or by working around my sore shoulder, I can pretend that everything is ok and continue on my merry way. We work around it. The problem is that things very seldom remain the same. My resident clothesline spider decides to expand his territory and take up more and more of my clothesline, my shoulder pain worsens to a point that I cannot reach up beyond my shoulder and my practice manager starts sending me “reminder emails” that I cannot avoid anymore. Whilst some avoidance can be a very successful strategy to keep us safe from stressful situations, unpleasant experiences or threats, it can also become counter productive

So what have I learnt about avoidance?

1. Avoidance can be helpful when threats are real. If that spider on the clothesline turns out to really be that gastly dangerous “it’ll kill a grown man within an hour” species that Australia seems prone to having, avoiding it is probably a good idea. We can never totally avoid all the things that we want to avoid. It is seldom that avoidance makes things go away. The spider is still on the line, my shoulder still hurts and the looming newsletter article deadline is still there.

2. Avoidance feeds fear and is an all consuming voracious creature. The more we avoid the greater the problem often becomes. This is particularly so with anxiety. The more anxious I feel, the more I avoid. The more I avoid, the more anxiety I feel. As time goes by, our world becomes smaller and smaller and we feel more and more trapped.

3. Avoidance prevents us from learning that something different can happen or that what we were so fearful of is not as bad as we expected it to be. It prevents us from really experimenting and checking it out, to determine if something is really a threat or not.

What have I learnt to do about it?

1. Acknowledge the problem. We cannot do anything about a problem until we acknowledge it. For me, it was acknowledging that I had a problem in my shoulder (and in all likelihood had torn a ligament), that I was frightened of that spider and that the thought of having to sit down and write an article brought back traumatic memories of writing my thesis.

2. Start small. Be it writing notes on what you’d like to include in the article, finding out about physiotherapists or reading up about whether your resident spider is indeed as dangerous as you imagined it to be. Keep pushing yourself to be at the edge of your comfort zone. Don’t try to aim for the big wins. Small sustainable goals are more likely to get you there. Remember the tortoise and the hare.

3. Get support and help. Having someone to walk you through the journey can be invaluable. It helps give you perspective, keeps you accountable and gives you someone to whine to at the end of the day. This is particularly so if you have been avoiding a situation because of traumatic experiences. Until you stop avoiding, it will continue to intrude in your life and limit you. It might be uncomfortable but keep practicing and trying. Eventually it becomes the new normal.

To quote loosely from Vivian Greene, perhaps life is not about trying to avoid the storms but learning how to dance in the rain. Now excuse me whilst I get a broom to try to relocate my eight-legged friend for the fifth time before I head out for my physiotherapy appointment.

Freeing Ourselves From Avoidance2019-06-11T12:54:47+10:00