Young people who are reluctant to discuss their mental-health problems face to face are turning to the web for support and information
THREE YEARS AGO Oisín Scollard set up a website he believes could have prevented the death of his brother, Cormac, had it been created earlier. Cormac, a 34-year-old sound engineer, took his own life in 2003, having been treated for depression and having regularly discussed his problems online. After Cormac’s death, however, Oisín felt that if his brother had found a more supportive and responsibly moderated environment, it might have made a difference.
“I think it would’ve helped Cormac realise that what he was going through was not abnormal. Often people with mental-health issues think their story is unique because they find it hard to get perspective. No one talks about it in this country, so how can you frame your own experience? I think the intensity of people’s difficulties becomes worse when they’ve no way of gauging whether anyone else feels the same way.”
Having founded Turn2me.org, a charity offering online mental-health support, Scollard, who is 34, and his brother Diarmuid, who is 49, are hoping to transform the options for people seeking psychological help in Ireland. For World Suicide Prevention Day, on Monday, Turn2Me is providing 24 hours of free online group sessions hosted by qualified psychologists, a service Scollard is hoping to expand pending further funding. (So far it has received money from the Arthur Guinness Fund and Vodafone's World of Difference programme, and an advertising grant from Google.)
In the coming weeks the site is aiming to upgrade its one-to-one counselling sessions (charged at €50 for 50 minutes, to cover the costs of providing qualified psychologists) from email and instant messaging to video conferencing, in addition to its current provision of group sessions and an anonymous support forum moderated by volunteers.
Recent studies in Ireland, such as the My World Survey and Learning to Reach Out report, have found that young people are reluctant to pursue traditional avenues of mental-health support and are increasingly likely to turn to the internet, so there is a need to develop services online. Aware and Childline have already branched into online support groups and email-based services, but developing public forums and one-to-one online sessions poses difficulties.
“The internet is a crowded space where there’s lot of information but not a lot of coherency,” says Joseph Duffy of Headstrong, the National Centre for Youth Mental Health. “The biggest issue is making sure it’s well monitored, that the people behind it are qualified and can provide good supervision, so that all clinical governance criteria is met. Sometimes with peer support, people are giving genuinely felt help but it mightn’t be well informed or they might not be able to see the seriousness of what someone else is saying, so it’s about monitoring these concerns.”
IS WEB-BASED THERAPY the best approach? Sceptics say that online interactions sacrifice revealing clues such as body language, eye contact and vocal inflections. Written communication also allows people to censor themselves, creating discrepancies between online and physical personas, which could affect the all-importance alliance between therapist and client.
Eoin O’Shea, Turn2me’s general manager and one of its counselling psychologists, argues that while the burgeoning area of online mental-health care remains open to dubious practitioners seeking financial gain, the opportunities to do so are no different in the unregulated world of face-to-face counselling. Turn2me currently provides no information online about its four qualified psychologists, but O’Shea says the upgraded one-to-one counselling system will include counsellor profiles.
Online therapy, he adds, has proven comparably effective across a number of recent studies; the absence of nonverbal cues is counterbalanced by the deeply personal information disclosed through anonymity. It’s a format appropriate for treating a limited level of distress, particularly with anxiety and depression, says O’Shea, and the site aims to reach people who might not otherwise engage with mental-health support. “For some people it represents a first step or a precursor; for others it involves additional support, but there is a third group of people who actually have a preference for distance modalities over face-to-face engagement.” O’Shea believes that, as with other modes of therapy previously greeted with scepticism or concern, online therapy requires time to develop.
One enthusiast of the industry’s potential is Cian Aherne, a 26-year-old trainee clinical psychologist at the University of Limerick. During his time at Samaritans Ireland, hundreds of emails arrived each day from people in extreme distress, often sharing intimate information that their senders were unlikely to offer in conversation. Whereas face-to-face sessions can take time to build trust, he says, these people communicated openly from the outset.
“One of the main goals of mental-health services over the past few years is to bring down that barrier of stigma and discomfort so you’re able to suss it all out beforehand,” he says. “A lot of people, in my experience, are left in the dark as to what service they need to access, so just being able to point someone in the right direction will make a difference.”
SHONA CLEARY WAS receiving in-patient treatment for post-traumatic stress disorder, depression and anxiety when she heard about Turn2me, three years ago. She signed up, began posting on the support forum and, with the encouragement of the staff caring for her, treated it as an interactive diary.
“I was in the depths of despair and just wanted to reach out to someone else because at the time nothing seemed to be working.” The more the 18-year-old participated on the forums, the better she felt, and eight months later she was appointed as a volunteer moderator.
Turn2me now has almost 17,000 registered users. All must be over 18 and can post only between noon and midnight, so that on-duty supervisors can monitor risk indicators.
Cleary says that many use the forum as their only outlet for mental-health concerns, often because they fear bringing it up with their family or a doctor. Those who prefer not to disclose their problems initially, she adds, are encouraged to share what they eventually contribute to the forum with a professional rather than to let the problem fester or make a hasty self-diagnosis.
“A lot of people type their symptoms into Google and then might think, Oh, I’m bipolar, or, I have a personality disorder, and so we’d encourage them to see a professional to get a proper diagnosis. We offer support; we don’t advise. We’re not professionals, we’re volunteers letting them know we’re there.”
Now 21, Cleary works part-time in hotel administration, and while she stills receives treatment she sees her online engagement as an integral part of her therapy and plans to study psychology at university.
Elaine Geraghty of the Inspire Ireland Foundation advises caution in the absence of regulation of online mental-health services. ReachOut.com, which the foundation operates, is a "psychoeducational" resource for young people that shares user-submitted experiences. It does not offer online counselling, explains Geraghty, partly because it's so resource-intensive.
“We know almost everyone has an engagement online these days, and in the future there may be a generation who won’t know what it’s like not to go online for everything, so it makes sense to have services for them in place,” she says. “It’s just about being responsible and delivering it in a safe and considered way.
Digital resources
Childline.ieOnline support includes a live chat service between 6pm and 10pm each day.
Drugs.ieOffers drug and alcohol information and support, including a service that lets you chat to a staff member online.
Bodywhys.ieOffers scheduled online group counselling for eating-disorder issues, a message board and an email-support service with a trained volunteer who endeavours to respond within three working days. Offers similar services for 13- to 18-year-olds as YouthConnect.
Samaritans.orgEmail and text support for people in crisis. Volunteers endeavour to reply within 12 hours. Email jo@samaritans.org or text 087-2609090.
Aware.ieOnline depression-related support includes group sessions scheduled weekly. Email-support service manned during business hours; trained volunteers respond by the next working day; wecanhelp@aware.ie.
ReachOut.comMental-health information for young people.
1Life Suicide-prevention text-message service (text HELP to 5144). Volunteers reply as soon as possible.