Integrating technology into the treatment of mental health and addictive disorders #digfestival
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Integrating technology into mental health and addiction treatment can help overcome barriers to access. E-health programs like SHADE and iTreAD provide online cognitive behavioral therapy to treat comorbid depression and substance use through modules addressing behaviors, thoughts, cravings and relapse prevention. While some populations may be wary of e-health due to concerns about trust, privacy and impersonal nature, studies found no differences in alliance, satisfaction or outcomes between online and in-person CBT. With proper promotion and transparency about program development, e-health can effectively expand treatment access for comorbid disorders.
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Integrating technology into the treatment of mental health and addictive disorders #digfestival
- 1. It’s worth a try… Integrating technology into the treatment of mental health and addictive disorders Associate Professor Frances Kay-Lambkin PhD Global eHealth Research & Innovation Cluster, UoN National Health and Medical Research Council Research Fellow
- 2. The mental health of Australians NSMHWB (2007)
- 3. Comorbidity is the rule ◉ 25-50% of people experience comorbidity – >1 mental disorder – One mental disorder and 1+ physical conditions ◉ Every year, approx. 340,000 Australians experience the combination of a mental health and alcohol/other drug problem – Excluding tobacco alone – Increasing by approx. 10% annually AIHW (2012) Comorbidity of mental disorders & physical conditions Sacks et al. (2013) J Substance Ab Treat, 44: 48-493 Rush (2007) Am J Psychiatry, 164(2): 201-204
- 4. Treatment access is poor ◉ In Australia, the proportion of adults with current mental health problems using traditional services has not increased: – 38% in 1997 vs. 35% in 2007. – Physical disorders = 80%. ◉ Despite government initiatives – Estimated annual investment $3.2 billion. – Australia – BOiMHC – 10 sessions with psychologist. Australian Bureau of Statistics (2008). ABS Cat No. 4326.0 Christensen & Hickie (2010). Medical J Aust 192(11): S53-S56.
- 5. Why don’t people seek treatment? Individual determinants Structural determinants •Mental health literacy •Support systems •Attitudes to services •Referral pathways •Attitudes to conditions •Payment systems •Perceived stigma •Geographical isolation •Time commitments •Lack of relevant services •Reliance on self (Barker, et al., 2005; Rickwood, et al., 2007)
- 6. How do we overcome these barriers?
- 7. The potential of e-health to respond... ◉ E-health = rapidly expanding field of health information and communication technology. ◉ Widespread recognition within health sector that better use of e-health initiatives should play a critical role in improving the healthcare system. ◉ Increasing acceptance for individuals to take a more active role in protecting their health and participating in their own health care.
- 8. Access to technology…bridging the digital divide Gen Pop Mild Dep Mod-Sev Dep Risky Drink Harmful Drink Psychosis PTSD + AOD Mobile 44% 34% 37% 46% 41% 34% 34% Mobile with Internet 22% 23% 30% 21% 41% 30% 48% Internet 84% 84% 79% 87% 100% 65% 66% Gen Pop=General Population (N=894) – no MH/AOD Mild Dep=PHQ-9 score 5-9 (N=188) Mod-Sev Dep=PHQ-9 score ≥ 10 (N=67) Risky Drink=AUDIT score 8-15 (N=135) Harmful Drink=AUDIT score ≥ 16 (N=22) Psychosis=Current diagnosis (N=115) PTSD+AOD=Current AOD treatment (N=29)
- 9. Previous use of the Internet for… Gen Pop Mild Dep Mod-Sev Dep Risky Drink Harmful Drink Psychosis PTSD + AOD Mental Health 9% 19% 39% 12% 27% 18% 17% AOD 2% 6% 5% 2% 32% 7% 31% Gen Pop=General Population (N=894) – no MH/AOD Mild Dep=PHQ-9 score 5-9 (N=188 Mod-Sev Dep=PHQ-9 score ≥ 10 (N=67 Risky Drink=AUDIT score 8-15 (N=135) Harmful Drink=AUDIT score ≥ 16 (N=22) Psychosis=Current diagnosis (N=115) PTSD+AOD=Current AOD treatment (N=29)
- 10. Potential of eHealth in comorbidity Individual determinants Structural determinants •Mental health literacy •Support systems •Attitudes to services •Referral pathways •Attitudes to conditions •Payment systems •Perceived stigma •Geographical isolation •Time commitments •Lack of relevant services •Reliance on self (Barker, et al., 2005; Rickwood, et al., 2007)
- 11. Does eHealth deliver for comorbidity?
- 12. SHADE (www.shadetreatment.com) • Self-Help for Alcohol/other drugs and DEpression • 10 modules of CBT/MI and mindfulness – Behavioural activation – Managing thoughts – Problem solving – Drink/drug refusal – Coping with cravings – Relapse prevention
- 13. iTreAD (www.itread.com.au) • Online monthly monitoring • 4 sessions of CBT for depression and binge drinking – Challenging thoughts – Behavioural activation – Coping with cravings • Online social networking
- 16. SHADoW • Serious game for depression and alcohol misuse – See links between mood and drinking • Pilot testing underway – Engagement of young people – Effective in translating key CBT messages to real life
- 17. Will eHealth overcome attitudinal barriers? ◉ Will populations with addictive disorders, who are typically low-treatment seeking access eHealth to support their concerns? – ?pride, ?fear of stigma, ?manage on their own
- 18. Consider using the Internet… Gen Pop Mild Dep Mod-Sev Dep Risky Drink Harmful Drink Psychosis PTSD + AOD M Health Treatment 17% 28% 39% 21% 45% 33% 55% AOD Treatment 7% 10% 7% 11% 36% 20% 62% Gen Pop=General Population (N=894) – no MH/AOD Mild Dep=PHQ-9 score 5-9 (N=188 Mod-Sev Dep=PHQ-9 score ≥ 10 (N=67 Risky Drink=AUDIT score 8-15 (N=135) Harmful Drink=AUDIT score ≥ 16 (N=22) Psychosis=Current diagnosis (N=115) PTSD+AOD=Current AOD treatment (N=29)
- 19. SHADE study ◉ No differences in therapeutic alliance or treatment satisfaction for therapist-delivered versus SHADE treatment. ◉ No relationship between treatment preference and retention, alliance or perceptions. ◉ If no preference, significantly greater benefit for alcohol use from SHADE. ◉ Content and modality of SHADE delivery acceptable • “Helped me take more control in my life” Kay-Lambkin et al. (2012), J Dual Diagnosis 8(4):262-276
- 20. The vital piece in the puzzle….us! What concerns people about eHealth? ◉ Sample with psychosis – Trust, credibility, accuracy of information – Privacy concerns – Impersonal ◉ Sample of General Population excl. psychosis – Reliability and accuracy of information – Confidentiality and anonymity – Impersonal Carroll & Rounsaville (2010) Current Psychiatry Reports 12: 426-432 Kay-Lambkin et al. (2011) BMC Public Health 11:277
- 21. How might we address this*? ◉ Website/Promotion/Champion – Provide evidence for efficacy – Expertise of developers – Transparency of sponsorship of site, ownership and authorship of content – Last updated information – Quality seal of approval – Recommended by peers/family/professionals/other sites ◉ Internet treatment a useful step within a larger therapeutic process ◉ Appropriate marketing in non-Internet environments *Kay-Lambkin et al. (2011) BMC Public Health 11:277) Klein et al. (2010) JMIR12 (5): e51p1-e51p12
- 22. Acknowledgements ◉ Amanda Baker ◉ Maree Teesson ◉ David Kavanagh ◉ Brian Kelly ◉ Terry Lewin ◉ Vaughan Carr Funding ◉ AERF ◉ NHMRC ◉ DoHA Institutions f.kaylambkin@unsw.edu.au
Notas del editor
- 16 millions Australians aged 18-85, almost half had a lifetime mental disorder – 1 in 5 in the past 12 months 14% had a 12-month anxiety disorder 6% had a 12-month depression 5% had a 12-month substance use disorder
- AIHW 2012 We are yet to understand the exact mechanisms underlying the comorbidity between mental disorders – Notwithstanding these debates..what we DO know is that comorbid mental health and addictive disorders have overlapping genetic vulnerablilities, overlapping environmental triggers(stress, trauma, early exposure to drugs), they involve similar brain regions and are both developmental disorders beginning in adolscence or even childhood.
- The reasons for this discrepancy between need for and receipt of treatment are complex. And its probably easiest to split into individual components such as recognition of problems, attitudes toward the problem and services, and perceived stigma associated with treatment and time commitments; and structural determinants include things such as family and community support systems, referral pathways, financial cost of treatment, geographical barriers and a lack of relevant services.
- Australia was one of the first nations to recognise the potential and benefits of e-health, leading to a number of initiatives in the 1990s aimed at better integrating technology into practice. E-health approaches have been recommended in the newly released Guidelines on the management of co-occurring alcohol and other drug and mental health conditions (led by Kath Mills) and on the NSW Health Professional Practice Guidelines for Psychosocial Interventions in Drug and Alcohol Services.
- Consider that, on average, 89% of Aust population report Internet usage …
- Interest/openness to using technology (the Internet) for mental health and AOD concerns…more severe more use
- And if we refer back to the major barriers to treatment in addictive disorders, this modality has the potential to alleviate more than half of these individual and structural determinants of treatment access…potentially more…
- Across two RCTs among people with severe depression and concurrent alcohol or cannabis dependence, Evidence that SHADE, with brief assistance from a clinician, is associated with significant improvements in depression, and significant reductions in alcohol use and cannabis use that are equivalent in magnitude to that associated with a face-to-face psychologist-delivered treatment.
- New Social Networking site – partnered with Cobalt to access and develop this site…and we have gone onto win just under $1 million in NHMRC (Australian) funding to run the first randomised trial of social networking for binge drinking and depression in young people.
- More severe, more open
- Increase adherence to evidence-based practice Empower clients to become more active agents in their own care Free up clinician time and resources Cost effective provision of high quality, high fidelity treatment – even for comorbid disorders