Moving online out of the firing line
How online forums can help meet the needs of young people in distress
‘We’re trying to change the conversation and demystify mental health so that small problems don’t become unmanageable as people get older,” says Elaine Geraghty, chief executive of the Irish division of international mental health support site, Reachout. com.
Geraghty was one of 10 speakers from Australia and Ireland charting developments in this new mental health support space at a recent conference on Technology for Wellbeing in Dublin. Bringing together support sites – Reachout.com, Turn2Me.org, spunout.ie, headsup.ie and drugs.ie – with organisations such as Mental Health Ireland, the National Office of Suicide Prevention, Aware and the Samaritans, the conference shared information about how best to help young people in distress who turn to the internet for support.
That the internet is the first port of call for many young people going through tough times is no longer in doubt.
Thousands of users visit the Irish site of reachout.com every week, and its sister site in Australia counted 1.4 million visitors in 2012.
The benefits to those living rurally or isolated was one of the reasons the original service was set up in Australia in 1997.
Reachout.com was launched in Ireland in 2009.
The biggest benefit of online forums, peer-based or professionally moderated support groups, online counselling and mobile phone apps (for relaxation, meditation, cognitive behaviour therapy, self-monitoring, etc) is that you can go on them anytime you like for as long as you like.
The biggest drawback is that you can also drop out any time you like and nobody will be any the wiser.
Eoin O’Shea from Turn2Me.org says people often seek online support before they go for professional help.
“Often people will use our site when they start thinking they have a mental health problem, as a precursor to offline help. Others will use it for out-of-hours support when there is no where else to go. And then, there are people who prefer to engage online.”
Turn2Me.org offers peer-to-peer forums, online support groups for depression and anxiety, one-to-one online counselling and a thought catcher mood tracking tool. Its latest development is to offer a structured eight-week online programme called Engage which uses all aspects of its service with follow-up recommendations at the end of the period.
Self-help online tools, apps and games for keeping fit – physically and mentally – are a huge growth area and the technology is already well advanced to support people via email, online chat or text support.
“The key will be to harness the potential of online technologies to help reduce the stigma around mental health and increase supports to manage stress, problem-solve and be resilient,” says Prof Margaret Barry from the Health Promotion Research Centre at NUI Galway.
One key question is how and when to moderate comments (before or after comment is posted or only when requested) to best help those in distress while not scaring others or, worse still, triggering harmful behaviour. Six to eight of the online organisations surveyed for the conference have moderating and crisis-response protocols.
“We recognise a disclosure of distress can be cathartic and a considered, careful personalised response can be reassuring,” says Derek Chambers of Reachout.com.
“There will always be issues around the fostering of unhealthy [online] discussions which feed into further morbid thoughts. We pre-moderate online comments to avoid this happening,” he adds.
Fourteen online support organisations have formed a Technology and Wellbeing network to develop a collective voice on these issues.
A high level of drop-out within online mental health support services was noted by each service provider. Another area discussed was the establishment of protocols to escalate the response of emergency help services such as the Samaritans and gardaí if necessary.
‘Signals of suicide’
Oisín Scollard, founder of Turn2Me.org, says there are more people seeking help online and keeping them online is important.
“There are five groups of people who are on our services: those seeking social or emotional support; those looking for information; those in need of one-to-one counselling; those seeking to offer emotional or social support; and “support surfers” who read all the reactions,” he explains.
He believes a new algorithm needs to be developed to assess risk online. “We need to be able to track the duration and type of content online with times and dates alongside questions answered in surveys and notes from moderators so we can watch for signals of suicide.
“A person might be very annoyed if we report them to gardaí but the data protection acts are nullified when it comes to using personal information to contact someone in crisis,” says Scollard, who set up Turn2Me.org with his brother Diarmuid in memory of their brother Cormac, who died by suicide.
Another challenge will be how to integrate online and offline services. Traditionally, therapists haven’t been drawn to the online space.
However, Freji Petersen, counsellor with the Trinity College Student Counselling Service, says she interacts with students using SilverCloud Health online mental health programmes.
“Some students feel more empowered to use online supports because they can choose how and when they use it. There is an option for sharing their work with a counsellor which means I can check what they’ve read, how they’ve tracked their mood with a diary of thoughts, feelings, behaviours and I can write reviews with recommendations.”
See reachout.com for papers from the Technology for Wellbeing Conference.