tag:theconversation.com,2011:/id/topics/mental-health-care-15150/articlesMental health care – The Conversation2023-12-18T04:17:23Ztag:theconversation.com,2011:article/2180222023-12-18T04:17:23Z2023-12-18T04:17:23ZHave we been trying to prevent suicides wrongly all this time?<figure><img src="https://images.theconversation.com/files/564114/original/file-20231207-24-kcxs7w.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stressed-man-treated-by-psychologist-psychiatrist-2188371701">witsarut sakorn/Shutterstock</a></span></figcaption></figure><p>Traditional approaches to preventing suicide have focused on “who is at risk?” The aim is to identify an individual and to help them get support.</p>
<p>But that approach doesn’t seem to be working. Australia’s suicide rates have remained stubbornly high. There was an increase in the rate of suicides from <a href="https://www.aihw.gov.au/suicide-self-harm-monitoring/data/deaths-by-suicide-in-australia/suicide-deaths-over-time">2012 to 2022</a>.</p>
<p>We often do not know who is most vulnerable to suicide, and if we do, we struggle to efficiently target resources to them when they need it most. So we need a fresh approach.</p>
<p>Maybe we’ve been asking the wrong question all this time. Rather than asking “who is at risk?” we should also ask “<em>when</em> is a person at risk?” </p>
<p>We know depression <a href="https://theconversation.com/suicide-prevention-takes-more-than-treating-depression-13781">increases</a> suicide risk, but on a given day most depressed people will not consider suicide. We need to know <em>when</em> a person’s risk has risen to help them access support immediately.</p>
<p>Our preliminary research conducted in a Perth psychiatric hospital, and <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fabn0000880">published recently</a>, suggests this might be worth pursuing.</p>
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Read more:
<a href="https://theconversation.com/focusing-on-people-at-high-risk-of-suicide-has-failed-as-a-suicide-prevention-strategy-104002">Focusing on people at 'high risk' of suicide has failed as a suicide prevention strategy</a>
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<h2>What we did</h2>
<p>We conducted a “proof of concept” study involving inpatients at the psychiatric hospital Perth Clinic. Patients were invited to complete questionnaires on iPads in each room. Over more than a decade, more than 20,000 patients participated in the study, resulting in about 350,000 completed questionnaires.</p>
<p>We then examined questionnaire data from 110 inpatients who attempted suicide in the hospital over an average 25-day period. These patients were typically female (78%) and had a diagnosis of major depression or an anxiety disorder. They were 14 to 77 years old.</p>
<p>Of note, nurses had rated roughly half as having “no” to “low risk” of suicide, based on interviews with patients.</p>
<p>We then looked for patterns in the data to see if we could see who and <em>when</em> someone was at increased short-term risk of attempting suicide.</p>
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Read more:
<a href="https://theconversation.com/how-do-i-do-suicide-watch-at-home-202845">How do I do 'suicide watch' at home?</a>
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<h2>What we found</h2>
<p>We found that on the day of a suicide attempt, a person’s perception they were a <a href="https://psycnet.apa.org/record/2017-47896-001">burden</a> to friends and family increased greatly.</p>
<p>The day before a suicide attempt, patients reported an increased loss of hope in their lives. They perceived they could not change things that mattered to them.</p>
<p>We used this data to develop an algorithm to monitor spikes in these and other key risk factors that may signal increased short-term risk of suicide attempts.</p>
<p>This algorithm, now live in the hospital, alerts staff to at-risk patients to facilitate targeted and immediate interventions when the risk of attempted suicide is at its highest.</p>
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Read more:
<a href="https://theconversation.com/how-to-ask-someone-youre-worried-about-if-theyre-thinking-of-suicide-100237">How to ask someone you're worried about if they're thinking of suicide</a>
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<h2>How can we apply these findings?</h2>
<p>Key signals we identified as indicators of short-term risk of suicide – perceptions of burden or hopelessness – are often <a href="https://psycnet.apa.org/record/2009-01414-000">not matched by reality</a>. </p>
<p>While people may think they are a burden, their friends and family members disagree. Far from being burdened, those friends and family are the ones who struggle to know how and when to give the assistance they desperately want to provide. Likewise, a <a href="https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2850.2003.00573.x">perception of hopelessness</a> is often transient and doesn’t always reflect reality.</p>
<p>So clinical staff can work with patients to help them re-evaluate these misguided beliefs, and to collaboratively develop coping strategies.</p>
<p>For instance, a core belief of “I am a burden” is replaced by “I wouldn’t think a loved one was a burden if they were suffering.”</p>
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<a href="https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse comforting patient, one hand on shoulder, one on hand on knee" src="https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565910/original/file-20231214-21-1xam5n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Clinical staff work with patients to help them re-evaluate their perceptions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-nurse-comforting-senior-man-on-738116425">Monkey Business Images/Shutterstock</a></span>
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<p>
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Read more:
<a href="https://theconversation.com/what-makes-a-good-psychologist-or-psychiatrist-and-how-do-you-find-one-you-like-120981">What makes a good psychologist or psychiatrist and how do you find one you like?</a>
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<h2>Where to now?</h2>
<p>The aim now is to trial our approach in a larger number of psychiatric patients, across multiple sites across Australia, to see if this gives staff enough time to intervene and prevent imminent suicides.</p>
<p>We’re also hoping to test our methods in the community. This includes predicting the risk of suicide among school students, and remotely monitoring people at risk of suicide who present to primary care, such as their GP. </p>
<p>For instance, we are working with GPs to extend Perth Clinic’s daily monitoring system to track the symptoms of GP patients between appointments. Through this approach the GPs can monitor the effectiveness of medications or identify periods of heightened risk that can be addressed at future appointments.</p>
<p>Our approach is just one aspect of suicide prevention. We also need to address the complex web of societal, socioeconomic and other factors that contribute to the type of distress we see in people contemplating suicide.</p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.</em></p><img src="https://counter.theconversation.com/content/218022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Page is a research consultant to Perth Clinic where the research was conducted. The research has been supported by the Australian Research Council's Linkage Scheme where Perth Clinic was the industry partner.</span></em></p><p class="fine-print"><em><span>Michael Kyron does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Rather than asking ‘who is at risk?’ of suicide we should also ask ‘when is a person at risk?’ Our preliminary research shows this has promise.Michael Kyron, Research Fellow, School of Psychological Science, The University of Western AustraliaAndrew Page, Pro Vice-Chancellor (Research), The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2192812023-12-07T17:28:07Z2023-12-07T17:28:07ZOCD is so much more than handwashing or tidying. As a historian with the disorder, here’s what I’ve learned<figure><img src="https://images.theconversation.com/files/563995/original/file-20231206-25-yjbxqt.jpg?ixlib=rb-1.1.0&rect=15%2C22%2C5077%2C3328&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/woman-touching-her-temples-hands-suffering-2196452389">Elena Abrazhevich/Shutterstock</a></span></figcaption></figure><p><em>Readers are advised that this article contains explicit discussion of suicide and suicidal and obsessional thoughts. If you are in need of support, contact details are included at the end of the article.</em> </p>
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<p>At the age of 12, “out of nowhere”, Matt says he started having repetitive thoughts concerning whether he wanted to end his life. Every time he saw a knife, he would ask himself: “Am I going to stab myself?” Or, when he was near a ledge: “Am I going to jump?”</p>
<p>Matt had heard a lot about teenage depression, and thought this must be what was going on. But it was confusing, he says: “I didn’t feel suicidal, I really enjoyed my life. I just had an intense fear of doing something to hurt myself.”</p>
<p>Shortly afterwards, pre-empted by hearing about a notorious banned film, Matt began questioning whether he, like the central character, might be a serial killer. These thoughts “kept coming and coming” and he would lie in bed running over scenarios, trying to work out whether he was “going crazy”:</p>
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<p>I really needed help. I didn’t know who to talk to. But it wasn’t on my radar to think about this as OCD.</p>
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<p>Obsessive-compulsive disorder (OCD) is a significant mental health diagnosis in the 21st century. The World Health Organization (WHO) lists it as <a href="https://www.bmj.com/content/348/bmj.g2183.long">one of the ten most disabling illnesses</a> in terms of loss of earning and reduced quality of life, and OCD is frequently cited as the fourth most common mental disorder globally after depression, substance abuse and <a href="https://www.nhs.uk/mental-health/conditions/social-anxiety/#:%7E:text=Social%20anxiety%20disorder%2C%20also%20called,better%20as%20they%20get%20older.">social phobia</a> (anxiety about social interactions).</p>
<p>Yet everything Matt knew about OCD, he tells me, came from daytime talkshows where “people were washing their hands 1,000 times a day – it was all about external and really extreme behaviours”. And that didn’t feel like what he was going through.</p>
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<p><em>Across the world, we’re seeing unprecedented levels of mental illness at all ages, from children to the very old – with huge costs to families, communities and economies. <a href="https://theconversation.com/uk/topics/tackling-the-mental-health-crisis-147216?utm_source=TCUK&utm_medium=ArticleTop&utm_campaign=MentalHealthSeries">In this series</a>, we investigate what’s causing this crisis, and report on the latest research to improve people’s mental health at all stages of life.</em></p>
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<p>A similar experience is recounted in the 2011 book <a href="https://overcoming.co.uk/582/Taking-Control-Of-OCD---VealeWillson">Taking Control of OCD</a> by John (not his real name) who, after a colleague had taken their own life, became “inundated with thoughts” about what he might do to himself. Every time he crossed the road, John thought: “What would happen if I stopped moving and was run over by a bus?” He also had thoughts of murdering those he loved. John recalled:</p>
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<p>Try as I might, I just couldn’t chase the thoughts out of my head … When I tried to explain what was going on to my girlfriend, I couldn’t find a way of articulating what was happening to me … At the time, I thought OCD was all about triple-checking you had locked the front door and that your drawers were tidy.</p>
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<p>Despite the prevalence of OCD in contemporary society, the experiences of Matt and John reflect two important features of this disorder. First, that the stereotype of OCD is one of washing and checking behaviours – the <a href="https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/overview/">compulsions</a> aspect, defined clinically as “repetitive behaviours that a person feels driven to perform”. And that obsessions – defined as “<a href="https://www.nhs.uk/mental-health/conditions/obsessive-compulsive-disorder-ocd/overview/">unwanted, unpleasant thoughts</a>” often of a harmful, sexual or blasphemous nature – are viewed as obscure, confusing and unrecognisable as OCD.</p>
<p>People who experience obsessional thoughts are therefore frequently unable to identify their symptoms as OCD – and <a href="https://pubmed.ncbi.nlm.nih.gov/26132683/">neither</a>, very often, are the experts they see in clinical settings. Due to mischaracterisations of the disorder, OCD sufferers with non-typical, less visible presentations usually <a href="https://www.sciencedirect.com/science/article/pii/S2666915321001578?via%3Dihub">go undiagnosed for ten or more years</a>.</p>
<p>When John visited his GP, he was diagnosed with depression. He recalled that the GP concentrated more on the visible effects of his distress - a lack of appetite and disrupted sleeping patterns. The thoughts remained invisible. As he put it:</p>
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<p>I don’t know how you’re supposed to tell someone you don’t know that you have thoughts about killing people you love.</p>
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<p>Even for those with “textbook” OCD such as my friend Abby, “the compulsion is just the tip of the iceberg”. Abby was able to self-diagnose at the age of 12, when she experienced handwashing and locking door compulsions. She says people still think of her as “Abby [who] likes to wash her hands a lot”.</p>
<p>Now, she tells me, “I realise that I have no interest in washing my hands – I’m a pretty messy person, and I don’t mind other people being messy.” Rather than a love of cleaning, her acts were related to the altogether scarier obsessional thought: “What if I am going to hurt other people?”</p>
<p>Clinical guidelines, such as those provided in the UK by the <a href="https://www.nice.org.uk/guidance/cg31/resources/obsessivecompulsive-disorder-and-body-dysmorphic-disorder-treatment-pdf-975381519301">National Institute for Health and Care Excellence</a>, define OCD as being characterised by both compulsions <em>and</em> obsessions. So, why do the difficulties encountered by Matt, John and Abby – of recognising the internal thoughts that dominate their lives – appear to be <a href="https://letsqueerthingsup.com/2018/05/12/i-didnt-know-i-had-ocd-heres-why-the-stereotypes-are-so-harmful/">so common</a>?</p>
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<a href="https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Wordcloud for obsessive-compulsive disorder (OCD)" src="https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564001/original/file-20231206-27-hklxdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">OCD is a multifaceted disorder, yet understanding tends to focus on the visual, compulsive aspect.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/obsessive-compulsive-disorder-ocd-word-cloud-1786299122">Colored Lights/Shutterstock</a></span>
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<h2>My experience of OCD</h2>
<p>From the age of 16, I have also suffered with thoughts that I later came to associate with OCD, but which began as invisible and tormenting. An article I wrote in 2014, entitled <a href="https://www.ocduk.org/the-unseen-obsession/">The Unseen Obsession</a>, described my experience of having left university midway through my studies due to a single thought that gathered “such power that I even ended up attacking my body in an attempt to eliminate its force”. I wrote:</p>
<blockquote>
<p>I have suffered with obsessional thoughts for the last four years, and can safely say that [OCD] is far from being about clean hands.</p>
</blockquote>
<p>My obsessions have taken many forms since my teenage years. They began with me wondering whether things really existed, whether my parents were really who they said they were, and whether I wanted to harm – and was a risk to – my family, friends, even my dog.</p>
<p>Many of us know what it is like to ruminate about a person, a conflict, or something else we feel anxious about. But for those with obsessional thoughts (diagnosed or otherwise), this is quite different to simply “overthinking”. As I attempted to explain in my article:</p>
<blockquote>
<p>Conversations falter as the thought leaps through your mind. Other topics seem less important, and time to yourself provides space to assess, analyse, and look for evidence of the thought being ‘true’ … [Obsessing] is like fighting: you push and shove your thoughts away and they come back with twice as much force. You spend time trying to avoid them and they pop up everywhere, taunting and mocking your failed attempt at running away.</p>
</blockquote>
<p>It took me six months of weekly therapy sessions before I felt able to voice my obsessional thought to my therapist – someone I had known for a number of years. My unwillingness to be open about it was not only tied up with feelings of shame about its taboo content, but also my inability to see such thinking as part of a recognised disorder.</p>
<p>The question of what constitutes OCD, why we understand – and misunderstand – it as we do, as well as my own experience of living with it, led me to study <a href="https://www.cambridge.org/core/journals/british-journal-for-the-history-of-science/article/visible-compulsions-ocd-and-the-politics-of-science-in-british-clinical-psychology-19481975/D431B7D6003860F9E6ABE50476BA46A4">how OCD became recognised and categorised as a mental health disorder</a>.</p>
<p>In particular, my research shows that there are important insights to be gained from the research decisions made by a group of influential clinical psychologists in south London in the early 1970s – shedding light on why so many people, myself included, still struggle to recognise and make sense of our obsessional thoughts.</p>
<h2>The origin of the concepts</h2>
<p>Categories of mental illness are not stable across time. As medical, scientific, and public knowledge about an illness changes, so does how it is experienced and diagnosed.</p>
<p>Prior to the 1970s, “obsessions” and “compulsions” did not exist in a unified category – rather, they appeared in an array of psychiatric classifications. At the start of the 20th century, for example, British doctor James Shaw <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/8D219344EF697D92E69BF9ED60F8508B/S000712500016204Xa.pdf/verbal-obsessions.pdf">defined</a> verbal obsessions as “a mode of cerebral activity in which a thought – mostly obscene or blasphemous – forces itself into consciousness”.</p>
<p>Such cerebral activity could, according to Shaw, arise in hysteria, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/neurasthenia">neurasthenia</a>, or as a precursor to delusions. One of his patients – a woman who experienced “irresistible, obscene, blasphemous and unutterable thoughts” – was diagnosed with obsessional melancholia, a “form of insanity”.</p>
<p>The symptom arose from what Shaw defined as “nervous weakness”, an explanation that reflected the <a href="https://academic.oup.com/book/25373/chapter-abstract/192459930?redirectedFrom=fulltext">broader 19th-century view</a> that obsessional thoughts were indicative of a fragile nervous system – either inherited, or weakened through overwork, alcohol or promiscuous behaviour (described as “<a href="https://pubmed.ncbi.nlm.nih.gov/3514404/">degeneration theory</a>”). Notably, Shaw did not mention any form of repetitive behaviour in relation to these verbal obsessions.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bearded man holding a cigar" src="https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=844&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=844&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=844&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1061&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1061&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563989/original/file-20231206-15-nk8woa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1061&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sigmund Freud, founder of psychoanalysis.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Sigmund_Freud_LIFE.jpg">Max Halberstadt via Wikimedia Commons</a></span>
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<p>At a similar time to Shaw’s writings, Sigmund Freud, the Austrian founder of psychoanalysis, developed his psychoanalytic category of “<a href="https://journals.sagepub.com/doi/10.1177/0957154X9800903504">Zwangsneurose</a> – translated in Britain as "obsessional neurosis” and in the US as “compulsion neurosis”. In Freud’s <a href="https://www.mhweb.org/freud/ratman1.pdf">writings</a>, the “Zwang” referred to persistent ideas that emerged from a repressed conflict between unresolved childhood impulses (those of love and hate) and the critical self (ego).</p>
<p>Freud’s <a href="https://ia802907.us.archive.org/17/items/SigmundFreud/Sigmund%20Freud%20%5B1909%5D%20Notes%20Upon%20A%20Case%20Of%20Obsessional%20Neurosis%20%28The%20Rat%20Man%20Case%20History%29%28James%20Strachey%20Translation%201955%29.pdf">most famous case study</a>, published in 1909, featured the “Rat Man”, a former Austrian army officer who possessed a variety of elaborate symptoms. In the first instance, he had become obsessed that he would fall victim to a horrific rat-based punishment that had been recounted to him by a colleague. The patient also expressed that if he had certain desires such as a wish to see a woman naked, his already-deceased father “will be bound to die”.</p>
<p>The Rat Man was described by Freud as engaging in a “system of ceremonial defences” and “elaborate manoeuvres full of contradictions” that have been read by some as the behavioural aspects of what would become OCD. However, there are crucial differences between the “defences” of Freud’s client and the compulsions of OCD, including that the former largely involved thinking rather than acting, and were by no means consistent or stereotyped.</p>
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<p><strong><em>This article is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.</em></p>
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<p>The psychoanalytic category of “obsessional neurosis” was adopted and modified in Britain during the first world war, and became a staple – but inconsistently defined – diagnosis in British psychiatric textbooks of the inter-war period. Up to the 1950s, the terms “obsession” and “compulsion” were being used interchangeably in psychiatric writing. The complexity surrounding their meaning is demonstrated in the <a href="https://www.google.co.uk/books/edition/Inquiries_in_Psychiatry_Clinical_and_Soc/JsZrAAAAMAAJ?hl=en">writings of Aubrey Lewis</a>, a leading figure in post-war British psychiatry, who referred to “obsessional illnesses” as being made up of “compulsive thoughts” and “compulsive inner speech”.</p>
<p>Like Freud, Lewis mentioned the “complex rituals” of the obsessional – such as the patient “who is perpetually putting himself in the greatest trouble to ensure that he never steps on a worm inadvertently”. But he cautioned against “the dangers of associating any kind of repetitious activity with obsessionality”, writing that “it certainly cannot be judged on behaviourist grounds”.</p>
<h2>Defining OCD by visible behaviour</h2>
<p>OCD began to emerge in the form we recognise it today from the early 1970s – and was established as a formal psychiatric disorder through its inclusion in the third and fourth editions of the American Psychiatric Association’s <a href="https://aditpsiquiatriaypsicologia.es/images/CLASIFICACION%20DE%20ENFERMEDADES/DSM-III.pdf">Diagnostic and Statistical Manual</a> (commonly known as DSM-III and DSM-IV) in 1980 and 1994.</p>
<p>The centrality of visible and measurable behaviours in the categorisation of OCD – particularly washing and checking – can be traced back to a series of experiments conducted by clinical psychologists in the early 1970s at the Institute of Psychiatry and the Maudsley Hospital in south London.</p>
<p>Under the direction of South African psychologist Stanley Rachman, the complex array of symptoms contained in the categories of obsessional illness and obsessional neurosis were divided into two: “visible” compulsive rituals, and “invisible” obsessional ruminations. While Rachman and his colleagues conducted a large research programme on compulsive behaviours, obsessions were relegated to the backburner.</p>
<p>For example, in <a href="https://www.sciencedirect.com/science/article/pii/000579677190009X">their investigation</a> of ten psychiatric inpatients diagnosed with obsessional neurosis, “compulsions had to be present for entry into the trial and patients complaining of ruminations were excluded” – a statement reiterated throughout subsequent experiments.</p>
<p>Indeed, this study did not merely require patients to exhibit some form of visible compulsion. The ten patients included were exclusively those with “visible handwashing” behaviour, which was viewed as the “easiest” symptom to experiment on. Likewise, the second round of studies only included patients who engaged in visible “checking” behaviour, such as whether a door was unlocked.</p>
<p>In a <a href="https://www.sciencedirect.com/science/article/pii/0005796771900088">1971 paper</a>, Rachman offered his rationale for taking this approach, explaining how “obsessional ruminators raise special problems for the clinical psychologist because of their subjective, private nature”. This, he argued, was in contrast with “the other main feature of obsessional neurosis, compulsive behaviour, which can be approached with greater ease. It is visible, has a predictable quality, and many reproducible analogies in animal research”.</p>
<p>Rachman viewed compulsions as “visible” and “predictable” in large part due to the way clinical psychology had developed as a new profession in Britain, at the Maudsley Hospital in particular, in the decades following the second world war. To differentiate their practice from the existing mental health professions of psychiatry (medically trained doctors specialising in mental health) and psychoanalysis (talking therapy derived from Freud), these early clinical psychologists presented themselves as “<a href="https://www.bps.org.uk/psychologist/eysenck-and-development-cbt">applied scientists</a>” who brought scientific methods from the laboratory to a clinical setting. Their conception of science was rooted in empiricism – with an emphasis on visibility, measurability and experimentation.</p>
<p>As part of this commitment to empirical science, these clinical psychologists adopted a <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fh0054288">model of anxiety</a> derived from 20th-century behaviourism. This focus on observable behaviour was <a href="https://www.cambridge.org/core/journals/journal-of-mental-science/article/abs/learning-theory-and-behaviour-therapy/38CA4A9BC0CA773F6BEE93EDDC71584F">viewed as</a> having much greater scientific value than psychoanalysis, which dealt with the “<a href="https://www.taylorfrancis.com/books/mono/10.4324/9780203766767/causes-cures-neurosis-psychology-revivals-eysenck-rachman">unverifiable</a>” and “unscientific” realm of thoughts and thinking.</p>
<p>So, when obsessional ruminations gained a renewed focus in the mid-1970s, it was through this lens of visible compulsive behaviours. Rachman and his colleagues started talking about “mental compulsions” (such as saying a good thought after a bad thought) as “equivalent to handwashing”- rather than focusing on the importance and content of these thoughts in their own right.</p>
<p>In the early 1980s, clinical psychology came under pressure from cognitive psychologists (those concerned with thinking and language) for its reductive focus on behaviour. But despite this move to <a href="https://www.sciencedirect.com/science/article/abs/pii/0005796785901056">include cognitive approaches</a>, the centrality of visible behavioural compulsions has continued to characterise perceptions of OCD in cultural and clinical domains. </p>
<p>This is perhaps most evident in media portrayals of the disorder – a critique taken up by cultural scholars such as <a href="https://www.tandfonline.com/doi/abs/10.1080/01639625.2013.872526">Dana Fennell</a>, who look at representations of OCD in TV and film.</p>
<p>The archetypal portrayal of OCD has <a href="https://www.ocduk.org/david-beckham-documentary-our-statement/">not been helped</a> by the recent publicity given to David Beckham and his <a href="https://www.mirror.co.uk/news/health/david-beckham-ocd-update-football-31102545">extensive tidying</a>. When I ask Abby what she thought about the <a href="https://www.theguardian.com/football/2023/apr/28/david-beckham-ocd-obsessive-compulsive-disorder-netflix-documentary">attention</a> that Beckham’s OCD was receiving in the media, she replies: “It’s so boring. It’s the same presentation that always gets thought of as OCD.”</p>
<h2>Limitations to the ‘gold standard’ treatment</h2>
<p>This archetypal portrayal of OCD also relates to how it is treated. The <a href="https://www.dovepress.com/getfile.php?fileID=54942">“gold standard” treatment</a> in the UK today is the behavioural technique of <a href="https://www.ocduk.org/overcoming-ocd/accessing-ocd-treatment/exposure-response-prevention/">exposure and ritual prevention</a> (ERP), either on its own or combined with cognitive therapy. ERP gained acceptance from the experiments of Rachman and colleagues in the early 1970s, when they were exclusively working with patients with observable behaviours.</p>
<p>One of their <a href="https://www.sciencedirect.com/science/article/abs/pii/S0005796772800032">key studies</a> involved patients from the Maudsley Hospital who repeatedly washed their hands. They were told to touch smears of dog excrement and put hamsters in their bags and in their hair, while being prevented from washing for increased lengths of time.</p>
<p>Such experiments were again governed by observability and measurability. The “success” of ERP treatment – and its perceived superiority over psychiatric and psychoanalytic methods – was demonstrated by a reduction in the patients’ visible handwashing behaviour.</p>
<p>Today, if you are diagnosed with OCD by a psychiatrist and given OCD-specialist treatment via the NHS, you will most likely be told to undergo the same kind of ERP procedure that hospital inpatients were experimentally given in the 1970s: touching a set of items that you fear (exposure) while being prevented from engaging in your usual compulsive behaviour.</p>
<p>An identical method is also used when it comes to obsessional thoughts. Patients are asked to identify their worrying obsession, then either expose themselves to provoking situations or repeat the thought in their mind without engaging in “mental compulsions” – such as counting, replacing a bad thought with a good thought, or trying to “solve” the content of the obsessional thought.</p>
<p>It’s certainly true that this form of behavioural therapy can be <a href="https://www.dovepress.com/getfile.php?fileID=54942">hugely helpful</a> in the treatment of OCD symptoms. Abby, after undergoing ERP for 14 years, said she had “developed a lot of practices around not giving into my [washing and checking] compulsions”.</p>
<p>I also found the approach beneficial in reducing the threatening quality of my obsessional thoughts. Repeating “I want to hurt my family” or “I don’t really exist” to myself over and over again, without actually trying to solve these issues, reduced the time I spent ruminating.</p>
<p>However, while being a huge advocate of ERP, Abby also observed that “sometimes when I get rid of a compulsion, it doesn’t mean I just get rid of the obsession.” While the “outward compulsions” disappear, “it doesn’t mean my mind stops cycling and mental questioning”.</p>
<p>Some contemporary clinicians have referred to ERP, designed around visible symptom reduction, as a “<a href="https://www.justinkhughes.com/wp-content/uploads/2021/03/ocd_texas_talk_with_molly_and_justin_2019__22common_pitfalls_of_erp_for_ocd_22.pdf">whack-a-mole technique</a>” – you get rid one symptom (obsession or compulsion) and another pops up.</p>
<p>ERP is frequently accompanied with cognitive therapy techniques, such as <a href="https://www.apa.org/pubs/books/supplemental/Treatment-for-Postdisaster-Distress/Handout-27.pdf">cognitive restructuring</a> (identifying beliefs and providing evidence for and against them), or being told that obsessions are “just thoughts”, that they are meaningless, and that you do not want to enact them.</p>
<p>Despite the success of cognitive-behaviour therapy (CBT) and ERP in scientific trials, a <a href="https://www.sciencedirect.com/science/article/pii/S0010440X21000018?via%3Dihub">major review of evidence</a> in 2021 questioned whether the effects of the approach in treating OCD had been overstated – reflecting the high proportion of OCD cases that are designated as “<a href="https://www.ncbi.nlm.nih.gov/books/NBK551808/">treatment resistant</a>”. </p>
<p>I also believe there are some crucial limitations to contemporary treatments for OCD. Exposure (ERP) techniques stem from a period in which thoughts were not being considered at all by clinical psychologists, while CBT designates the content of obsessional thoughts as unimportant. Matt, like me, has found that CBT “can only take you so far”, explaining:</p>
<blockquote>
<p>Part of this was that [CBT therapists] are so committed to the idea that thoughts don’t have meaning … [They] treat your symptom and once those are gone, you should get on with your life. I didn’t find that there was a way of thinking about [my] ruminations in the context of my whole life.</p>
</blockquote>
<h2>Experiences of alternative treatments</h2>
<p>So much of my understanding about OCD has changed since I first wrote about it for <a href="https://www.rethink.org/aboutus/">Rethink Mental Illness</a> almost a decade ago. Thinking about the historical development and categorisation of OCD has, it turns out, given me a greater sense of ease regarding this widely misunderstood condition. I feel less bound by our current conceptual frameworks, and more able to reflect on what I think is helpful in terms of how to successfully manage my obsessional thoughts.</p>
<p>For example, despite being warned away from psychoanalysis from a young age (my mum is a clinical psychologist, and psychologists are often fervently anti-psychoanalytic!), I have found psychoanalysis incredibly helpful in becoming comfortable with my thoughts. </p>
<p>This is because CBT typically focuses on present symptoms without looking into their meaning or how they relate to your personal history, and this comes into tension with my desire, as a historian, to think about the past. In contrast, psychoanalysis locates obsessional thoughts in history – pointing to childhood as a crucial point of psychic development. I have been able to understand my obsessions as the result of a deep childhood fear concerning the death of my loved ones, from which I developed a rigid desire for control.</p>
<p>As a young teenager trying to determine what was going on with him, Matt went to the public library and took out a <a href="https://ia903102.us.archive.org/15/items/petergay1989freudreader/Adam%20Phillips%20%5B2006%5D%20Penguin%20Freud%20Reader.pdf">Freud reader</a>. He describes this as “the worst possible thing for a 14-year-old to read”, as it made him believe “that I did really have all these [murderous suicidal] impulses and all my fears are true”.</p>
<p>Despite this experience, while training to become a social worker, he “got into psychoanalysis as an alternate way to think about therapy and think about my own experience”. For him, psychoanalysis revealed the opposite to the image of “OCD as handwashing”.</p>
<p>Instead, he says, it focused on the aspects of “obsessionality that are internal”, showing him that the “mind is so powerful that it can produce a lot of imaginary fears”. It also allowed him to see “OCD symptoms as wrapped up with my whole life”.</p>
<p>Particularly profound in psychoanalytic thought is the acceptance of the complexity and unknowability at the heart of human experience. As Jaqueline Rose, professor of humanities at Birkbeck, University of London, <a href="https://fitzcarraldoeditions.com/books/the-plague">wrote:</a>: </p>
<blockquote>
<p>Psychoanalysis begins with a mind in flight, a mind that cannot take the measure of its own pain. It begins, that is, with the recognition that the world – or what Freud sometimes refers to as ‘civilisation’ – makes demands on human subjects that are too much to bear.</p>
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<p>This idea of “a mind in flight” has helped me think about my obsessions – whether my parents are really who they say they are; am I going to hurt those I love? – as part of a battle for certainty and control that is both unattainable and understandable, considering the world we live in.</p>
<p>The aim of psychoanalytic treatment is not to eradicate symptoms but to bring to light the difficult knots that humans have to deal with. Matt refers to psychoanalysis as acknowledging “a sort of messiness of the mind … I’ve found the psychoanalytic view of accepting your own messiness extremely helpful”. Rose similarly describes psychoanalysis as “the opposite of housework in how it deals with the mess we make”.</p>
<p>In the UK, psychoanalysis has been rejected within NHS service provision. And I believe this is, at least in part, a result of historical critiques levelled at it by clinical psychologists as they developed behaviour therapies to treat OCD in the late 20th century.</p>
<h2>‘A lot of emotion and sadness’</h2>
<p>While compulsive behaviour such as handwashing and checking is widely perceived as “representative” of OCD, the tormenting experience of having obsessional thoughts is still rarely acknowledged and discussed. The <a href="https://www.theguardian.com/commentisfree/2019/feb/21/ocd-sex-disorder-pure-rose-cartwright">shame and confusion</a> attached to such thoughts, coupled with the feeling of being misunderstood, make this an important issue to address, particularly when <a href="https://www.madeofmillions.com/articles/pure-o-an-exploration-into-a-lesser-known-form-of-ocd">misdiagnosis of OCD</a> is so high.</p>
<p>My <a href="https://www.cambridge.org/core/journals/british-journal-for-the-history-of-science/article/visible-compulsions-ocd-and-the-politics-of-science-in-british-clinical-psychology-19481975/D431B7D6003860F9E6ABE50476BA46A4">PhD on the history of OCD</a> has also showed me the ways in which psychological research shapes how we conceive of diagnostic categories – and consequently, ourselves. While psychology’s commitment to objectivity, empiricism and visibility has provided tools that are tremendously useful in the clinic, my research sheds lights on how the often-exclusive focus on visible symptoms has at times trumped the appreciation of the complex experience of having obsessional thoughts.</p>
<p>I first met Matt in 2019 at the first <a href="https://ocdinsociety.wixsite.com/home/2019">OCD in Society</a> conference, held at Queen Mary University of London, where he was giving a presentation on the “multiple meanings of OCD”. We discussed our own experiences of the disorder, and what we thought that history, psychoanalysis and anthropology could contribute to understandings of OCD.</p>
<p>Matt was 34, and he told me this was the first time he “had ever voiced the internal stuff out loud, and heard other people talk about it”. Recalling how this made him feel, he continued:</p>
<blockquote>
<p>I felt a lot of emotion and sadness. The isolation had been such a big part of my life that I had stopped noticing it. Then being out of the isolation was such a relief, it made me realise how bad it had been.</p>
</blockquote>
<hr>
<p><em>If you are experiencing suicidal thoughts and need support, you can call your GP, <a href="https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-use-111/">NHS 111</a>, or free helplines including <a href="https://www.samaritans.org/">Samaritans</a> (116 123), <a href="https://www.thecalmzone.net/">Calm</a> (0800 585858) or <a href="https://papyrus-uk.org/">Papyrus</a> (0800 068 4141).</em></p>
<p><em>In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found <a href="http://www.suicide.org/international-suicide-hotlines.html">here</a>.</em></p>
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<p class="fine-print"><em><span>Eva Surawy Stepney receives funding from the Arts and Humanities Research Council (AHRC) via the White Rose College of the Arts and Humanities (WRoCAH). </span></em></p>Research decisions made by clinical psychologists in the 1970s can help explain why so many people, myself included, struggle to make sense of our obsessional thoughts.Eva Surawy Stepney, PhD Candidate in History, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2074762023-08-16T12:28:50Z2023-08-16T12:28:50ZAs the mental health crisis in children and teens worsens, the dire shortage of mental health providers is preventing young people from getting the help they need<figure><img src="https://images.theconversation.com/files/534699/original/file-20230628-23-9wa1lm.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5584%2C3731&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anxiety, depression and suicide among U.S. teens continue to increase. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-girl-in-trouble-feeling-sad-and-depressed-royalty-free-image/1135281941?phrase=distressed+teenager&adppopup=true">Paolo Cordoni/iStock via Getty Images Plus</a></span></figcaption></figure><p>The hospital where I practice recently admitted a 14-year-old girl with <a href="https://www.samhsa.gov/mental-health/post-traumatic-stress-disorder#">post-traumatic stress disorder</a>, or PTSD, to our outpatient program. She was referred to us six months earlier, in October 2022, but at the time we were at capacity. Although we tried to refer her to several other hospitals, they too were full. During that six-month wait, she attempted suicide. </p>
<p>Unfortunately, this is an all-too-common story for young people with mental health issues. A 2021 survey of 88 children’s hospitals reported that they <a href="https://www.cdc.gov/nchs/products/databriefs/db471.htm">admit, on average, four teens per day</a> to inpatient programs. At many of these hospitals, more children await help, but there are simply not enough services or psychiatric beds for them. </p>
<p>So these children languish, sometimes for days or even a week, in hospital emergency departments. This is not a good place for a young person coping with grave mental health issues and perhaps considering suicide. Waiting at home is not a good option either – the family is often unable or unwilling to deal with a child who is distraught or violent. </p>
<p>I am a <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/28534">professor of psychiatry and pediatrics</a> at the University of Colorado, where I founded and direct the <a href="https://medschool.cuanschutz.edu/psychiatry/PatientCare/STARTcenter">Stress, Trauma, Adversity Research and Treatment Center</a>. For 30 years, my practice has focused on youth stress and trauma. </p>
<p>Over those years, I have noticed that these young patients have become more aggressive and suicidal. They are sicker when compared to years past. And the <a href="https://blogs.cdc.gov/nchs/2023/06/15/7396/#">data backs up my observation</a>: From 2007 through 2021, suicide rates among young people ages 10 to 24 increased by 62%. From 2014 to 2021, homicide rates rose by 60%. The situation is so grim that in October 2021, health care professionals <a href="https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/">declared a national emergency</a> in child mental health. </p>
<p>Since then, the crisis has not abated; it’s only gotten worse.
But there are <a href="https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-health-workforce-shortage#">not enough mental health professionals</a> to meet the need. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/tuCuFddCaqM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How school bullying led to tragedy.</span></figcaption>
</figure>
<h2>The numbers behind the suffering</h2>
<p>The American Academy of Child and Adolescent Psychiatry reported in May 2023 that there is a <a href="https://www.aacap.org/aacap/zLatest_News/Severe_Shortage_Child_Adolescent_Psychiatrists_Illustrated_AACAP_Workforce_Maps.aspx">drastic shortage of child and adolescent psychiatrists</a> across the U.S. </p>
<p>For every 100,000 children in the U.S. – with 1 in 5 of those children having a mental, emotional or behavioral disorder in a given year – there are only 14 child and adolescent psychiatrists available to treat them, <a href="https://www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce_Maps/Home.aspx">according to the American Academy of Child and Adolescent Psychiatry</a>. At least three times as many are needed. </p>
<p>There is also a significant shortage of child therapists – social workers, psychologists, licensed professional counselors – as well. This is particularly the case in <a href="https://doi.org/10.1001/jamapediatrics.2018.5399">rural areas across the country</a>. </p>
<p>Studies show that young people in the U.S. are <a href="https://www.pewresearch.org/social-trends/2019/02/20/most-u-s-teens-see-anxiety-and-depression-as-a-major-problem-among-their-peers/">increasingly stressed and traumatized</a>. The <a href="https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teens-and-social-media-use/art-20474437#">constant barrage of information</a> via social media and the demand to participate in it is complex, and interactions can be harmful to a child’s mental health. </p>
<p>Young people deal with <a href="https://cyberbullying.org/cyberbullying-statistics-age-gender-sexual-orientation-race">cyberbullying</a> and endless exposure to social media content <a href="https://theconversation.com/mounting-research-documents-the-harmful-effects-of-social-media-use-on-mental-health-including-body-image-and-development-of-eating-disorders-206170">focused on body image</a>.</p>
<p>But what children and adolescents see online is not the only problem. Much of life still happens offline, and a lot of it is not good. Millions of young people deal every day with <a href="https://ncsacw.acf.hhs.gov/research/child-welfare-and-treatment-statistics.aspx#">alcoholic, drug-abusing or neglectful parents</a>; peers who <a href="https://drugabusestatistics.org/teen-drug-use/">drink, vape and use drugs</a>; violence at <a href="https://www.cdc.gov/violenceprevention/communityviolence/index.html">their schools or in their streets</a>; and overwhelmed caregivers – whether parents or others – preoccupied with financial or other personal problems. </p>
<p>For an adolescent already struggling to make sense of the world, any one of these issues can be overwhelming. </p>
<h2>Not enough time or money</h2>
<p>The U.S. health care system does very little to support these children or their families. This pattern begins at the moment of birth, and it is baked into the system. </p>
<p>Ideally, prospective parents or those who are pregnant would receive parenting classes that continue through the child’s developmental phases. That generally <a href="https://www.gse.harvard.edu/ideas/ed-magazine/19/08/parent-approved">does not happen</a>. Then, many new parents do not have <a href="https://www.americanprogress.org/article/universal-home-visiting-models-can-support-newborns-families/">nursing and maternal care visits</a> or <a href="https://www.pewresearch.org/short-reads/2019/12/16/u-s-lacks-mandated-paid-parental-leave/">paid parental leave</a>. And for those families struggling financially, there is <a href="https://doi.org/10.1007/s10826-022-02322-0">not an adequate safety net</a>. </p>
<p>Nor can some families afford mental health treatment to support their children’s needs. <a href="https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/The-Doctor-is-Out/DoctorIsOut">Many mental health providers don’t take insurance</a> and instead opt for out-of-pocket payments from patients. This is due to the low reimbursement rates from most insurers, which makes it very difficult to sustain a practice. Depending on the service, the cost could be anywhere from US$100 to $600 per session. </p>
<p>To see providers that do take insurance, there are usually co-pays – typically between $20 to $50 a week. But it can often be challenging for the insured to find a suitable in-network provider to meet a child’s needs.</p>
<p>The payments add up, particularly when mental health treatment takes many months, and sometimes years, to have an effect. There is a reason why it takes so long. Unlike medical doctors, mental health professionals do not simply make a diagnosis and provide medication or surgery. Instead, for treatments to work and to change the outcome for young people who are struggling, an ongoing – and lengthy – <a href="https://www.apa.org/monitor/2019/11/ce-corner-relationships">relationship between the therapist and the patient is needed</a>. </p>
<p>Treating a child is significantly more difficult than treating an adult. That is, in part, because children are constantly developing and changing. But perhaps the most formidable challenges are the <a href="https://doi.org/10.1186/s40723-021-00094-6">multiple entities</a> a child therapist may have to work with: caregivers, the school system, the courts and child welfare agencies. What’s more, getting a diagnosis, treatment or both often involves working with multiple providers, such as a primary care doctor, individual therapist, family-focused therapist and psychiatrist. </p>
<p>In the institute where I work, the psychiatry department loses money on almost every patient we treat. If it weren’t for fundraising and fostering relationships with donors, the department could only provide care to a select few. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/EHCeodippgo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Emotional abuse by parents includes threats, bullying, humiliation and insults.</span></figcaption>
</figure>
<h2>Possible solutions</h2>
<p>Struggling children and teens in the U.S. need earlier interventions. Although schools are ideal places to teach social skills, they still do not offer enough activities to help young people <a href="https://raisingchildren.net.au/school-age/behaviour/understanding-behaviour/resilience-how-to-build-it-in-children-3-8-years">develop resilience to cope with adversity</a>. </p>
<p>Sometimes, young patients see primary care doctors who don’t have enough training in this area. Telephone hotline programs, which offer these doctors free consultations from mental health professionals to help assess problems in young patients, should be available throughout the U.S. But right now, <a href="https://www.rand.org/news/press/2019/07/15.html">only 19 states have such programs</a>. One bright spot: The <a href="https://theconversation.com/as-suicides-rise-in-the-us-the-988-hotline-offers-hope-but-most-americans-arent-aware-of-it-210356">988 Suicide and Crisis Lifeline</a>, which launched in July 2022, is available 24/7. </p>
<p>When a young person needs treatment, parents should prioritize finding a mental health provider right away. Asking the child’s primary doctor and school counselors for a reference is a good start. If the child is already on a waiting list, a parent or guardian should call the provider weekly to check in and make sure the child is not forgotten. </p>
<p>The process can be discouraging and daunting, but in our current environment, which provides limited support, that’s the way it is. And without a heavy lift from parents, the child remains at great risk.</p><img src="https://counter.theconversation.com/content/207476/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Berkowitz is affiliated with Sensye, inc. I am a consultant to Senseye, Inc. a startup developing a device to make objective psychiatric diagnoses</span></em></p>Millions of young people in the US are suffering, whether from abuse at home, pressure from social media or exposure to violence. But navigating the mental health care system can be disheartening.Steven Berkowitz, Professor of Psychiatry, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2115132023-08-16T04:51:48Z2023-08-16T04:51:48ZNot all mental health apps are helpful. Experts explain the risks, and how to choose one wisely<figure><img src="https://images.theconversation.com/files/542935/original/file-20230816-15-67z0ok.jpeg?ixlib=rb-1.1.0&rect=49%2C30%2C4044%2C2694&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There are thousands of mental health apps available on the app market, offering services including meditation, mood tracking and counselling, among others. You would think such “health” and “wellbeing” apps – which often present as solutions for conditions such as <a href="https://www.headspace.com/">anxiety</a> and <a href="https://www.calm.com">sleeplessness</a> – would have been rigorously tested and verified. But this isn’t necessarily the case. </p>
<p>In fact, many may be taking your money and data in return for a service that does nothing for your mental health – at least, not in a way that’s backed by scientific evidence. </p>
<h2>Bringing AI to mental health apps</h2>
<p>Although some mental health apps connect users with a <a href="https://www.betterhelp.com/get-started/?go=true&utm_source=AdWords&utm_medium=Search_PPC_c&utm_term=betterhelp+australia_e&utm_content=133525856790&network=g&placement=&target=&matchtype=e&utm_campaign=15228709182&ad_type=text&adposition=&kwd_id=kwd-401317619253&gclid=Cj0KCQjwoeemBhCfARIsADR2QCtfZHNw8mqpBe7cLfLtZBD-JZ5xvAmDCfol8npbAAH3ALJGYvpngtoaAtFlEALw_wcB¬_found=1&gor=start">registered therapist</a>, most provide a fully automated service that bypasses the human element. This means they’re not subject to the same standards of care and confidentiality as a registered mental health professional. Some aren’t even designed by mental health professionals. </p>
<p>These apps also increasingly claim to be incorporating artificial intelligence into their design to make personalised recommendations (such as for meditation or mindfulness) to users. However, they give little detail about this process. It’s possible the recommendations are based on a user’s previous activities, similar to Netflix’s <a href="https://help.netflix.com/en/node/100639">recommendation algorithm</a>.</p>
<p>Some apps such as <a href="https://legal.wysa.io/privacy-policy#aiChatbot">Wysa</a>, <a href="https://www.youper.ai/">Youper</a> and <a href="https://woebothealth.com/">Woebot</a> use AI-driven chatbots to deliver support, or even established therapeutic interventions such as cognitive behavioural therapy. But these apps usually don’t reveal what kinds of algorithms they use. </p>
<p>It’s likely most of these AI chatbots use <a href="https://www.techtarget.com/searchenterpriseai/feature/How-to-choose-between-a-rules-based-vs-machine-learning-system">rules-based systems</a> that respond to users in accordance with predetermined rules (rather than learning on the go as adaptive models do). These rules would ideally prevent the unexpected (and often <a href="https://www.vice.com/en/article/pkadgm/man-dies-by-suicide-after-talking-with-ai-chatbot-widow-says">harmful and inappropriate</a>) outputs AI chatbots have become known for – but there’s no guarantee. </p>
<p>The use of AI in this context comes with risks of biased, discriminatory or completely inapplicable information being provided to users. And these risks haven’t been adequately investigated.</p>
<h2>Misleading marketing and a lack of supporting evidence</h2>
<p>Mental health apps might be able to provide certain benefits to users <em>if</em> they are well designed and properly vetted and deployed. But even then they can’t be considered a substitute for professional therapy targeted towards conditions such as anxiety or depression.</p>
<p>The <a href="https://theconversation.com/pixels-are-not-people-mental-health-apps-are-increasingly-popular-but-human-connection-is-still-key-192247">clinical value</a> of automated mental health and mindfulness apps is <a href="https://www.sciencedirect.com/science/article/abs/pii/S1077722918300233?casa_token=lwm1E6FhcG0AAAAA:saV7szbZl4DqbvmZiomLG9yMWi_4-zbmy3QCtQzVEQr957QX1E7Aiqkm5BcEntR0mVFgfDVo">still being assessed</a>. Evidence of their efficacy is generally <a href="https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0000002">lacking</a>. </p>
<p>Some apps make ambitious claims regarding their effectiveness and refer to studies that supposedly support their benefits. In many cases these claims are based on less-than-robust findings. For instance, they may be based on: </p>
<ul>
<li><a href="https://sensa.health/">user testimonials</a></li>
<li>short-term studies with narrow <a href="https://www.wired.co.uk/article/mental-health-chatbots">or homogeneous cohorts</a></li>
<li><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533203/#">studies involving</a> researchers or funding from the very group <a href="https://www.theguardian.com/us-news/2022/apr/13/chatbots-robot-therapists-youth-mental-health-crisis">promoting the app</a></li>
<li>or evidence of the benefits of a <a href="https://www.headspace.com/meditation/anxiety">practice delivered face to face</a> (rather than via an app).</li>
</ul>
<p>Moreover, any claims about reducing symptoms of poor mental health aren’t carried through in contract terms. The fine print will typically state the app does not claim to provide any physical, therapeutic or medical benefit (along with a host of other disclaimers). In other words, it isn’t obliged to successfully provide the service it promotes. </p>
<p>For some users, mental health apps may even cause harm, and lead to increases in the very <a href="https://pubmed.ncbi.nlm.nih.gov/34074221/">symptoms</a> people so often use them to address. The may happen, in part, as a result of creating more awareness of problems, without providing the tools needed to address them. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542936/original/file-20230816-19-d3oqit.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">While a well-designed mental health app may bring benefits to a user, this shouldn’t be confused with evidence of efficacy.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>In the case of most mental health apps, research on their effectiveness won’t have considered <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9505389/">individual differences</a> such as socioeconomic status, age and other factors that can influence engagement. Most apps also will not indicate whether they’re an inclusive space for marginalised people, such as those from culturally and linguistically diverse, LGBTQ+ or neurodiverse communities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-effective-is-mindfulness-for-treating-mental-ill-health-and-what-about-the-apps-182436">How effective is mindfulness for treating mental ill-health? And what about the apps?</a>
</strong>
</em>
</p>
<hr>
<h2>Inadequate privacy protections</h2>
<p>Mental health apps are subject to standard consumer protection and privacy laws. While data protection and <a href="https://cybersecuritycrc.org.au/sites/default/files/2021-07/2915_cscrc_casestudies_mentalhealthapps_1.pdf">cybersecurity</a> practices vary between apps, an investigation by research foundation Mozilla <a href="https://foundation.mozilla.org/en/privacynotincluded/articles/are-mental-health-apps-better-or-worse-at-privacy-in-2023">concluded that</a> most rank poorly. </p>
<p>For example, the mindfulness app <a href="https://www.headspace.com/privacy-policy">Headspace</a> collects data about users from a <a href="https://foundation.mozilla.org/en/privacynotincluded/headspace/">range of sources</a>, and uses those data to advertise to users. Chatbot-based apps also commonly repurpose conversations to predict <a href="https://legal.wysa.io/privacy-policy">users’ moods</a>, and use anonymised user data to train the language models <a href="https://www.youper.ai/policy/privacy-policy">underpinning the bots</a>.</p>
<p>Many apps share so-called <a href="https://theconversation.com/popular-fertility-apps-are-engaging-in-widespread-misuse-of-data-including-on-sex-periods-and-pregnancy-202127">anonymised</a> data with <a href="https://www.wysa.com/">third parties</a>, such as <a href="https://www.headspace.com/privacy-policy">employers</a>, that sponsor their use. Re-identification of <a href="https://www.unimelb.edu.au/newsroom/news/2017/december/research-reveals-de-identified-patient-data-can-be-re-identified">these data</a> can be relatively easy in some cases.</p>
<p>Australia’s Therapeutic Goods Administration (TGA) doesn’t require most mental health and wellbeing apps to go through the same testing and monitoring as other medical products. In most cases, they are lightly regulated as <a href="https://www.tga.gov.au/how-we-regulate/manufacturing/medical-devices/manufacturer-guidance-specific-types-medical-devices/regulation-software-based-medical-devices">health and lifestyle</a> products or tools for <a href="https://www.tga.gov.au/sites/default/files/digital-mental-health-software-based-medical-devices.pdf">managing mental health</a> that are excluded from TGA regulations (provided they meet certain criteria).</p>
<h2>How can you choose an app?</h2>
<p>Although consumers can access third-party rankings for various mental health apps, these often focus on just a few elements, such as <a href="https://onemindpsyberguide.org/apps/">usability</a> or <a href="https://foundation.mozilla.org/en/privacynotincluded/categories/mental-health-apps/">privacy</a>. Different guides may also be inconsistent with each other.</p>
<p>Nonetheless, there are some steps you can take to figure out whether a particular mental health or mindfulness app might be useful for you.</p>
<ol>
<li><p>consult your doctor, as they may have a better understanding of the efficacy of particular apps and/or how they might benefit you as an individual</p></li>
<li><p>check whether a mental health professional or trusted institution was involved in developing the app </p></li>
<li><p>check if the app has been rated by a third party, and compare different ratings</p></li>
<li><p>make use of free trials, but be careful of them shifting to paid subscriptions, and be wary about trials that require payment information upfront</p></li>
<li><p>stop using the app if you experience any adverse effects.</p></li>
</ol>
<p>Overall, and most importantly, remember that an app is never a substitute for real help from a human professional.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ai-chatbots-are-still-far-from-replacing-human-therapists-201084">AI chatbots are still far from replacing human therapists</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/211513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeannie Marie Paterson receives funding from the Australian Research Council and has taken part in industry led roundtable discussions about digital mental health. </span></em></p><p class="fine-print"><em><span>Nicholas T. Van Dam receives funding from the Three Springs Foundation Pty Ltd to establish the Contemplative Studies Centre at the University of Melbourne. </span></em></p><p class="fine-print"><em><span>Piers Gooding receives funding from the Australian Research Council to examine the regulation of digital technologies in mental health care.</span></em></p>Claims regarding on these apps’ effectiveness are often based on less than robust findings.Jeannie Marie Paterson, Professor of Law, The University of MelbourneNicholas T. Van Dam, Associate Professor, School of Psychological Sciences, The University of MelbournePiers Gooding, Postdoctoral Research Fellow, Disability Research Initiative, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2062492023-06-14T12:33:53Z2023-06-14T12:33:53ZAdjusting jobs to protect workers’ mental health is both easier and harder than you might think<figure><img src="https://images.theconversation.com/files/530941/original/file-20230608-16844-hfat5o.jpg?ixlib=rb-1.1.0&rect=0%2C475%2C6621%2C3776&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Work doesn't have to make you feel burned out.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/businessman-working-late-in-office-royalty-free-image/1132122136">Luis Alvarez/DigitalVision via Getty Images</a></span></figcaption></figure><p>U.S. employees are increasingly <a href="https://www.workplacementalhealth.shrm.org/?_ga=2.1662386.2091759886.1686692934-92904937.1683801257">struggling with mental health challenges</a> tied to their jobs, such as depression, anxiety and <a href="https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642">burnout</a>. </p>
<p><a href="https://scholar.google.com/citations?hl=en&view_op=list_works&gmla=AHoSzlXHC1hBAKTmRZFVoOEhKGrtTOLup2PNl_qvOrfCvLDJjqEZQNO8kCvJoURoHNFIoSpwmC3Ra4ZbI3yr5C50S000&user=D0iz6OYAAAAJ">We’re professors</a> <a href="https://scholar.google.com/citations?user=m-85A0gAAAAJ&hl=en&oi=ao">who research how employees interact</a> and <a href="https://scholar.google.com/citations?user=5hVxoXwAAAAJ&hl=en&oi=ao">workplace well-being</a>. After noticing that research on mental health and work had not kept up with the increasing prevalence of mental health challenges, we reviewed existing findings on mental health and work to see how scholars can best investigate these issues going forward.</p>
<p>We found that employers could greatly reduce the causes of many of their employees’ mental health challenges through basic human resources approaches, such as taking tasks away from someone who is perpetually swamped or providing more job flexibility. But those fixes, as we explained in the journal <a href="https://doi.org/10.5465/annals.2021.0211">Academy of Management Annals</a>, would require work-related changes employers rarely make or authorize. </p>
<p>We analyzed the findings from 556 articles by researchers on this topic and observed that helping individual employees cope after their problems emerge is far more common than taking steps to preemptively fix problems that are contributing to workers’ conditions. </p>
<h2>Culture and job design</h2>
<p>When you think about jobs that can take a toll on mental health, some very demanding and stressful professions may come to mind. <a href="https://doi.org/10.3109/09638237.2010.541300">Doctors, nurses</a>, <a href="https://doi.org/10.1001/archgenpsychiatry.2010.54">soldiers</a> and <a href="https://doi.org/10.1177/1078390317695266">first responders</a>, for example, often do suffer due to their <a href="https://theconversation.com/seeing-dead-fruit-flies-is-bad-for-the-health-of-fruit-flies-and-neuroscientists-have-identified-the-exact-brain-cells-responsible-207283">regular contact with illness and death</a> on the job.</p>
<p>Yet, we found that the tasks employees perform are often not what leads to their mental health degradation. Instead, an employer’s culture and the way its jobs are designed play big roles.</p>
<p>This pattern can explain why poor mental health manifests in all lines of work, not just emotionally demanding jobs. The Centers for Disease Control and Prevention has found, for instance, that <a href="https://www.cdc.gov/suicide/facts/disparities-in-suicide.html">suicide rates</a> for farmworkers, truckers and warehouse workers are among the nation’s highest.</p>
<p>An employer’s culture lays the groundwork for the quality of social interactions among its employees – and, depending on the profession, with clients, students or the public.</p>
<p>The way people deal with one another can prove important. For instance, employees who endure <a href="https://doi.org/10.1371/journal.pone.0135225">workplace bullying</a> and <a href="https://doi.org/10.2307/2392498">don’t have a supportive boss or colleagues that they can talk to</a> are more likely to have poor mental health.</p>
<p>The way that a job is designed can cause stress, anxiety and feelings of mental and emotional exhaustion. <a href="https://doi.org/10.2307/2392498">Not having the authority to make decisions</a>, <a href="https://doi.org/10.1080/1359432X.2012.711523">lacking clarity about responsibilities</a> and facing obligations that <a href="https://doi.org/10.1177/0192513X20929059">regularly conflict with personal obligations</a>, infringing upon personal and family time, can all increase the risk of mental health problems. </p>
<p>Workplace culture and job design also matter for people doing inherently traumatic jobs. </p>
<p>A review of 61 studies of <a href="https://doi.org/10.3109/09638237.2015.1057334">humanitarian aid workers’ mental health</a> made clear that poor leadership and insufficient support for workers caused disproportionate damage to their mental health. These factors were separate from the trauma they regularly witnessed and experienced in the aftermath of disasters.</p>
<p>This body of research indicates that all employers can reduce work-related mental health risks by scrutinizing how jobs are designed and determining whether any positions should be reconfigured for the sake of their employees’ mental health.</p>
<h2>Mental health benefits</h2>
<p>Employers have a choice. They can take steps to prevent mental health damage before it occurs, or they can deal with its aftermath. Both are important, but according to the body of research we’ve reviewed, the latter is far more common.</p>
<p>People with <a href="https://doi.org/10.1080/09585192.2020.1867618">chronic mental illnesses can thrive</a> at work in the right conditions.
And most U.S. employers today do provide <a href="https://doi.org/10.1007/s11414-014-9412-0">access to mental health benefits</a>, partly due to the Affordable Care Act. The ACA, which Congress passed in 2010, requires insurance companies to treat mental health care the same way they treat physical health care when offering coverage.</p>
<p>About <a href="https://www.workplacementalhealth.shrm.org/wp-content/uploads/2022/04/Mental-Health-in-America-A-2022-Workplace-Report.pdf">78% of U.S. employers provide mental health benefits</a>, including employee assistance programs, and work benefits that provide individual mental health, financial and legal support. Such measures are useful, but only after the harm has taken place. These benefits generally do nothing about psychological hazards tied to work and preventing work-related harm.</p>
<p>Further, many employees who need help <a href="https://doi.org/10.1177%2F08901171221112488d">don’t take advantage of these programs</a>.</p>
<h2>4 steps to reduce the toll work takes on mental health</h2>
<p>Here are four steps employers can take to address the causes of poor mental health:</p>
<ol>
<li><p><strong>Revise job descriptions</strong>.
Employers should eliminate ambiguity, wherever that’s possible, about core duties and responsibilities. They should communicate with employees to ensure they understand why their jobs might require flexibility and adaptation. In times when workloads get unavoidably large, such as what happens at accounting firms in the weeks before Tax Day, employers should strive to balance long shifts with opportunities for employees to rest and recharge.</p></li>
<li><p><strong>Proactively train staff on the positive behaviors expected of them</strong>.
Just as employers strategically plan which job-related skills are important, they can also strategically identify what interpersonal skills are important and value these like technical capabilities with hiring and promotions. If employees engage in bullying behavior, employers can retrain, reassign or fire them accordingly.</p></li>
<li><p><strong>Help employees build resilience</strong>. <a href="https://doi.org/10.1007/s11896-008-9030-y">Research on police officers</a> suggests that when they get resilience-building training before experiencing trauma on the job, it can reduce the risk of developing post-traumatic stress disorder. Similar types of resilience training could also help in less inherently traumatic lines of work.</p></li>
<li><p><strong>Don’t assume that employees will speak up</strong>. Only <a href="http://www.mindsharepartners.org/mentalhealthatworkreport-2021">65% of employees with mental health challenges</a> say that they would tell a co-worker, manager or human resources representative about those problems. They may <a href="https://doi.org/10.1177/10596011211002010">conceal the severity</a> of these issues even if they do talk about them, due to the stigma associated with mental health problems. Proactively addressing the causes of poor mental health for everyone is key, because there’s no way for employers to know the extent of these problems.</p></li>
</ol>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/530947/original/file-20230608-30-1ow56g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Construction workers wearing hard hats and bright-colored vests getting a safety briefing" src="https://images.theconversation.com/files/530947/original/file-20230608-30-1ow56g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530947/original/file-20230608-30-1ow56g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530947/original/file-20230608-30-1ow56g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530947/original/file-20230608-30-1ow56g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530947/original/file-20230608-30-1ow56g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530947/original/file-20230608-30-1ow56g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530947/original/file-20230608-30-1ow56g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Employers can strengthen workers’ mental health, just as physical safety has gotten better over time at construction sites.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/construction-engineers-getting-a-safety-briefing-royalty-free-image/694033313?phrase=hard+hats+construction+safety&adppopup=true">Westend61/Getty Images</a></span>
</figcaption>
</figure>
<h2>Spotting hazards</h2>
<p>Spotting physical hazards on the job is easier than identifying psychological hazards. Yet that doesn’t mean the psychological hazards are less dangerous or can’t be addressed.</p>
<p><a href="https://www.bls.gov/opub/btn/volume-9/nearly-50-years-of-occupational-safety-and-health-data.htm">Requiring hard hats, posting warnings</a> and <a href="https://doi.org/10.1037/0021-9010.65.1.96">mandating safe work habits have reduced accidents</a> in factories, on construction sites and at other workplaces. Likewise, <a href="https://doi.org/10.1037/a0021484">researchers have found that redesigning jobs</a> and adopting better workplace cultures can go a long way toward improving mental health.</p><img src="https://counter.theconversation.com/content/206249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaclyn Koopmann previously worked on research funded by a grant from the National Institute on Alcohol Abuse and Alcoholism. </span></em></p><p class="fine-print"><em><span>Emily Rosado-Solomon and Matthew A. Cronin do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Changing workplace culture and the way jobs are designed can stave off depression, anxiety and burnout.Emily Rosado-Solomon, Assistant Professor of Management, Babson CollegeJaclyn Koopmann, Associate Professor of Management and Entrepreneurship, Auburn UniversityMatthew A. Cronin, Professor of Management, George Mason UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2008922023-05-01T19:08:27Z2023-05-01T19:08:27ZAre you under digital distress? 3 ways tech-triggers may be affecting your mental health<figure><img src="https://images.theconversation.com/files/521725/original/file-20230418-20-r6tg4p.jpg?ixlib=rb-1.1.0&rect=25%2C224%2C5725%2C3604&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Small, proactive countermeasures can reduce digital distress and make us feel more empowered over our mental health.</span> <span class="attribution"><span class="source">(Pexels/Andrea Piacquadio)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/are-you-under-digital-distress-3-ways-tech-triggers-may-be-affecting-your-mental-health" width="100%" height="400"></iframe>
<p><a href="https://www.mentalhealthweek.ca/">Mental Health Week</a>, which runs from May 1 to 7, provides an opportunity to reflect on our collective well-being. In addition to rising <a href="https://doi.org/10.1111%2Fapps.12304">mental health issues</a>, there seems to be a general <a href="https://dictionary.apa.org/malaise">malaise</a> across normally well individuals in society. This is manifesting as cognitive and physical exhaustion, limited patience, disinterest in work and a resentment of the stressors in our lives. </p>
<p>Many of these stressors may be coming from interactions with technology: small but frequent frustrations that quickly dissipate, but when added up become micro-aggressive tech-triggers of <em>digital distress</em>, defined here as a form of <a href="https://dictionary.apa.org/psychological-distress">psychological distress</a> caused by a dysfunctional user experience with technology. </p>
<p>Tech-triggers are pervasive, yet seemingly innocuous because we’ve learned to click them away or compartmentalize their effects. No one is going to do anything about them until we acknowledge their harm, and that it’s a problem. Here are three main types of tech-triggers and their corresponding effects to consider if this is affecting you. </p>
<h2>Pop-ups & prompts — I’m lost!</h2>
<p>Pop-ups are designed to interrupt and draw our attention through notifications, calendar reminders, software updates, website ads, low-battery alerts and more. <a href="https://www.nytimes.com/2008/06/22/jobs/22shifting.html">Frequent disruptions put us on high alert</a> like a jack-in-the-box, triggering a release of adrenaline, norepinephrine and cortisol. These chemicals are designed to make us be alert and ready to protect ourselves when we are under threat; but when we are not in actual danger, they just make us feel like we’re on edge.</p>
<p>Prompts for our username and password can be the ultimate trigger. With many people having login details for numerous websites, it can be challenging to keep track of it all. And often, trying to log into one of your accounts can feel like an oppressive regime of trial and error, sifting through your memory for ludicrously jumbled passwords and immemorable usernames.</p>
<p>Keeping such things in our heads is antithetical to the way our <a href="https://www.washingtonpost.com/wellness/2023/03/13/brain-memory-pandemic-covid-forgetting/">memory works</a>, and repeat, failed attempts can create the same psychological state as being lost. The state of being <a href="https://doi.org/10.1177/1056492615578915">psychologically lost</a> involves feeling isolated, uncertain and disoriented.</p>
<p>With too many pop-ups and prompts, we may be in constant <a href="https://www.britannica.com/science/fight-or-flight-response">fight or flight mode</a>. It’s no wonder they make us feel lost and jumpy. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/521914/original/file-20230419-28-8i63q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man sitting at a table looks at his phone with a stressed look on his face." src="https://images.theconversation.com/files/521914/original/file-20230419-28-8i63q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521914/original/file-20230419-28-8i63q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521914/original/file-20230419-28-8i63q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521914/original/file-20230419-28-8i63q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521914/original/file-20230419-28-8i63q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521914/original/file-20230419-28-8i63q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521914/original/file-20230419-28-8i63q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many of the stressors we face come from our interactions with technology.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Digital clutter — I’m failing!</h2>
<p>Digital clutter creates a slow-burn of deep-seated awareness that there is too much to manage, and we’re failing at it. <a href="https://www.inc.com/david-finkel/overwhelming-inbox-heres-a-simple-trick-to-try-before-declaring-email-bankruptcy.html">Unclearable email queues</a>, cluttered digital folders and our inability to complete tech-tasks (like printing photos or deleting old drafts) can create a <a href="https://doi.org/10.1006/anbe.1998.1049">psychological state of failure</a>. Organizing and decluttering is our way of feeling in control, but sometimes there is just so much to manage. It can feel defeating. </p>
<p>So, too, can the <a href="https://hbr.org/2022/01/the-psychology-of-your-scrolling-addiction">infinite scroll feature</a> on social media apps. Long sessions of scrolling, swiping and tapping make our brain check out and send neurochemical signals of <a href="https://www.forbes.com/sites/carolinebeaton/2016/04/07/this-is-what-happens-to-your-brain-when-you-fail-and-how-to-fix-it/?sh=37399ad01b81">demotivation and failure</a>. </p>
<p>This may be a combination of rising cortisol and lowering dopamine, which creates a biophysical experience of feeling stressed and bored at the same time. </p>
<p>This might be amplified by the frequent failure experienced with other tech-triggers, such as <a href="https://doi.org/10.1177/154193121005400437">disruptive</a> software updates and continuously newer versions of tech, just different enough to make you feel like you don’t know what you are doing. </p>
<p>This constant state of upgrade is antithetical to how we learn. Humans are <a href="https://www.edweek.org/ew/articles/2015/09/23/carol-dweck-revisits-the-growth-mindset.html?print=1">motivated by growth</a>: we like to learn more and get better at tasks, not to feel suddenly stupid and slowed down. With too much to sort through and more on the way, our system is frequently triggered for failure. It’s no wonder we feel overwhelmed. </p>
<h2>Cyber insecurity — I’m afraid!</h2>
<p>A third tech-trigger is caused by apprehensions about our cyber-security and how safe our digital information <em>really</em> is. Although online shopping and banking seems secure, there can be a sneaking suspicion that our credit card and financial information are not as protected as we’re told. We manage this fear with a few clicks, or perhaps with a <a href="https://time.com/6200717/online-shopping-psychology-explained/">purchase that restores our sense of control</a>.</p>
<p><a href="https://www.psychologytoday.com/ca/basics/terror-management-theory">Terror management theory</a> suggests that societies gain comfort through avoidance. Is it possible people click “allow all” on cookie notifications to make themselves feel better? If so, the same theory explains how this can also trigger existential anxiety and depression. With so much at stake, our system is frequently triggered to feel unsafe, and it’s no wonder our brain is warning us to stay alert. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/521917/original/file-20230419-26-ppr208.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A graphic showing a man running away from a laptop with envelopes flying out of it." src="https://images.theconversation.com/files/521917/original/file-20230419-26-ppr208.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521917/original/file-20230419-26-ppr208.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521917/original/file-20230419-26-ppr208.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521917/original/file-20230419-26-ppr208.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521917/original/file-20230419-26-ppr208.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521917/original/file-20230419-26-ppr208.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521917/original/file-20230419-26-ppr208.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Digital clutter creates a slow-burn of deep-seated awareness that there is too much to manage, and we’re failing at it.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>What can we do about it?</h2>
<p>The effects of these tech-triggers mean we might regularly feel lost, stupid and afraid. The question is: what can we do about it? Many of these interactions are embedded in our work and lifestyles and yet, our bodies and minds are telling us this isn’t right. </p>
<p>Digital distress may be our body’s way of warning us that something’s got to change. If so, awareness is a start, and can help us better manage the situation and regulate our responses. Here are a few things you can try:</p>
<p>• Take the time to review your settings for pop-up blockers, cookies, authorized data access and notifications. Turn them off (or better yet, set a time to turn off your devices) and see if you feel more calm. </p>
<p>• Schedule time for sorting through digital clutter before it becomes overwhelming (or better yet, consider what you want to receive or save in the first place). If you don’t deal with it now, you’ll have to deal with it later with more stress.</p>
<p>• Stay alert for workplace tech-triggers and challenge them when they first arise. Some so-called solutions are problematic, like having to log in to the same account repeatedly throughout the day or having to go through too many authentication steps. Employers might reconsider tactics if employee mental health is on the line. </p>
<p>We can also create small changes that make us less tech-dependent, such as bringing back wall clocks so we can glance at time without a screen; noting schedules on paper to avoid being drawn into email via our digital calendar; and change our settings in apps and devices to have more control over our digital experience.</p>
<p>Small, proactive countermeasures can increase our self-efficacy in a way that will reduce our digital distress and make us feel more empowered over our mental health.</p><img src="https://counter.theconversation.com/content/200892/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brittany Harker Martin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many stressors may be coming from interactions with technology: small but frequent frustrations that quickly dissipate, but when added up trigger digital distress.Brittany Harker Martin, Associate Professor, Leadership, Policy & Governance, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1967222022-12-20T22:37:43Z2022-12-20T22:37:43ZMental blocks: how better design of acute mental health units could aid recovery<figure><img src="https://images.theconversation.com/files/501670/original/file-20221217-11-hrs470.jpg?ixlib=rb-1.1.0&rect=0%2C57%2C3834%2C2098&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Ruby Crooks</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>It is a niche kind of membership that lets you in behind the doors of an acute mental health facility. Unless you work there or are admitted as an inpatient, these publicly funded private spaces that house people at their most vulnerable are really difficult to get into. </p>
<p>This makes them challenging to study and, without such research, challenging for architects to design well. We opened up the black box of acute mental health care facilities in New Zealand to understand their purpose, how people experience them and what informs their architectural design.</p>
<p>Design matters. Fit-for-purpose psychiatric facility design promotes better mental health and wellbeing. This is a no-brainer for people who work and stay in these units. </p>
<p>Unfortunately, the evidence base for the architectural design of acute mental health facilities has been haphazard, with costly implications. </p>
<p>To understand how these settings serve their populations and if we can do better, we studied four acute mental health facilities around New Zealand, looking at the old, the new and some in between. </p>
<p>We examined policy documents and architectural plans and made site visits to take photographs, conduct a building survey and interview staff, service users and visiting family members.</p>
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Read more:
<a href="https://theconversation.com/how-psychological-aspects-of-healing-are-important-for-hospital-design-178890">How psychological aspects of healing are important for hospital design</a>
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<h2>Not fit for purpose</h2>
<p>In terms of the purpose of acute mental health facilities, we found <a href="https://www.mdpi.com/1660-4601/18/5/2343">confusion</a>. Only one facility had a written model of care, which is the critical blueprint for architects to understand what and who they are designing for. </p>
<p>Fortunately, we did find consensus that the underpinning philosophy of care was the “recovery model”. We figured recovery principles, in concert with <a href="https://www.tandfonline.com/doi/full/10.1080/1177083X.2022.2093229">Indigenous Māori values</a> and models of health and wellbeing, could and should inform the architectural blueprint for these buildings. </p>
<figure class="align-center ">
<img alt="A model of what mental health facilities could look like." src="https://images.theconversation.com/files/502049/original/file-20221220-18-yirdb5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/502049/original/file-20221220-18-yirdb5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502049/original/file-20221220-18-yirdb5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502049/original/file-20221220-18-yirdb5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502049/original/file-20221220-18-yirdb5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502049/original/file-20221220-18-yirdb5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502049/original/file-20221220-18-yirdb5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Architecture students were asked to come up with design visions for mental health facilities that support recovery and Indigenous Māori values.</span>
<span class="attribution"><span class="source">Ruby Crooks</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>A recovery-oriented environment suggests a design that fosters connection, hope, identity, meaning, empowerment and safety. This was not what we found. </p>
<p>While service users were relieved to get sleep, respite and diagnosis or treatment for their distressing symptoms and spoke highly of the staff compassion and quality of care, for many the acute mental health environment was confusing, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0266935">frightening</a>, disempowering, restrictive, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0259984">boring</a> and sometimes unsafe and <a href="https://doi.org/10.3389/fpsyt.2022.940130">traumatising</a>.</p>
<h2>Name in vain</h2>
<p>In what feels like institutional gaslighting, the naming of these units is bewilderingly Kafkaesque. We found “open units”, the name given to lower-acuity facilities, typically have their doors locked. Given the voluntary status of some patients, this is counter intuitive. </p>
<p>Then there are the warm-fuzzy, therapeutic-sounding names for the prison-like seclusion wings, often with Indigenous Māori names, implying such spaces are peaceful retreats when inpatients felt they were anything but. </p>
<p>There is hope however. New Zealand has an aspirational goal of <a href="https://www.hqsc.govt.nz/assets/Our-work/Mental-health-and-addiction/Resources/Zero-seclusion-change-package/Zero-seclusion-change-package-final.pdf">zero seclusion</a>. Bafflingly, we are yet to build a facility without a seclusion wing. </p>
<h2>Mind numbing</h2>
<p>Service users talked about boredom in dilapidated, resource-scarce and low-stimulus environments. There was little to do in many of the wards and, while all had TVs and a few dog-eared books, activities and allocated spaces were often limited. </p>
<p>Often art rooms, sensory rooms and other occupational therapy spaces were locked and completely unused due to a lack of staff or the ability to supervise effectively. </p>
<p>Facility decision-making around recreation sometimes appeared dubious. Some had exercise bikes inappropriately located in the public reception, or a broken basketball hoop, and colouring-in and smoothie-making seemed central to some recreational programmes. </p>
<p>Lack of meaningful activities led some to start or restart smoking, which was the dominant activity observed in the internal ward courtyards, despite hospital smokefree polices. <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0266935">Fear of violence</a> was cited as a major barrier to smokefree implementation. </p>
<h2>Beds and meds</h2>
<p>We were struck by the paucity of therapeutic options. While all units had occupational therapists, social workers and psychiatrists, the main treatment was medication, or as some staff described it, “beds and meds”. </p>
<p>Although many were grateful for medication, service users complained about the absence of talking therapies, lamented the lack of access to psychologists and many just wanted someone, anyone, to talk to. We found service users <a href="https://www.tandfonline.com/doi/full/10.1080/1177083X.2022.2093230">counselling each other</a>. </p>
<p>We also found a lack of consideration of various gendered and cultural needs in the models of care, building design and layout. Shared bathrooms were described as “gross” and there were issues with acoustic and visual privacy.</p>
<figure class="align-center ">
<img alt="A design suggestion for a mental health facility" src="https://images.theconversation.com/files/502050/original/file-20221220-20-l94y32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/502050/original/file-20221220-20-l94y32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502050/original/file-20221220-20-l94y32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502050/original/file-20221220-20-l94y32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502050/original/file-20221220-20-l94y32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502050/original/file-20221220-20-l94y32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502050/original/file-20221220-20-l94y32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The look and feel of acute mental health buildings, such as this design vision, can affect people’s sense of recovery.</span>
<span class="attribution"><span class="source">Ruby Crooks</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<p>Buildings and models of care did not accommodate or consider Māori values and cultural practices well, although New Zealand’s newest facility, Tiaho Mai in Auckland, boasts bi-cultural features due to co-design with Māori.</p>
<p>At a time when evidence suggests a more “domestic” look and feel of acute mental health care buildings would be more therapeutic, New Zealand’s facilities are more hospital-like or institutional <a href="https://www.mdpi.com/1660-4601/19/14/8832">than those in the UK</a>. </p>
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<strong>
Read more:
<a href="https://theconversation.com/design-makes-a-place-a-prison-or-a-home-turning-human-centred-vision-for-aged-care-into-reality-156937">Design makes a place a prison or a home. Turning 'human-centred' vision for aged care into reality</a>
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</em>
</p>
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<p>Courtyards, critical in locked facilities to access fresh air, sunshine and nature, were also institutional, often no more than a concrete pad with little to no nature. They <a href="https://doi.org/10.3390/ijerph191811414">failed to provide</a> any real therapeutic value. </p>
<p>There were some positives though. Encouragingly, many staff told us, despite all the challenges associated with working in these settings, they stayed because the work was interesting, they loved the people and enjoyed that their work made a <a href="https://doi.org/10.3390/ijerph192013619">difference to people’s lives</a>.</p>
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<h2>How we can do better</h2>
<p>The current model and buildings are not serving people well. While the prospect of bulldozing the current stock might appeal, without places to safely care for people experiencing profound mental distress, our most vulnerable may find themselves dislocated from their homes and communities, or worse, in the criminal justice system. </p>
<p>We should and are making improvements to our existing stock of buildings, and some are being totally rebuilt. In the interim, small changes to these environments to foster more inpatient autonomy can be made, including self-locking bedroom doors, built-in privacy controls and the provision of lockers to store valuables.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/your-home-office-or-uni-affects-your-mood-and-how-you-think-how-do-we-know-we-looked-into-peoples-brains-189797">Your home, office or uni affects your mood and how you think. How do we know? We looked into people's brains</a>
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</em>
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<p>However, a more profound transformation around the model of care itself is required. Fortunately, a major paradigm shift towards alternative models of acute mental health care is brewing. Many countries, including New Zealand, are re-examining care provision with a <a href="https://apps.who.int/iris/handle/10665/341648">human rights lens</a>.</p>
<p>We need to work together to re-create a mental health system that reflects values of human rights, autonomy and person-centred practice and aligns with the rights of Indigenous people. We need a suite of options and new models of mental health care to provide the blueprints for our architects to design and upgrade our places of care.</p><img src="https://counter.theconversation.com/content/196722/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabrielle Jenkin received funding from Royal Society of New Zealand (contractUOO1623) (Marsden Fund) </span></em></p><p class="fine-print"><em><span>Elizabeth Kathleen Morton and Jacqueline McIntosh do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New Zealand’s acute mental health facilities are not fit for purpose. Although many inpatients are grateful for medication, they lament the lack of access to psychologists and therapeutic activities.Gabrielle Jenkin, Director Suicide and Mental Health Research Group University of Otago Wellington, University of OtagoElizabeth Kathleen Morton, Student researcher in mental health and neuroscience, King's College LondonJacqueline McIntosh, Senior Lecturer in Architecture, Te Herenga Waka — Victoria University of WellingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1895092022-11-18T13:31:40Z2022-11-18T13:31:40ZDoctors often miss depression symptoms for certain groups – a routine screening policy for all adult primary care patients could significantly reduce the gap<figure><img src="https://images.theconversation.com/files/495727/original/file-20221116-20-p9ujg0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2000%2C1500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Depression is a leading cause of disability worldwide.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/male-patient-sitting-on-exam-table-in-clinic-room-royalty-free-image/114147001">Thomas Barwick/Stone via Getty Images</a></span></figcaption></figure><p>Depression is a costly and debilitating condition that profoundly influences a person’s quality of life. In 2020, <a href="https://www.nimh.nih.gov/health/statistics/major-depression">more than 21 million adults</a> in the U.S. reported having at least one major depressive episode in the previous year. Depression symptoms increased dramatically during the COVID-19 pandemic, and now affect nearly <a href="https://doi.org/10.1016/j.lana.2021.100091">1 in 3 American adults</a>. </p>
<p>There are also many <a href="https://doi.org/10.1001/archpsyc.62.6.629">disparities in access to depression treatment</a>. Clinicians are less likely to recognize and treat depressive symptoms in <a href="https://doi.org/10.1176/appi.ps.201900407">certain groups</a>, including racial and ethnic minorities, men, older adults and people with language barriers. These disparities may be driven by poor patient-physician communication about mental health, cultural differences in discussing depressive symptoms, stigma around mental illness and limited available treatment options. </p>
<p>Limited time to discuss mental health symptoms in depth in primary care settings may also contribute to the depression treatment gap. As a <a href="https://profiles.ucsf.edu/maria.garcia">researcher and primary care physician</a> focused on improving access to mental health treatment, I have seen many patients struggle to have their depressive symptoms recognized by their clinicians and access quality care. Depression screening often only occurs when a clinician suspects the patient may have depression or when the patient specifically requests mental health care.</p>
<p>But making depression screening a routine practice could help reduce treatment disparities. In January 2016, the U.S. Preventive Services Task Force began <a href="https://doi.org/10.1001/jama.2015.18392">recommending depression screening for all adults</a>. In October 2022, given the mental health effects of the pandemic, it extended the recommendation to include screening all <a href="https://doi.org/10.1001/jama.2022.18187">adolescents age 12 and up</a> for depression and suicide risk during routine wellness checkups.</p>
<p>In our recent study, my team and I found that implementing <a href="https://doi.org/10.1001/jamanetworkopen.2022.27658">universal, routine depression screening</a> for adults in primary care is one way to make detection more equitable. </p>
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<figcaption><span class="caption">Depression and anxiety increased across the U.S. during the pandemic.</span></figcaption>
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<h2>Depression screening in one large health system</h2>
<p>The goal of our study was to evaluate whether the six primary care practices in the University of California, San Francisco health system had adopted routine depression screening for all their adult patients, and whether traditionally undertreated or untreated groups were being screened.</p>
<p>Medical assistants were asked to administer the screening test before patients saw their clinician. The clinician, after reviewing and discussing the results with the patient, could then arrange a follow-up appointment, prescribe a depression medication or submit a referral to a behavioral health specialist. </p>
<p>After two years, we analyzed data for 52,944 adult patients who had an appointment at one of the primary care clinics in that period. Screening rates were initially low – only 40.5% of patients were screened. Furthermore, men, older adults, racial and ethnic minorities, those with public health insurance, and those with language barriers were all less likely to be screened. For example, patients who spoke a Chinese language were almost half as likely to be screened as patients who spoke English.</p>
<p>However, with the UCSF health system’s coinciding focus on equity, screening rates increased to 88.8% by 2019. UCSF Health established a task force that met over the course of the project to discuss its progress, share best practices across primary care clinics and actively make adjustments to address screening disparities.</p>
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<p>Overall, screening rates dramatically increased over those two years for all groups at risk of having their depression go unrecognized and untreated.</p>
<h2>Improving depression care for all patients</h2>
<p>Depression is a <a href="https://www.who.int/news-room/fact-sheets/detail/depression">leading cause of disability worldwide</a>. It can affect a person’s ability to manage other chronic conditions, and can lead to worsened disability and earlier death. </p>
<p>Our research found that increasing universal screening efforts can help reach groups that are less likely to be screened and treated for depression. We ensured that screening tools were available in other languages, clinical staff were periodically trained, and screening was integrated with routine clinical tasks. We also made sure that our efforts were aligned with the UCSF health system’s priorities, quality improvement efforts and reimbursement policies to reduce the burden of implementation and ensure sustainability.</p>
<p>While depression screening is necessary, it is not sufficient on its own to decrease care disparities for depression. Additional research is needed to see whether improved screening will lead to increased treatment and care engagement among at-risk groups.</p>
<p>Our team’s next steps are to evaluate whether a positive screen led to initiation of treatment for depression, and whether all patient groups were equally likely to engage in treatment. Our hope is that the lessons we learned from implementing routine depression screening in our primary care practices can encourage other health care systems around the country to do the same, and help better serve diverse patient populations.</p><img src="https://counter.theconversation.com/content/189509/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maria Garcia receives funding from the National Institute on Minority Health and Health Disparities.</span></em></p>Men, older adults, people with language barriers and racial and ethnic minorities are less likely to be screened for depression.Maria Garcia, Assistant Professor of Medicine, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921622022-11-14T01:52:17Z2022-11-14T01:52:17ZPharmacists could help curb the mental health crisis – but they need more training<figure><img src="https://images.theconversation.com/files/494050/original/file-20221108-16-f7uebu.jpg?ixlib=rb-1.1.0&rect=18%2C18%2C6164%2C4097&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://theconversation.com/drafts/192162/edit">Shutterstock</a></span></figcaption></figure><p>Chances are you live within 2.5 kilometres of a community pharmacy and visit one about every <a href="https://www.guild.org.au/__data/assets/pdf_file/0020/12908/Vital-facts-on-community-pharmacy.pdf">three weeks</a>. </p>
<p>You don’t need an appointment. The wait time is usually short. These factors make <a href="https://pubmed.ncbi.nlm.nih.gov/33867054/">pharmacists highly accessible</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755826/">healthcare professionals</a>. </p>
<p>Pharmacists are regularly sought after for advice, including about mental health. In fact, pharmacists may be among the <a href="https://mhaustralia.org/general/pharmacists-role-mental-health">first</a> health professional contacted about a <a href="https://pubmed.ncbi.nlm.nih.gov/20225134/">health concern</a>. They are also in <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">regular contact</a> with patients experiencing mental health issues or crises.</p>
<p>Despite the fact most pharmacists believe it is part of their role to <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">provide mental health-related help</a>, they may <a href="https://pubmed.ncbi.nlm.nih.gov/34560826/">lack the confidence</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">respond to, raise or manage</a> mental health issues with patients. In our recent study, pharmacists report not intervening about <a href="https://onlinelibrary.wiley.com/doi/10.1111/eip.13361">25% of the time</a> when they believe a patient is experiencing a problem or crisis. </p>
<p>Providing pharmacists with early intervention skills could help them address these challenges. </p>
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Read more:
<a href="https://theconversation.com/pixels-are-not-people-mental-health-apps-are-increasingly-popular-but-human-connection-is-still-key-192247">Pixels are not people: mental health apps are increasingly popular but human connection is still key</a>
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<h2>The pandemic has seen mental health decline</h2>
<p>The COVID pandemic has seen anxiety and depression <a href="https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide">increase by 25%</a> globally, signalling a broader mental health decline. </p>
<p>Poor mental health affects around 20% of the <a href="https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/latest-release">Australian population</a> each year, and <a href="https://www.abs.gov.au/media-centre/media-releases/study-paints-picture-mental-disorders-australia">44% of Australians</a> over their lifetime. In a <a href="https://psychology.org.au/about-us/news-and-media/media-releases/2022/bleak-new-figures-confirm-depth-of-mental-health-c">recent survey</a> of 11,000 people, 24% of them said their mental health had declined over the previous six months. </p>
<p>Most concerning is that about 60% of people experiencing a mental health issue <a href="https://www.blackdoginstitute.org.au/about/who-we-are/#:%7E:text=And%20roughly%2060%25%20of%20these,this%20through%20'translational'%20research.">won’t seek help</a>. This means people are more likely to remain undiagnosed and disconnected from support. </p>
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<h2>Pharmacists’ many hats</h2>
<p>While dispensing and consulting are critical activities for pharmacists, they also help patients with questions and advice about their health, including their mental health.</p>
<p>Generally, <a href="https://pubmed.ncbi.nlm.nih.gov/21070104/">pharmacists in Australia</a> have high levels of mental health-related literacy and <a href="https://pubmed.ncbi.nlm.nih.gov/33867054/">evidence-based treatments</a>.</p>
<p>Despite this, pharmacists report a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9098086/">lack of confidence</a> which <a href="https://pubmed.ncbi.nlm.nih.gov/28153705/">prevents them</a> from raising mental health issues with patients. This is possibly because only 29% of pharmacists in Australia have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350138/">mental health crisis training</a>.</p>
<p>A lack of confidence in raising and addressing mental health-related issues means patients are likely to remain undiagnosed, untreated, and unsupported.</p>
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Read more:
<a href="https://theconversation.com/scared-of-needles-claustrophobic-one-longer-session-of-exposure-therapy-could-help-as-much-as-several-short-ones-193525">Scared of needles? Claustrophobic? One longer session of exposure therapy could help as much as several short ones</a>
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<h2>4 key elements of mental health first aid</h2>
<p>Many of us are familiar with first aid as immediate help offered to an injured or sick person. But what if the issue is not physical, but mental? Many people don’t know what immediate help they can offer. </p>
<p>As with physical injury or illness, timely and high-quality immediate help is critical. </p>
<p>There are a variety of not-for-profit and commercial mental health first aid training programs. A recent literature review of programs for mental health professionals suggests they can <a href="https://pubmed.ncbi.nlm.nih.gov/35500153/">minimise stigma</a> and <a href="https://www.tandfonline.com/doi/full/10.3109/09540261.2014.924910">increase knowledge</a>. They can also bolster <a href="https://www.sciencedirect.com/science/article/pii/S1551741122001991">confidence</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/29851974/">intentions to help</a>. </p>
<p>Across the programs, there are four common elements to providing high-quality mental health first aid.</p>
<p><strong>1. Recognise someone may be experiencing a mental health issue or crisis</strong></p>
<p>Recognising a mental health issue or crisis involves taking notice of verbal, physical, emotional and behavioural indicators. Given pharmacists interact with patients about every three weeks, they may be in a good position to notice changes. </p>
<p>They may express sadness, anger, frustration, hopelessness, shame or guilt. Patients might say: “There’s no hope” or “I can’t go on like this”.</p>
<p>Physical indicators include fatigue, sleeping difficulties, restlessness, muscle tension, upset stomach, sweating, difficulty breathing, changes in appetite or weight. </p>
<p>Emotional indicators reflect how a person is feeling and include significant mood changes, teariness, agitation, anger, desperation or anxiety. </p>
<p><a href="https://www.blackdoginstitute.org.au/resources-support/fact-sheets/">Symptom guides</a> for anxiety, depression, bipolar disorder, and suicidal ideation are available. </p>
<p><strong>2. Approach and assesses the person</strong></p>
<p>Opening the dialogue can be as simple as, “How are you? I have noticed [symptoms] and am concerned.” </p>
<p>Your role is not to clinically diagnose a patient; however, it is valuable to assess the patient’s risk and level of urgency. Risk and urgency will help inform whether the person is in immediate danger or can use other non-urgent support services. </p>
<p>The TED acronym can guide first discussions in the following way: </p>
<blockquote>
<p>Tell me … </p>
<p>Explain how that has been impacting you … </p>
<p>Describe what is happening … </p>
</blockquote>
<p><strong>3. Listen in an active way and communicate without judgement</strong> </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1636963/">Active listening</a> involves confirming you are hearing and understanding the other person. <a href="https://www.ucsfhealth.org/education/active-listening-strategies">Ways of doing this include</a>: nodding, appropriate eye contact, and summarising what has been shared. </p>
<p>Communicating without judgement involves demonstrating genuine concern for the other person and talking about their experience. </p>
<p>Open-ended questions usually use “how” and “what” queries. You could say something like: “I’ve noticed some changes recently, what’s happening for you?” or “I see you are filling a prescription for sleep tablets. How are you sleeping?” </p>
<p><strong>4. Refer the person to supports</strong></p>
<p>People who are struggling with their mental health can benefit from sharing details with professionals, like general practitioners, or family and friends – but they might need encouragement to seek this support out.</p>
<p>The support system recommended should match the level of urgency. Urgent services include Lifeline for free 24-hour <a href="https://www.lifeline.org.au/">phone, chat, and text message</a> support. The <a href="https://www.suicidecallbackservice.org.au/">Suicide Call Back Service</a> is also a free 24/7 counselling service. </p>
<p>If in doubt or in an emergency, dial 000. </p>
<p>Non-urgent and free online support is available from <a href="https://www.headtohealth.gov.au/">Head to Health</a>, the <a href="https://www.blackdoginstitute.org.au/">Black Dog Institute</a> and <a href="https://www.beyondblue.org.au/">Beyond Blue</a>. </p>
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Read more:
<a href="https://theconversation.com/how-to-look-after-your-mental-health-if-youre-at-home-with-covid-174536">How to look after your mental health if you're at home with COVID</a>
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<h2>Could training community pharmacists help?</h2>
<p>Studies in <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">Australia</a>, <a href="https://www.sciencedirect.com/science/article/pii/S155174112200002X">New Zealand</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350138/">Canada</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/32580909/">abroad</a> all point to pharmacists’ believing <a href="https://pubmed.ncbi.nlm.nih.gov/30070236/">they need more training</a> in mental health first aid. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32139284/">Research</a> suggests almost 70% of patients believe all pharmacists should have mental health first aid training. Patients report feeling significantly more comfortable speaking about mental illness with a pharmacist with this training. </p>
<p>And emerging evidence shows mental health first aid training can increase the <a href="https://ijmhs.biomedcentral.com/articles/10.1186/1752-4458-8-46">quality</a> of help provided by pharmacists. </p>
<p>In our <a href="https://onlinelibrary.wiley.com/doi/10.1111/eip.13361">study</a>, we found Australian pharmacists with mental health first aid training were more likely to intervene than untrained pharmacists. </p>
<p>While the overall quality of the first aid provided by both mental health first aid trained and untrained pharmacists was high, some key differences existed. Trained pharmacists assessed patients and encouraged other supports (such as from friends and family) more. They also felt more confident discussing suicide risk. </p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/192162/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Carpini collaborates with Mental Health First Aid (MHFA) Australia on research projects. Specifically, MHFA Australia has assisted in the dissemination of surveys and recruitment of participants for other research studies that do not overlap with findings related to pharmacists. MHFA Australia was not involved in the research examining pharmacists in any way. Joseph does not receive compensation, directly or indirectly, from MHFA Australia. He has completed Mental Health First Aid training. </span></em></p><p class="fine-print"><em><span>Deena Ashoorian collaborates with Mental Health First Aid Australia on research projects. In addition to being a pharmacist, Deena is an accredited Master Instructor of the Mental Health First Aid program.</span></em></p><p class="fine-print"><em><span>Rhonda Clifford collaborates with students and colleagues to deliver MHFA research projects and other projects related to Mental Health.</span></em></p>Pharmacists develop basic mental health knowledge as part of their formal training. But they report a lack the confidence about raising mental health issues with patients.Joseph A Carpini, Lecturer, Organizational Behaviour and Human Resource Management, The University of Western AustraliaDeena Ashoorian, Senior Lecturer, Pharmacy Discipline, The University of Western AustraliaRhonda Clifford, Professor, Allied Health, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1848482022-06-16T19:53:40Z2022-06-16T19:53:40ZAfter years of COVID, fires and floods, kids’ well-being now depends on better support<p><a href="https://www.pwc.com.au/government/government-matters/covid-19-education-how-australian-schools-are-responding.html">Every student in every school</a> in Australia has experienced unprecedented disruptions to their schooling over the past three years. On top of the disruptions and stress of COVID-19 lockdowns, isolation from their schools, their friends and (for many) their extended families, tens of thousands of Australian families have also seen their communities ravaged by fires and floods. </p>
<p>Kids have had to spend lunchtimes indoors to avoid the smoky haze and ash falling on their playgrounds. They have been rescued from their rooftops by boat and helicopters. Lives have been lost and <a href="https://www.deakin.edu.au/about-deakin/news-and-media-releases/articles/fires,-floods,-and-a-global-pandemic-principals-talk-about-alarming-stress-and-workloads-during-year-like-no-other">communities devastated</a>. </p>
<p><a href="https://researchoutput.csu.edu.au/en/publications/transitions-from-remote-delivery-to-reopening-a-review-of-evidence">Our research</a> on post-crisis schooling and the <a href="https://link.springer.com/article/10.1007/s13384-022-00518-3">impacts of COVID-19</a> found the disruptions to schooling had significant impacts on the well-being of teachers and students, whereas academically the kids were OK.</p>
<p>And yet schools and teachers are still under pressure to make sure students don’t “fall behind” academically. This concern has often overshadowed trickier questions like “how are they coping?” In Australia, we have just one professionally trained school counsellor for <a href="https://news.nswtf.org.au/blog/media-release/2020/10/students-risk-due-lack-school-counsellor">every 750 students</a>.</p>
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<h2>What did the research find?</h2>
<p><a href="https://link.springer.com/article/10.1007/s13384-021-00436-w?mc_cid=2fec9e3b41&mc_eid=UNIQID">Reading results of year 3 and 4 students</a> in 2020 were not significantly different from students who did the same tests in 2019. The picture was <a href="https://theconversation.com/remote-learning-didnt-affect-most-nsw-primary-students-in-our-study-academically-but-well-being-suffered-154171">more complex in mathematics</a> – some students achieved more and some slightly less than their 2019 peers. Overall, though, students have continued to progress at the same rate.</p>
<p>However, <a href="https://link.springer.com/content/pdf/10.1007/s13384-022-00518-3.pdf">teachers’ morale and feelings of self-efficacy</a> dropped substantially in 2020. </p>
<p>And disruptions to schooling and home lives have had a massive impact on the well-being and mental health of students. <a href="https://www.theage.com.au/national/victoria/calls-for-help-surge-as-teens-mental-health-suffers-in-lockdown-20200910-p55u7m.html">Mental health support services</a>, such as Kids Helpline, reported increases in calls of up to 28% in Victoria while they endured repeated lockdowns. </p>
<p>Teachers from all levels of schooling reported seeing decreased engagement and increases in poor behaviour and student anxiety. One teacher told us: </p>
<blockquote>
<p>And even the engagement, their concentration levels really, really dropped off a lot. […] they can’t sit still for more than a minute and, like I said, normally before COVID they were fine. They were able to participate in class discussions. And all of a sudden now, engagement […] they can’t sit still anymore. They’ve always got to be up. Focus and concentration floats in and out […] routine is gone, it’s not there anymore.</p>
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<h2>How can we support communities under pressure?</h2>
<p>Natural disasters like fires and floods can traumatise children, particularly when their communities have been hit repeatedly. While children often show resilience immediately following natural disasters like bushfires, <a href="https://education.nsw.gov.au/content/dam/main-education/about-us/educational-data/cese/2020-impact-of-bushfires-on-student-wellbeing-and-learning.pdf">studies</a> show up to one in five students report moderate to severe symptoms of trauma six to 12 months after the event.</p>
<p>Kids across the country have lost their homes and their schools. Many students, particularly those in the flooded Northern Rivers region of New South Wales, are living in temporary accommodation and going to “pop-up classrooms”. Sometimes these are in a different town, adding up to two hours of travel time for students and families. That’s stressful and exhausting for kids and families suffering from trauma.</p>
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<p>Following repeated national emergencies, children need opportunities to <a href="https://www.emerald.com/insight/content/doi/10.1108/DPM-10-2013-0177/full/html?casa_token=sCUQzzTfbOcAAAAA:7Qua0oNxiWo3nq5QI-Llqed9_fFyrPbGnFX_4bqfLujNGnxJ6uEEoqCWGz2L_sfytC0-f0wqFc57riRqbrHIjB-cg7EbbaP1D70IOJRAJ-EdPb4WM7GjTg">talk about their experiences</a>. It helps them to respond, recover and build resilience. </p>
<p>As a key part of the community, schools are uniquely placed to support children and their families in times of crisis. Calls for <a href="https://theconversation.com/its-almost-like-a-second-home-why-students-want-schools-to-do-more-about-mental-health-179644">mental health literacy programs</a> in schools offer one part of the solution. However, this is a complex issue that requires both immediate and ongoing responses.</p>
<h2>Invest more in support services</h2>
<p>On average, there’s only <a href="https://news.nswtf.org.au/blog/media-release/2020/10/students-risk-due-lack-school-counsellor">one professionally trained school counsellor</a> to deal with the needs of students for every two schools in Australia – and there are far fewer counsellors in regional areas. Students are waiting <a href="https://news.nswtf.org.au/blog/media-release/2020/10/students-risk-due-lack-school-counsellors">more than four weeks</a> to see their school counsellor. Schools and communities are desperate for this urgent and critical support.</p>
<p>Most teachers and school staff have limited training in how to understand impacts of trauma on student learning and behaviour, and in effective teaching practices for students who have experienced trauma. Departments need to invest in ensuring all teachers have these skills to support our kids in the years to come. The immediate solution can’t rely on our already overworked teachers.</p>
<p>Access to professional support for the mental health and well-being of our children is paramount. The current funding of <a href="https://www.dese.gov.au/national-school-chaplaincy-program-nscp">$62.4 million a year</a> provided for school chaplains, <a href="https://theconversation.com/school-chaplains-may-be-cheaper-than-psychologists-but-we-dont-have-enough-evidence-of-their-impact-148521">who do not require specialist training</a> in psychology, could be re-allocated to ensure adequate and appropriately trained support for all children, particularly those who have lived through the most recent crises. While school chaplains reported increases in student mental health issues, family conflicts and behavioural issues in 2021, they made <a href="https://schoolchaplaincy.org.au/snapshot-2022/">less than 15% of referrals</a> in schools to other supports. </p>
<p>Schools are pillars of their communities. In the current crisis in the Northern Rivers, principals and teachers have again responded with unparalleled community spirit. But they need more support. </p>
<p>Established crisis communication plans can help principals, teachers, students and their families stay connected and feel some sense of control over their own lives. A strategic approach to setting up public and mental health hubs within schools for the whole community is essential for building resilience and getting kids ready to learn.</p>
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<p><em>This article is part of The Conversation’s <a href="https://theconversation.com/au/topics/breaking-the-cycle-119149">Breaking the Cycle</a> series, which is supported by a philanthropic grant from the Paul Ramsay Foundation.</em></p><img src="https://counter.theconversation.com/content/184848/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jess Harris received funding from the Paul Ramsay Foundation, the Department of Education and Training (Victoria) and the NSW Department of Education for the research. This article is part of The Conversation's Breaking the Cycle series, which is about escaping cycles of disadvantage. The series is supported by a philanthropic grant from the Paul Ramsay Foundation.</span></em></p>Research on the impacts on schooling of COVID and bushfire and flood disasters has found academically the kids are mostly OK. It’s their well-being and recovery from trauma that demand our attention.Jess Harris, Associate Professor in Education, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1846352022-06-09T20:10:41Z2022-06-09T20:10:41ZMental distress is rising, especially for low-income middle-aged women. Medicare needs a major shakeup to match need<figure><img src="https://images.theconversation.com/files/467633/original/file-20220608-22-dk0liv.jpg?ixlib=rb-1.1.0&rect=25%2C38%2C4207%2C2785&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/middle-aged-woman-grey-hair-600w-503245660.jpg">Shutterstock</a></span></figcaption></figure><p>Mental health services are poorly targeted, outcomes are getting worse, and out-of-pocket payments are increasing. The new government faces a tough challenge in improving mental health.</p>
<p>This year marks 30 years since the first <a href="https://journals.sagepub.com/doi/10.1080/00048679309075767">national mental health policy</a>. The latest <a href="https://www.health.gov.au/resources/publications/the-australian-governments-national-mental-health-and-suicide-prevention-plan">national mental health and suicide prevention plan</a> is the sixth of its kind. But services are increasingly <a>fragmented and chaotic</a> and the number of people reporting <a href="https://doi.org/10.3389/fpsyt.2022.815904">very high psychological distress</a> was rising even before COVID.</p>
<p>Medicare spending and out-of-pocket mental health-care costs are increasing but those most needing care aren’t getting it: mental health services use <a href="https://theconversation.com/when-its-easier-to-get-meds-than-therapy-how-poverty-makes-it-hard-to-escape-mental-illness-114505">goes up in better-off areas</a> where mental health-care needs are lower. A new government needs to address this mental health triple-whammy of spending, costs and areas of need.</p>
<h2>Middle-aged women on low incomes are struggling</h2>
<p>Very high psychological distress is rising most steeply in the middle-aged; <a href="https://doi.org/10.3389/fpsyt.2022.815904">more than doubling</a> for women aged 55–64 (3.5% to 7.2%) from 2001–2018.</p>
<p>Earning less is associated with much <a href="https://doi.org/10.3389/fpsyt.2022.815904">worse mental health</a>. When we combine gender and income, we see that of men in the highest 20% income bracket, just 0.4% have very high psychological distress. The rate of this high level of distress is 28 times greater (11.9%) for women in the lowest 20% income bracket.</p>
<p>So, mental health services should be targeted to people with low incomes, particularly middle-aged women. But Medicare for mental health fails any reasonable <a href="https://doi.org/10.5694/mja14.00330">test of universality</a> that would mean equitable delivery of mental health care for all Australians. </p>
<p>Rather, it follows an “<a href="https://theconversation.com/three-charts-on-why-rates-of-mental-illness-arent-going-down-despite-higher-spending-97534">inverse care law</a>” that sees those needing the most getting the least. Often, poorer individuals in mid-life and in poorer communities – who really need psychological, allied health and psychiatric services – only get a minimal level of GP treatment, sometimes so restricted in range that it <a href="https://doi.org/10.1177%2F0004867419857821">makes mental health worse</a>.</p>
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Read more:
<a href="https://theconversation.com/labels-like-psycho-or-schizo-can-hurt-weve-workshopped-alternative-clinical-terms-179756">Labels like 'psycho' or 'schizo' can hurt. We've workshopped alternative clinical terms</a>
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<h2>Help is out of reach for many</h2>
<p>This mismatch between need and services follows from a market-driven service model. </p>
<p>Most Commonwealth government mental health-care support is through Medicare rebates – supporting services by GPs, psychiatrists and psychologists. </p>
<p>Medicare rebates are for services provided by individual clinicians, rather than oriented toward team-based care. A GP can unlock additional mental health support through a “mental health treatment plan”, or a psychiatrist referral, allowing Medicare rebates for visits to psychologists or other professionals. </p>
<p>But here’s the rub. These visits often require out-of-pocket payments of more than <a href="https://grattan.edu.au/wp-content/uploads/2022/03/Not-so-universal-how-to-reduce-out-of-pocket-healthcare-payments-Grattan-Report.pdf">A$200 per year</a>, with only about 40% of people having all their Medicare-subsidised psychologist services bulk-billed. And these plans are only [reviewed by their GP about <a href="https://www.mja.com.au/journal/2019/210/7/runaway-giant-ten-years-better-access-program#panel-article">half the time</a>.</p>
<p>So Medicare support for psychiatrists and psychologists is inequitable and poorly targeted. Essentially, both psychologists and psychiatrists are out of reach for people on low incomes. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mental-health-new-study-finds-simply-believing-you-can-do-something-to-improve-it-is-linked-with-higher-wellbeing-179499">Mental health: new study finds simply believing you can do something to improve it is linked with higher wellbeing</a>
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<h2>Agree on where we’re heading</h2>
<p>Taxpayers get better value for money when there is a closer alignment between spending and need. The first step in service redesign is agreeing on a destination. </p>
<p>The current expression of what the mental health system should look like, in operational terms rather than policy waffle, is the <a>national mental health strategic planning framework</a>. But this does not consistently guide planning and it needs revision. It should incorporate how social drivers of health, including relative disadvantage, affect community mental health-care needs. </p>
<p>The government also needs to decide whether it will direct more money into mental health; there was no pre-election commitment to this. Mental health needs – especially for people on low incomes – are not being met. Without extra money, redistribution of funding will be required. The current “haves” will argue vociferously against redistribution to the “have-nots”, causing political pain.</p>
<h2>A fresh frame</h2>
<p>Commonwealth responses to addressing mental health needs have been siloed and poorly integrated into broader health care. Labor’s pre-election <a href="https://www.alp.org.au/policies/strengthening-medicare-taskforce">Strengthening Medicare policy</a> provides new context and the potential for a more integrated response to mental health needs.</p>
<p>In the next five to ten years, <a href="https://www.smh.com.au/politics/federal/australians-encouraged-to-register-with-a-gp-under-new-funding-model-20211111-p59858.html">block payments to GPs</a> for patients enrolled with their practice will supplement fee-for-service and performance payments. But where will mental health fit in? And what opportunities might enrolment present for improving access to integrated primary mental health care for everyone? </p>
<p>Enrolment-based funding will need to be risk-adjusted, with higher payments for patients with greater needs. Mental health status should be calculated as a health factor in the new formula. Then, general practices caring and supporting more people living with mental illness would attract higher funding. </p>
<p>Risk-adjustment also should be higher for people with social or economic drivers of poor mental health, such as unemployment. Then we need to figure out what services and support GPs would provide for the new enrolment payments. </p>
<p>A low payment, implying few extra services, would not drive the significant transformations needed in mental health-care provision. A higher payment, perhaps phased in, could help reshape mental health care. Existing funding for mental health-care plans could be collapsed into the enrolment payment. So could the cost of a psychologist and other services which these plans unlock. </p>
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<h2>A new funding model</h2>
<p>Funding should allow allied health professional such as social workers and occupational therapists to use their discipline-specific skills. GPs would be able to employ psychologists and other providers directly or subcontract them. Primary health networks might also have a role here in accrediting services or developing service networks with GPs.</p>
<p>A new funding model, involving funding weighted for those in greatest need, and more closely integrated into general practice, could transform access to mental health services. It would be more equitable and seamless, leading to higher quality care for the same cost.</p><img src="https://counter.theconversation.com/content/184635/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This story is part of The Conversation's Breaking the Cycle series, which is about escaping cycles of disadvantage. It is supported by a philanthropic grant from the Paul Ramsay Foundation.</span></em></p><p class="fine-print"><em><span>Graham Meadows is a member of the Australian Labor Party. </span></em></p>The rate of very high psychological distress is rising most steeply in the middle aged, especially in middle-aged women on low incomes. New funding should match this need.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneGraham Meadows, Professor of Adult Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1783892022-06-06T12:50:32Z2022-06-06T12:50:32ZTherapy on the go: Mildly depressed or simply stressed, people are tapping apps for mental health care<figure><img src="https://images.theconversation.com/files/466424/original/file-20220531-14-xkt67t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More and more people are experimenting with mental health apps and discovering their benefits and limits.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/high-angle-shot-of-fitness-young-asian-sports-woman-royalty-free-image/1396029512?adppopup=true">d3sign/Moment via Getty Images</a></span></figcaption></figure><p>It might be surprising to think about browsing for therapists and ordering up mental health care the way you can peruse a menu on Grubhub or summon a car on Lyft.</p>
<p>But over the last decade, digital access to therapy has become increasingly common, in some cases replacing the traditional model of in-person weekly sessions between a therapist and client.</p>
<p>Apps for mental health and wellness range from mood trackers, meditation tools and journals to therapy apps that match users to a licensed professional. My team’s research focuses on therapy apps that work by matching clients to a licensed professional.</p>
<p>As a <a href="https://www.fordham.edu/info/24281/gss_full-time_faculty_profiles/11298/lauri_goldkind/">social work researcher</a>, I am interested in understanding how these apps <a href="https://doi.org/10.1177%2F1044389421997796">affect clients and practitioners</a>. My research team has studied the care that app users receive. We have talked to therapists who use apps to reach new clients. We’ve also analyzed app contracts that mental health professionals sign, as well as the agreements clients accept by using the apps.</p>
<p>Real questions persist about how apps are regulated, how to <a href="https://doi.org/10.2196%2F23776">ensure user privacy and care quality</a> and how remote therapy can be reimbursed by insurance. While those debates continue, people are regularly using apps to connect to therapists for help with emotional and mental struggles. And through these apps, therapists are interacting with people who may never have considered therapy before. </p>
<h2>A ready-made market</h2>
<p>In the first year of the pandemic, rates of depression and anxiety <a href="https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide">increased by 25%</a> worldwide, according to the World Health Organization. In a June 2020 survey from the Centers for Disease Control and Prevention, <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm">40.9% of respondents reported</a> at least one adverse mental or behavioral health condition, compared to <a href="https://www.cdc.gov/nchs/products/databriefs/db380.htm">only 19% in 2018</a>.</p>
<p>The old model of therapy, in which therapists and patients sat face to face, was already out of reach for many. In fact, mental health apps are a response to the demand from clients seeking more accessible therapy services. </p>
<p>The COVID-19 pandemic turbocharged both trends – the growing need for mental health care and using technology to access it. For existing mental health clients, stay-at-home orders closed clinics and therapists’ offices to in-person visits, resulting in an <a href="https://theconversation.com/covid-19-mental-health-telemedicine-was-off-to-a-slow-start-then-the-pandemic-happened-177670">unprecedented shift to online access to therapy</a>. </p>
<h2>How matching apps work</h2>
<p>Consumer mental health platforms like Better Help and TalkSpace match clients to licensed therapy providers. With advertising on television, across social media channels and on highway billboards, the apps promote flexibility, convenience and the potential to receive support with slogans like “You deserve to be happy” or “Feeling better starts with a single call.” </p>
<p>When app users enter a platform’s online space, its proprietary software offers a digital dashboard and communication tools. These platforms also promise instant access to a professional therapist, immediate responsiveness from them as well as anonymity. </p>
<p>App users choose a therapist by reviewing a list of providers accompanied by thumbnail photos, resume-like bios and consumer reviews. Users also choose how they’ll connect with therapists – phone or video calls, email, text or some combination. The apps also let clients change therapists at any time. </p>
<p>As the client and their chosen therapist connect and communicate, behind the scenes the app collects and maintains records, later calculating the chosen therapist’s payment and billing the app user.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/465163/original/file-20220524-19-fx7egl.jpeg?ixlib=rb-1.1.0&rect=21%2C0%2C4784%2C3637&q=45&auto=format&w=1000&fit=clip"><img alt="Against a lavender background, two smartphones, held by the hands of unseen people, are turned toward each other, with brightly colors speech bubbles, like the kind in comic books, coming out of the phones" src="https://images.theconversation.com/files/465163/original/file-20220524-19-fx7egl.jpeg?ixlib=rb-1.1.0&rect=21%2C0%2C4784%2C3637&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465163/original/file-20220524-19-fx7egl.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=453&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465163/original/file-20220524-19-fx7egl.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=453&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465163/original/file-20220524-19-fx7egl.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=453&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465163/original/file-20220524-19-fx7egl.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=569&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465163/original/file-20220524-19-fx7egl.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=569&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465163/original/file-20220524-19-fx7egl.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=569&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">For some people, entering a therapist’s office might never be an option, but they might find treatment through their smartphone more accessible.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/two-women-having-a-virtual-conversation-via-royalty-free-image/1359131200">We Are/DigitalVision via Getty Images</a></span>
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<h2>Apps and their risks</h2>
<p>Curiously, while mental health app platforms promote themselves as providers of mental health services, they actually don’t take <a href="https://www.betterhelp.com/terms/">responsibility for the counseling services they are providing</a>. The apps consider therapists to be independent contractors, with the platform acting as a matching service. And the apps can help users find a more suitable fit if they request it.</p>
<p>But no law or precedent protects consumers or clarifies app users’ rights. This differs from face-to-face therapy, in which practitioners work under the oversight of state licensing boards and federal law. Some of the major therapy apps have been accused of <a href="https://www.nytimes.com/2020/08/07/technology/talkspace.html">mining client data</a> and <a href="https://foundation.mozilla.org/en/privacynotincluded/betterhelp/">being at risk for data breaches</a>. </p>
<p>Like other virtual spaces, online mental health service domains operate under ever-evolving and localized regulations.</p>
<h2>Who benefits from these apps?</h2>
<p>The social workers our team interviewed talked a lot about who can benefit from this kind of app-based therapy and – importantly – who can’t. For example, the platforms are not set up to treat people with <a href="https://smiadviser.org/about/serious-mental-illness">serious mental illness</a> or mental disorders that substantially interfere with a person’s life, activities and ability to function independently. </p>
<p>Similarly, app-based psychotherapy is not suitable for those having suicidal thoughts. The platforms screen users for <a href="https://theconversation.com/why-do-teens-engage-in-self-harm-clinical-psychologists-explain-how-to-help-teens-reduce-their-emotional-distress-181419">risk of self-harm</a> when they sign up. If a client ever poses harm to themselves or someone else, user anonymity on the apps makes it almost impossible for a therapist to send a crisis response team. App-based practitioners told our research team that they sometimes end up monitoring their clients for signs of crisis by contacting them through the app more frequently. It’s one reason app therapists, who also screen users, sometimes reject potential clients who may need a higher level of care.</p>
<p>For those without severe mental illness, app-based therapy may be helpful in matching clients with a professional familiar with a range of problems and stressors. This makes apps attractive to those with anxiety and mild to moderate depression. They also appeal to people who wouldn’t ordinarily seek out office-based therapy, but who want help with life issues such as marital problems and work-related stress. </p>
<p>The apps could also be practical and convenient for those who can’t or won’t get formal therapy, even remotely, from a mental health clinic or office. For instance, the anonymity of apps might appeal to people suffering from conditions like social anxiety or agoraphobia, or for those individuals who can’t or won’t appear on a video call. </p>
<p>Therapy apps have helped to normalize the idea that it’s OK to pursue mental health treatment through nontraditional routes. And with high-profile people such as <a href="https://brandingforum.org/marketing/michael-phelps-talkspace-mental-health/">Michael Phelps</a> and <a href="https://www.elle.com/beauty/a36877443/ariana-grande-better-help-free-therapy/">Ariana Grande</a> partnering with these apps, they might even be on their way to making mental health treatment cool. </p>
<p><em>Editor’s Note: This story has been updated to eliminate mention of Alma, a mental health platform that matches clients with therapists, but does not have an app for users.</em></p><img src="https://counter.theconversation.com/content/178389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauri Goldkind does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How do mental health apps compare to in-person therapy? A social worker and expert on technology and human services explains.Lauri Goldkind, Associate Professor of Social Work, Fordham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1828002022-05-12T13:57:40Z2022-05-12T13:57:40ZHow reform to the Mental Health Act should balance people’s treatment with increased autonomy<figure><img src="https://images.theconversation.com/files/462709/original/file-20220512-22-fesfjr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Involuntary detention under the Mental Health Act poses ethical challenges.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-nurse-comforting-senior-man-on-738116425">Monkey Business Images | Shutterstock</a></span></figcaption></figure><p>Around the world, compulsory powers are used to detain and treat people deemed to have mental health problems. In the UK, most people experiencing such problems receive treatment voluntarily, in the community. However, at times of acute mental health crisis, some may be compulsorily detained in the interests of their own health or safety, or for the protection of other people. </p>
<p>In England and Wales, decisions about whether or not to detain are normally made by an approved mental health professional and two doctors. These decisions are ethically challenging, because they involve removing a person’s autonomy. They allow them to be detained and to be given medication against their will. </p>
<p>In the <a href="https://inews.co.uk/news/politics/queens-speech-2022-planning-reforms-bill-of-rights-and-mental-health-overhaul-included-in-government-agenda-1618021">Queen’s speech 2022</a>, Boris Johnson re-stated his government’s intention to reform the Mental Health Act. “Our mental health laws are antiquated,” Johnson said ahead of the speech. “Every person deserves to be treated with dignity, and it is our duty to ensure that the rights and freedoms of our most vulnerable in society are protected and respected”. While many of the measures he announced are laudable, better resources and funding will be required for them to be effective.</p>
<figure class="align-center ">
<img alt="Boris Johnson in a blue suit pictured behind a lecturn outside." src="https://images.theconversation.com/files/462711/original/file-20220512-17-kgkjle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462711/original/file-20220512-17-kgkjle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462711/original/file-20220512-17-kgkjle.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462711/original/file-20220512-17-kgkjle.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462711/original/file-20220512-17-kgkjle.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462711/original/file-20220512-17-kgkjle.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462711/original/file-20220512-17-kgkjle.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Prime Minister Boris Johnson has acknowledged how urgently these reforms are needed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-uk-24th-july-2019-boris-1460208128">Michael Tubi | Shutterstock</a></span>
</figcaption>
</figure>
<h2>How we think about mental health is changing</h2>
<p>Changes in mental health law reflect our evolving attitudes to people with mental health problems. On the one hand, the law allows for professionals to give people treatment against their will and to deprive them of their liberty when the conditions of the Mental Health Act are met. On the other hand, it can provide people who use mental health services with rights and protections to ensure that they are not detained without good reason and to enable them to receive the treatment they want. </p>
<p>The <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1074113/Lobby_Pack_10_May_2022.pdf">government’s plans</a> to reform the Mental Health Act were first <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/951398/mental-health-act-white-paper-web-accessible.pdf">published</a> in 2021. This followed a government-commissioned independent <a href="https://www.gov.uk/government/publications/modernising-the-mental-health-act-final-report-from-the-independent-review">review</a>, which recognised the importance of <a href="https://theconversation.com/review-recommends-empowering-neglected-mental-health-patients-but-changes-may-not-go-far-enough-108367">human rights</a> in mental health care. It highlighted the need to restore dignity and enable service users to participate in decisions about their own care. </p>
<p>The subsequent white paper noted widespread concerns about rising detention rates, citing a 40% increase between 2006 and 2016. It acknowledged that black people were much more likely to be detained under the Mental Health Act and discharged under a <a href="https://theconversation.com/uk-still-using-ineffective-compulsory-treatment-for-people-with-mental-illness-59209">community treatment order</a> (these orders mean that people should be treated in the community after leaving hospital, but the doctor in charge of their care can return them to hospital for treatment if necessary). It also included concerns about the way that people with learning disabilities and autistic people are treated under the Mental Health Act. </p>
<p>Reforms were last introduced <a href="https://www.legislation.gov.uk/ukpga/2007/12/contents">in 2007</a> by the New Labour government. They were driven by the assumed need <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2850.2007.01188.x">to manage risks of violence</a> posed by mentally ill people <a href="https://academic.oup.com/medlaw/article/8/2/210/937605">living in the community</a> and alleviate public concerns about this. The changes gave mental health professionals more control by expanding detention criteria and introducing community treatment orders. </p>
<p>The government aims to increase the threshold for admission, so that people are only involuntarily detained where it is strictly necessary. Changes to the admission criteria are also set to limit the use of the legislation for autistic people and people with a learning disability. And existing safeguards in the Mental Health Act will be strengthened, for example, by giving patients the right to formally challenge detention more frequently, via mental health tribunals. </p>
<p>Other new measures to promote autonomy include giving patients better support, by offering detained people the option of an independent advocate (a paid professional who can speak on their behalf) and by allowing people to choose their own “nominated person”. This new role replaces the “nearest relative” role, as specified in the current version of the act. Currently, a family member is selected from a fixed list and given certain powers to object to detention or apply for discharge. This has been criticised for not allowing people to choose who they would like to represent them. </p>
<figure class="align-center ">
<img alt="A professional sits with a young man in an office setting." src="https://images.theconversation.com/files/462713/original/file-20220512-24-pcyx3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462713/original/file-20220512-24-pcyx3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462713/original/file-20220512-24-pcyx3u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462713/original/file-20220512-24-pcyx3u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462713/original/file-20220512-24-pcyx3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462713/original/file-20220512-24-pcyx3u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462713/original/file-20220512-24-pcyx3u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There is increasing understanding that human rights and autonomy are crucial to mental health care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-college-student-meeting-campus-counselor-1704719680">Monkey Business Images | Shutterstock</a></span>
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</figure>
<h2>Reforms will need proper resources to be effective</h2>
<p>While rebalancing the powers granted to professionals and the rights of the people who use mental health service is important, these tabled reforms leave several questions unanswered. The new nominated person role, in particular, is welcome. However, <a href="https://academic.oup.com/bjsw/advance-article/doi/10.1093/bjsw/bcab258/6517149">our research shows</a> that nearest relatives feel emotionally unsupported and unsure about how to use their legal powers to protect their relative’s rights. Education and support to nominated persons must be provided if the role is to be effective. </p>
<p>Further, <a href="https://committees.parliament.uk/publications/6669/documents/71689/default/">the House of Commons Health and Social Care Committee</a> has said that restrictions on detaining autistic people and people with a learning disability in hospital will only succeed if they are accompanied by significant improvements to the community support people can access. </p>
<p>Giving detained people increased rights to mental health tribunals and advocacy is laudable in theory. It will however also need resourcing. <a href="https://journals.sagepub.com/doi/abs/10.1177/1471301218770478">Research indicates</a> that while advocacy services have increasingly been promised, government evaluations have highlighted that the provision of advocacy services varies widely across geographical areas. </p>
<p>Finally, <a href="https://www.sciencedirect.com/science/article/pii/S2215036619304067">research has shown</a> that people are more likely to be detained when they are experiencing economic deprivation. The proposed reforms do not specifically address this, although they are accompanied by wider system supports and investment, for example in schools, maternity services and for groups most affected by the pandemic. The government’s wider levelling-up policy is also set to include a <a href="https://www.gov.uk/government/consultations/mental-health-and-wellbeing-plan-discussion-paper-and-call-for-evidence">new mental health plan</a>. </p>
<p>The government has promised service users more rights. These new safeguards will be tokenistic, however, without being properly resourced and supported on the ground.</p><img src="https://counter.theconversation.com/content/182800/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeremy Dixon receives funding from the National Institute for Health and Care Research. </span></em></p><p class="fine-print"><em><span>Judy Laing receives research grant funding from the Wellcome Trust. </span></em></p>Without funding and thorough resources, reforms to our mental health care system will not be effective.Jeremy Dixon, Senior Lecturer in Social Work, University of BathJudy Laing, Professor of Mental Health Law & Policy, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777162022-04-29T12:15:42Z2022-04-29T12:15:42ZPsychologists are starting to talk publicly about their own mental illnesses – and patients can benefit<figure><img src="https://images.theconversation.com/files/450539/original/file-20220307-126059-8fyp0q.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5982%2C3350&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mental health professionals who have experienced mental illness have much to offer to their patients.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/upset-and-tired-boy-teenager-sitting-on-the-floor-royalty-free-image/1191509927?adppopup=true">Bulat Silvia/iStock/Getty Images Plus via Getty Images</a></span></figcaption></figure><p><a href="https://www.apa.org/monitor/2022/01/special-kicking-stigma">From sports and entertainment celebrities</a> like <a href="https://theconversation.com/simone-biles-and-naomi-osaka-put-the-focus-on-the-importance-of-mental-performance-for-olympic-athletes-165219">Simone Biles</a>, <a href="https://nypost.com/2021/06/30/ariana-grande-giving-away-1m-worth-of-therapy-to-fans/">Ariana Grande</a> and <a href="https://www.cnn.com/2021/07/22/entertainment/ryan-reynolds-anxiety-scli-intl-wellness/index.html">Ryan Reynolds</a> to <a href="https://khn.org/news/coming-out-about-mental-health-on-social-media/">everyday social media users</a> on Facebook, Twitter and TikTok, more people are <a href="https://doi.org/10.2196/22600">talking publicly about mental health</a>. </p>
<p>Yet both students and professionals across fields have long been advised that talking openly about their own mental health experiences <a href="https://doi.org/10.1186/1471-244X-12-11">risks negative judgments</a> from co-workers and supervisors, which can potentially damage their careers. Ironically, even professionals in mental health fields are advised to <a href="https://doi.org/10.1037/ser0000507">conceal their own experiences with mental illness</a>. </p>
<p>This culture of silence is counter to what psychologists know to be true about battling stigma: that talking openly about mental health can <a href="https://doi.org/10.1007/s00127-021-02076-y">help reduce stigma and encourage others to seek help</a>. </p>
<p>Stigmatizing openness about mental illness can also result in the <a href="https://doi.org/10.1176/appi.ps.202000468">systemic discrimination against</a> and <a href="https://doi.org/10.31234/osf.io/ksnfd">exclusion from mental health professions</a> of people who can make valuable contributions to the field – whether in spite of or because of their unique mental health experiences.</p>
<p>We are a <a href="https://scholar.google.com/citations?user=Gi0_2s4AAAAJ&hl=en&oi=ao">doctoral candidate</a> and an <a href="https://scholar.google.com/citations?user=k_sJ0W0AAAAJ&hl=en&oi=ao">assistant professor</a> of clinical psychology who have both experienced mental illness. In a recent study, we explored <a href="https://doi.org/10.31234/osf.io/xbfr6">how common mental health issues are</a> among clinical psychologists and trainees, and whether those issues affected them professionally.</p>
<p>In a related commentary, we and our psychology colleagues wrote openly about <a href="https://doi.org/10.31234/osf.io/ksnfd">our own experiences with mental illness</a> to show others that success in mental health careers is possible for people who currently live, or have lived, with mental illness.</p>
<h2>Psychologists are people, too</h2>
<p>In a forthcoming peer-reviewed study, almost 1,700 psychology faculty members and trainees completed an online survey that <a href="https://doi.org/10.31234/osf.io/xbfr6">asked about their mental health experiences</a>. This is the largest study to date on the rates of mental illness in graduate programs that train clinical, counseling and school psychologists. </p>
<p>Our survey asked participants two separate questions: whether they had ever experienced “mental health difficulties” and if they had ever been diagnosed with a mental illness by a professional. Asking both questions was important, because some mental health difficulties are not labeled as specific conditions, and not all respondents may have had access to a mental health provider who could make a formal diagnosis.</p>
<p>Over 80% of all respondents reported having mental health difficulties at some point, and 48% reported having a diagnosed mental illness. These rates are similar to <a href="https://www.nami.org/mhstats">rates of mental illness in the general population</a>. </p>
<p>Our findings show that, far from being immune to the conditions they treat in others, psychologists grapple with mental health difficulties or illnesses just as much as their patients do.</p>
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<figcaption><span class="caption">Stephen Lewis, an associate professor of clinical child and adolescent psychology at the University of Guelph in Ontario, tells the story of his own life. These experiences led him to specialize in the study of self-harm – called “nonsuicidal self-injury” – in the profession.</span></figcaption>
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<p>Mental illnesses are <a href="https://www.cdc.gov/genomics/resources/diseases/mental.htm#">leading causes of disability</a> worldwide. This fact may partly explain why <a href="http://dx.doi.org/10.1037/ser0000613">there’s a stigma among psychology professionals</a> about disclosing them: Some may see mental illness as an insurmountable handicap to being effective at researching mental illness <a href="https://psycnet.apa.org/fulltext/2022-32137-001.html">or treating it in others</a>.</p>
<p>However, in our survey of psychology faculty members and trainees, 95% of respondents with mental health difficulties reported having “no” or “mild” professional problems related to these experiences. Over 80% of those with diagnosed mental illness reported the same. </p>
<p>This finding highlights that experiencing mental illness is not by any means a barrier to being a capable and effective psychologist.</p>
<h2>Stigma as a barrier to inclusion</h2>
<p>Through another upcoming study, we identified some of <a href="https://doi.org/10.31234/osf.io/ksnfd">the structural barriers within clinical psychology</a> that may discourage psychologists from talking about their own mental illness. </p>
<p>One key barrier is that – again, ironically – stigma toward mental illness exists from within the mental health profession. We have found that psychologists and trainees with mental illness may be unfairly viewed as <a href="https://doi.org/10.31234/osf.io/ksnfd">damaged, incompetent or hard to work with</a> by their colleagues. We based this conclusion on our personal experiences in the profession, combined with the <a href="https://doi.org/10.1186/1471-244X-12-11">large body of research</a> on the dynamics of disclosing mental illness.</p>
<p>Previous research has found that sharing one’s mental health difficulties, disability or illness in a training setting may result in lost professional opportunities, such as <a href="http://dx.doi.org/10.1037/sah0000332">being hired</a> or <a href="https://dsq-sds.org/article/view/5487/4653">promoted</a> or <a href="https://doi.org/10.1037/ser0000507">winning an award</a>. </p>
<p>However, research also shows that sharing one’s mental illness may open up other opportunities to <a href="https://dsq-sds.org/article/view/5487/4653">receive support and accommodations on the job</a>, such as <a href="https://doi.org/10.1177/0149206317741194">adjustment of job tasks, work schedules</a> and time and performance expectations. </p>
<h2>Lived experience counts</h2>
<p>As therapists ourselves who have worked with hundreds of clients, we have found that our mental health struggles help us understand and empathize with the challenges faced by our patients. </p>
<p>Research suggests that we are not alone. Studies show that therapists may use their experiences <a href="https://doi.apa.org/fulltext/2022-32137-001.html">to inform how they work with clients</a>. In fact, some widely used and scientifically backed therapies were developed by <a href="https://www.nytimes.com/2011/06/23/health/23lives.html">psychologists with lived mental health experience</a> – such as “<a href="https://behavioraltech.org/research/evidence/">dialectical behavior therapy</a>,” which aims to help clients <a href="https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/">live in the moment</a>, deal with stress and emotions in healthy ways and improve relationships. </p>
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<figcaption><span class="caption">Marsha Linehan talks about how she used her own mental health experiences to develop dialectical behavioral therapy.</span></figcaption>
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<p>As research scientists, we have found that our mental health experiences <a href="https://doi.org/10.1037/ser0000507">not only inform our ideas</a> but also help us grapple effectively with the inevitable setbacks that come with a profession defined by endless hours of data collection, grant writing and a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999612/">publish-or-perish culture</a>.</p>
<p>Having personal experience with mental health challenges reminds us why our work has meaning and is worth the struggle: to help and improve the lives of real people dealing with real traumas and real emotional struggles. </p>
<h2>Psychologists ‘coming out’ proud</h2>
<p>Although we have chosen to make our struggles public, we are not saying that others like us should feel that they must talk openly about it – or that all psychologists must have had mental health experiences in order to treat patients or do research effectively.</p>
<p>Rather, we believe that psychologists who have chosen to talk about their mental illness may be able to use their positions to destigmatize openness about these health issues – for other mental health providers as well as the patients they serve.</p>
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<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Psychologists have mental health difficulties and illnesses at the same rate as the general population – but the profession has long stigmatized talking about them in public.Andrew Devendorf, Doctoral Candidate, Clinical Psychology, University of South FloridaSarah Victor, Assistant Professor of Clinical Psychology, Texas Tech UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1802662022-04-01T10:19:04Z2022-04-01T10:19:04ZAutistic people are six times more likely to attempt suicide – poor mental health support may be to blame<figure><img src="https://images.theconversation.com/files/455768/original/file-20220401-21-34ofei.jpg?ixlib=rb-1.1.0&rect=22%2C0%2C4885%2C3634&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young autistic women are around 13 times more likely to attempt suicide than women who aren't autistic.
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-attractive-latin-woman-lying-home-1147331654">SB Arts Media/ Shutterstock</a></span></figcaption></figure><p>One person dies by suicide <a href="https://save.org/about-suicide/suicide-statistics/">every 40 seconds</a>. Some of those <a href="https://www.who.int/news-room/fact-sheets/detail/suicide">most at risk</a> include people experiencing mental health difficulties (such as depression) and vulnerable groups who experience discrimination (such as LGBTQ+ people). </p>
<p>Yet one at-risk group that is still largely overlooked when it comes to this crisis is autistic people. Research shows that autistic people are six times more likely to <a href="https://www.psychiatrist.com/jcp/neurodevelopmental/autism-spectrum-disorders/autism-spectrum-disorder-and-suicide-attempts/">attempt death by suicide</a> – and up to seven times more likely to <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/premature-mortality-in-autism-spectrum-disorder/4C9260DB64DFC29AF945D32D1C15E8F2">die by suicide</a> – compared to those who are not autistic. </p>
<p>This risk of death by suicide is <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/premature-mortality-in-autism-spectrum-disorder/4C9260DB64DFC29AF945D32D1C15E8F2">even greater</a> among autistic people without intellectual disabilities. The greatest risk is among autistic women, who are <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/premature-mortality-in-autism-spectrum-disorder/4C9260DB64DFC29AF945D32D1C15E8F2">13 times more likely</a> to die by suicide than women who are not autistic. </p>
<p>It’s not entirely clear why autistic people are at increased risk of having suicidal thoughts and behaviour, though it’s likely a number of factors are at play.</p>
<p>For example, <a href="https://www.sciencedirect.com/science/article/pii/S0272735822000290?via%253Dihub">negative childhood experiences</a> – such as bullying – have been associated with suicidal thoughts and behaviour in autistic youth. In autistic adults, <a href="https://link.springer.com/article/10.1007/s10803-017-3274-2">loneliness</a>, <a href="https://link.springer.com/article/10.1007/s10803-020-04393-8">social and communication difficulties</a>, feeling like a <a href="https://link.springer.com/article/10.1007/s10803-020-04393-8">burden to others</a> and a <a href="https://molecularautism.biomedcentral.com/articles/10.1186/s13229-018-0226-4">lack of support</a> have also been linked. </p>
<p>Camouflaging autistic behaviour – such as adjusting your behaviour to fit into certain social situations (such as forcing eye contact) – has also been linked to <a href="https://link.springer.com/article/10.1007/s10803-019-04323-3">increased risk of suicide</a>. Having a <a href="https://link.springer.com/article/10.1007/s10803-020-04433-3">mental health condition</a>, such as depression, is also linked with an increased likelihood of experiencing suicidal thoughts and behaviour. </p>
<p>While some of these risk factors may be increased by <a href="https://link.springer.com/article/10.1007/s10803-020-04372-z">certain autistic tendencies</a> (such as a tendency to hyper focus on particular thoughts or behaviour), it’s likely there are many broader <a href="https://autisticadvocacy.org/wp-content/uploads/2016/06/whitepaper-Increasing-Neurodiversity-in-Disability-and-Social-Justice-Advocacy-Groups.pdf">social, political and cultural factors</a> at play – such as autistic people feeling excluded from society, or <a href="https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/bjdp.12350">not feeling they belong</a>.</p>
<h2>Barriers to support</h2>
<p>Having access to mental health services is one important way of <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.1672">preventing suicide</a>. But many autistic people <a href="https://cdn.ymaws.com/www.autism-insar.org/resource/resmgr/files/policybriefs/2021-insar_policy_brief.pdf">struggle to get support</a> if they’re experiencing suicidal thoughts.</p>
<p>Again, there are a number of reasons why they may struggle to get the help they need. The first being a <a href="https://journals.sagepub.com/doi/10.1177/1362361318816053?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%2520%25200pubmed">lack of access</a> to mental health services. This may be due to long waiting lists, caused in part by a significant and <a href="https://www.bmj.com/content/375/bmj.n2706">historic lack of funding</a> to mental health services in the UK. </p>
<figure class="align-center ">
<img alt="Young man sits alone on a chair in a waiting room." src="https://images.theconversation.com/files/455767/original/file-20220401-23-t4dbwl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455767/original/file-20220401-23-t4dbwl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455767/original/file-20220401-23-t4dbwl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455767/original/file-20220401-23-t4dbwl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455767/original/file-20220401-23-t4dbwl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455767/original/file-20220401-23-t4dbwl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455767/original/file-20220401-23-t4dbwl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many autistic people have to wait for mental health support.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boy-teenager-sits-on-chair-his-1424490473">RozochkaIvn/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Another factor is that healthcare staff <a href="https://journals.sagepub.com/doi/10.1177/1362361318816053?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%2520%25200pubmed">often lack training</a> on how to support autistic people who may be experiencing suicidal thoughts. There is also <a href="https://cdn.ymaws.com/www.autism-insar.org/resource/resmgr/files/policybriefs/2021-insar_policy_brief.pdf">no consensus</a> within the medical community on how best to <a href="https://molecularautism.biomedcentral.com/articles/10.1186/s13229-021-00449-3">help autistic people</a> in this way.</p>
<p>These problems for healthcare professionals is partly because the severity, type and intensity of suicidal thoughts may present differently in autistic people. Communication difficulties in some autistic people may also make it hard for them to express how they are feeling. And unless they’re asked outright by a healthcare professional if they’re experiencing suicidal thoughts, this behaviour may be missed by current clinical tools, such as screening questionnaires.</p>
<p>Our research has even been able to show just how big this lack of knowledge really is. Our study, which was conducted in Canada, found that <a href="https://link.springer.com/article/10.1007/s10803-021-05102-9">half of autistic people</a> with suicidal thoughts or behaviour who attended a psychiatric hospital emergency room were missed during initial health screenings. This is staggering, especially considering how important this initial screening is to ensure timely mental health support for those at serious risks. </p>
<p>It’s clear that more needs to be done to help autistic people get the support they need and deserve. Part of this simply comes down to increasing awareness, so that people working in healthcare may better recognise possible warning signs of suicide and better help autistic people who are struggling with mental health more broadly. Greater awareness of the mental health problems autistic people may face is also important for friends and family of autistic people, so they may be able to look for and recognise certain risk factors, and offer support if possible. </p>
<p>If you suspect someone close to you may be struggling with suicidal thoughts, it’s important to reach out to them, asking them how they’re feeling and giving them the time and space to articulate what they’re feeling, seeing or thinking. Remaining nonjudgmental, without criticising or blaming them also is key. Merely asking if they are having thoughts of ending their life is a key suicide prevention tool. </p>
<p>If you feel you are in crisis, speak to someone as soon you can to let them know you are thinking of ending your life. It may be helpful to call an ambulance or an emergency crisis team or attend a local emergency room if you feel you are in crisis. </p>
<p>–</p>
<p><em>If you’re struggling with suicidal thoughts, the following services can provide you with support:</em></p>
<p><em>In the UK and Ireland – call Samaritans UK at 116 123.</em></p>
<p><em>In the US – call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or IMAlive at 1-800-784-2433.</em></p>
<p><em>In Australia – call Lifeline Australia at 13 11 14.</em></p>
<p><em>In other countries – visit IASP or Suicide.org to find a helpline in your country.</em></p><img src="https://counter.theconversation.com/content/180266/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Jachyra has been supported by the Canadian Institutes of Health Research Fellowship Program and the Centre for Addiction and Mental Health Discovery Fund Talent Competition Post-Doctoral Fellowship.</span></em></p><p class="fine-print"><em><span>Jacqui Rodgers receives funding from Autistica, ESRC, NIHR. </span></em></p><p class="fine-print"><em><span>Sarah Cassidy receives funding from the National Institute of Health Research, Autistica, the Economic and Social Research Council, the International Society for Autism Research, Slifka Ritvo Foundation, and the Chief Scientist Office Scotland. </span></em></p>Many autistic people struggle to get mental health support, or are missed by the healthcare system entirely.Patrick Jachyra, Assistant Professor of Exercise and Neurodevelopmental Disabilities, Durham UniversityJacqui Rodgers, Professor of Psychology and Mental Health, Newcastle UniversitySarah Cassidy, Associate Professor of Mental Health and Autism, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1790562022-03-28T14:04:09Z2022-03-28T14:04:09ZCharities are contributing to growing mistrust of mental-health text support — here’s why<figure><img src="https://images.theconversation.com/files/454702/original/file-20220328-15-1y7pha0.png?ixlib=rb-1.1.0&rect=0%2C0%2C8750%2C5815&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Johnny Lighthands</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Like many areas of society, mental healthcare has <a href="https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey">changed drastically</a> as a result of the pandemic. Forced to adapt to a growing demand for counselling and crisis services, mental health charities have had to quickly increase their digital services to meet the needs of their users. </p>
<p>Unfortunately, some charities have experienced growing pains as they transition to an unfamiliar environment that increasingly involves the use of data-driven technologies, such as machine learning – a type of artificial intelligence. </p>
<p>Recently, two charities faced a public backlash as a result of how they used machine learning and handled data from users who contacted their mental health support services at a point of crisis. </p>
<p>When it was <a href="https://www.politico.com/news/2022/01/28/suicide-hotline-silicon-valley-privacy-debates-00002617">recently reported</a> that US-based Crisis Text Line shared anonymised user data with another organisation – Loris AI – that specialises in the development of machine learning technologies, there were many critical responses on social media decrying the perceived commercialisation of sensitive data as a shocking betrayal of trust. In response, Crisis Text Line <a href="https://www.crisistextline.org/blog/2022/01/31/an-update-on-data-privacy-our-community-and-our-service/">ended its data-sharing relationship</a> with Loris AI and asked the company to delete the data it had sent.</p>
<p>A couple of weeks later, it came to light that Shout, the UK’s biggest crisis text line, had similarly shared anonymised data with researchers at <a href="https://www.theguardian.com/society/2022/feb/19/mental-health-helpline-funded-by-royals-shared-users-conversations">Imperial College London</a> and used machine learning to analyse patterns in the data. Again, this data came from the deeply personal and sensitive conversations between people in distress and the charity’s volunteer counsellors. </p>
<p>One of the primary reasons behind this partnership was to determine what could be learned from the anonymised conversations between users and Shout’s staff. To investigate this, the research team used machine learning techniques to uncover personal details about the users from the conversation text, <a href="https://www.frontiersin.org/articles/10.3389/fdgth.2021.779091/full">including age and non-binary gender</a>. </p>
<p>The information inferred by the machine learning algorithms falls short of personally identifying individual users. However, many users were outraged when they discovered how their data was being used. With the spotlight of social media turned towards them, <a href="https://twitter.com/GiveUsAShout/status/1495159435555131403?ref_src=twsrc%5Etfw">Shout responded</a>:</p>
<blockquote>
<p>We take our texters’ privacy incredibly seriously and we operate to the highest standards of data security … we have always been completely transparent that we will use anonymised data and insights from Shout both to improve the service, so that we can better respond to your needs, and for the improvement of mental health in the UK.</p>
</blockquote>
<p>Undoubtedly, Shout and Crisis Text Line have been transparent in one sense – they directed users to permissive privacy policies before they accessed their service. But as we all know, these policies are <a href="https://www.linklaters.com/en/insights/blogs/digilinks/does-anyone-read-privacy-notices-the-facts">rarely read</a>, and they should not be relied on as meaningful forms of consent from users at a point of crisis. </p>
<p>It is, therefore, a shame to see charities such as Shout and Crisis Text Line failing to acknowledge how their actions may contribute to a growing culture of distrust, especially because they provide essential support in a climate where mental ill-health is <a href="https://www.nhsconfed.org/publications/reaching-tipping-point">on the rise</a> and public services are stretched as a <a href="https://www.who.int/publications/i/item/978924012455">result of underfunding</a>. </p>
<h2>An unsettling digital panopticon</h2>
<p>As a researcher specialising in the <a href="https://www.turing.ac.uk/research/research-projects/ethical-assurance-digital-mental-healthcare">ethical governance of digital mental health</a>, I know that research partnerships, when handled responsibly, can give rise to many benefits for the charity, their users, and society more generally. Yet as charities like Shout and Crisis Text Line continue to offer more digital services, they will increasingly find themselves operating in a digital environment that is already dominated by technology giants, such as Meta and Google. </p>
<p>In this online space, <a href="https://www.techrepublic.com/article/facebook-data-privacy-scandal-a-cheat-sheet/">privacy violations</a> from social media platforms and <a href="https://www.bbc.co.uk/news/technology-58761324">technology companies</a> is, unfortunately, all too common. Machine learning technology is still not sophisticated enough to replace human counsellors. However, as the technology has the potential to make organisations more efficient and support staff in making decisions, we are likely to see it being used by a growing number of charities that provide mental health services.</p>
<p>In this unsettling digital panopticon, where our digital footprints are closely watched by public, private and third sector (charities and community groups) organisations, for an overwhelming variety of obscure and financially motivated reasons, it is understandable that many users will be distrustful of how their data will be used. And, because of the blurred lines between private, public and third-sector organisations, violations of trust and privacy by one sector could easily spill over to shape our expectations of how other organisations are likely to handle or treat our data. </p>
<p>The default response by most organisations to data protection and privacy concerns is to fall back on their privacy policies. And, of course, privacy policies serve a purpose, such as clarifying whether any data is sold or shared. But privacy policies do not provide <a href="https://journals.sagepub.com/doi/abs/10.1177/2053951718816724">adequate cover</a> following the exposure of data-sharing practices, which are perceived to be unethical. And charities, in particular, should not act the same way as private companies.</p>
<p>If mental health charities want to regain the trust of their users, they need to step out from the shade of their privacy policies to a) help their users understand the benefits of data-driven technologies, and b) justify the need for business models that depend on data sharing (such as, to provide a sustainable source of income).</p>
<p>When people are told about the benefits of responsible data sharing, many are willing to <a href="https://www.thebritishacademy.ac.uk/documents/1887/Data-Governance-public-engagement-review.pdf">allow their anonymised data</a> to be used. The benefits of responsible research partnerships include the development of intelligent decision-support systems that can help counsellors offer more effective and tailored support to users. </p>
<p>So if a charity believes that a research partnership or their use of data-driven technologies can lead to improved public health and wellbeing, they have legitimate grounds to engage users and society more broadly and rebuild a culture of trust in data-driven technologies. Doing so can help the charity identify whether users are comfortable with certain forms of data sharing, and may also lead to the co-development of alternate services that work for all. In other words, they should not hide behind vague privacy policies, they should be shouting about their work from the rooftops.</p>
<p><em>This article has been amended to make clear that the user data shared by Crisis Text Line was anonymised, and that this practice was disclosed in the organisation’s terms of service and privacy policy. Crisis Text Line told The Conversation that the charity obtains consent to its terms of service from users via text message, and that its user data has never been commercialised.</em></p><img src="https://counter.theconversation.com/content/179056/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Burr receives research funding from the UKRI's Trustworthy Autonomous System's Hub.
He is chair of an IEEE research programme that explores the ethical assurance of digital mental healthcare.</span></em></p>Mental health charities that provide support via text message have come under fire for sharing users anonymised data.Christopher Burr, Ethics Fellow, Alan Turing InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1733122022-02-22T13:42:41Z2022-02-22T13:42:41ZThink therapy is navel-gazing? Think again<figure><img src="https://images.theconversation.com/files/443113/original/file-20220128-23-183a6zz.jpg?ixlib=rb-1.1.0&rect=31%2C6%2C2086%2C1403&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many clients come to therapy wanting to look beyond themselves – talking about relationships, values and even spirituality.</span> <span class="attribution"><span class="source">SDI Productions/E+ via Getty Images</span></span></figcaption></figure><p>Midway through a recent lecture <a href="https://www.bu.edu/sth/profile/steven-j-sandage/">about my psychology research</a>, a bright graduate student voiced a familiar question.</p>
<p>“I have heard <a href="https://www.mayoclinic.org/tests-procedures/psychotherapy/about/pac-20384616#:%7E:text=Psychotherapy%20is%20a%20general%20term,%2C%20feelings%2C%20thoughts%20and%20behaviors.">psychotherapy</a> makes people more self-absorbed,” they said. “So how can you encourage a practice that has such a negative social impact?”</p>
<p>I am often struck by these negative stereotypes, despite <a href="https://www.apa.org/news/press/releases/2021/10/mental-health-treatment-demand">growing demand</a> for counseling – particularly amid the pandemic. The well-entrenched image seems to be that psychotherapy is an indulgent, narcissistic cocoon where therapists enable patients to “navel-gaze” and <a href="https://www.theguardian.com/commentisfree/2021/aug/23/is-it-your-mothers-fault-and-your-dads-how-psychotherapy-excavates-the-past-to-free-the-present">blame others for their problems</a>.</p>
<p>Full disclosure: I have seen examples of this during my 27 years in practice. But most patients are genuinely trying to improve close relationships, recover a sense of meaning and purpose and live consistently with their core values.</p>
<p>Mental health care often focuses on reducing patients’ symptoms. However, a growing body of research, including <a href="https://www.virtueandflourishing.com/">a project</a> I co-lead with <a href="https://sites.google.com/view/rap-lab/rap-lab/dr-jesse-owen">psychologist Jesse Owen</a>, investigates therapeutic approaches that also focus on increasing patients’ overall sense of well-being, or “flourishing.”</p>
<p>In many times and places, these kinds of concerns would be considered part of character development, or ethical or religious in nature. In fact, <a href="https://doi.org/10.1037/scp0000108">a large body of research</a> shows that most people want to engage <a href="https://www.apa.org/pubs/books/relational-spirituality-psychotherapy">spiritual, religious or existential issues in mental health treatment</a>, and that psychotherapies that engage patients’ spiritual practices <a href="https://onlinelibrary.wiley.com/doi/10.1002/jclp.22681">are effective for both mental and spiritual health</a>.</p>
<h2>Dual-factor treatment</h2>
<p>Decades of research show <a href="https://www.wiley.com/en-us/Bergin+and+Garfield%27s+Handbook+of+Psychotherapy+and+Behavior+Change,+7th+Edition-p-9781119536581">psychotherapy is effective</a> for alleviating the most common forms of psychological suffering, such as anxiety and depression. But wellness is about more than reducing suffering. </p>
<p>Over the past three decades, the field of <a href="https://theconversation.com/explainer-what-is-positive-psychology-and-how-can-you-use-it-for-yourself-75635">positive psychology</a> has grown, emphasizing how people can foster their strengths, virtues and well-being. Many thinkers, such as psychologist <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674932258">William James</a> and minister and author <a href="https://www.simonandschuster.com/books/The-Power-of-Positive-Thinking/Dr-Norman-Vincent-Peale/9780743234801">Norman Vincent Peale</a>, explored similar ideas in the 20th century. But now, empirical research has <a href="https://doi.org/10.1037/pst0000285">demonstrated that counseling informed by positive psychology can be effective</a> in improving well-being and increasing such qualities as forgiveness, compassion and gratitude.</p>
<p><a href="https://www.virtueandflourishing.com/overview">The project</a> I am co-leading with Professor Owen, funded by the <a href="https://www.templeton.org/?gclid=Cj0KCQiApL2QBhC8ARIsAGMm-KE9eSOY0DrPO1P7HNcMldVCDDHz5_a1ANwoPf9MJwVrNj6tt_Bx0RMaAhSgEALw_wcB">John Templeton Foundation</a>, is part of a growing trend of researchers seeking to integrate practices of positive psychology, spirituality and holistic well-being into mental health care, with careful attention to individual patients’ different needs. </p>
<p>For example, <a href="https://www.mcleanhospital.org/profile/mary-zanarini">Mary Zanarini</a>, an international expert on <a href="https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237">borderline personality disorder</a>, is testing a group therapy that develops skills in such virtues as forgiveness, humility and gratitude alongside other strategies, such as reflecting on and regulating emotions.</p>
<p>In a <a href="https://guilfordjournals.com/doi/10.1521/pedi_2019_33_395">2020 study</a> with patients diagnosed with borderline personality disorder, she found that patients’ ability to forgive and accept was correlated with their long-term ability to sustain work or education and a close relationship, in addition to their symptom remission.</p>
<p>In a separate <a href="https://doi.org/10.1002/jclp.22185">clinical study</a> with patients also suffering from borderline personality disorder, my colleagues and I also found that as patients developed a greater capacity to forgive, they experienced fewer mental health symptoms and less anxiety and frustration in close relationships.</p>
<p>These projects reflect a move toward what psychologists call <a href="https://doi.org/10.1016/j.brat.2017.01.008">dual-factor approaches</a>, which reduce symptoms of mental distress while also trying to increase flourishing.</p>
<p>Dual-factor frameworks recognize that experiencing mental health symptoms and well-being are not mutually exclusive. For example, in a study with <a href="https://doi.org/10.1002/jcad.12396">patients 18-29 years old</a>, our team at Boston University identified a subgroup of patients we labeled “resilient.” They showed the highest rate of symptoms, the lowest levels of life satisfaction and multiple serious stresses. Yet this resilient group functioned better in relationships, work or school than would be expected. Over the course of treatment, many moved into the category of “flourishing.”</p>
<h2>Cultivating strengths</h2>
<p>So what contributes to resilience in the face of suffering? A few months into the pandemic, we looked at that question in <a href="https://doi.org/10.1002/capr.12503">a follow-up study</a> with adults. </p>
<p>Similar to the previous study, people in one group scored more highly on well-being than would be expected, given their mental health symptoms. They demonstrated <a href="http://dx.doi.org/10.1037/scp0000267">fortitude</a>, finding opportunities for growth even amid stress. Those in another group, who also functioned better than expected given their mental health symptoms, demonstrated active forms of coping, such as deepening relationships or developing new hobbies, spiritual practices or creative interests.</p>
<figure class="align-center ">
<img alt="An older man trims a bonsai tree as a child watches." src="https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446668/original/file-20220216-15-1s9ieat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Active forms of coping include working on new hobbies, like gardening.</span>
<span class="attribution"><span class="source">Karen Moskowitz/The Image Bank via Getty Images</span></span>
</figcaption>
</figure>
<p>Philosophers across many different cultures have suggested humans move toward flourishing by <a href="https://plato.stanford.edu/entries/aristotle-ethics/">cultivating virtues</a> amid hardships. <a href="https://www.wiley.com/en-us/Virtue-p-9780745649542">The word “virtue”</a> can imply rigidity or perfectionism, yet its original meaning is about drawing on human strengths and practical wisdom to navigate life – such as the fortitude participants showed in our study.</p>
<p>Humility, gratitude and forgiveness are what some psychologists call “relational virtues,” ones that support healthy relationships. <a href="https://www.virtueandflourishing.com/our-team">Our team</a> is investigating how these three virtues might contribute to positive mental health over time.</p>
<p>Our initial evidence across two clinical studies is that patients generally tend to become <a href="https://doi.org/10.1002/capr.12199">less narcissistic</a> and <a href="https://doi.org/10.1002/capr.12389">feel less superior to others</a> over the course of psychotherapy. As patients develop more humility, their relationships improve and they report fewer symptoms of anxiety and depression.</p>
<p>For many people, relational virtues tie in with their spiritual or religious practices – which are themselves important to these patients’ well-being. Among those who value spirituality, a sense of being connected to the sacred <a href="https://doi.org/10.1080/19349637.2020.1791781">was positively related</a> to their overall functioning.</p>
<p>Based on <a href="https://www.virtueandflourishing.com/">our research</a>, a key factor linking virtue and positive mental health appears to be growth in emotion regulation, such as learning skills in mindfulness and processing complicated emotions such as shame, envy or pride. Our theory is that relational virtues often emerge in therapy when patients experience a balance of challenge and support and their core values are taken seriously. </p>
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<p>We need much more research to further validate these connections among relational virtues, emotion regulation and flourishing. But there are already enough data points to paint a more complicated and constructive public image of psychotherapy than the cynical stereotype.</p>
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<p><a href="https://www.ats.edu/">Boston University School of Theology is a member of the Association of Theological Schools.</a></p>
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<p class="fine-print"><em><span>Steven Sandage received funding from the John Templeton Foundation - grant #61603 - "Mental Healthcare, Virtue, and Human Flourishing." </span></em></p>Our research investigates the connections among mental health, holistic well-being and relational virtues – ideas that many people think of as ethical or religious.Steven Sandage, Professor of the Psychology of Religion and Theology, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1710082022-02-15T13:22:33Z2022-02-15T13:22:33ZAfter the FDA issued warnings about antidepressants, youth suicides rose and mental health care dropped<figure><img src="https://images.theconversation.com/files/445533/original/file-20220209-19735-a32t0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The link between antidepressant use and increases in suicidal thoughts or behaviors among treated youth is unproven.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/having-a-bad-day-royalty-free-image/640139784?adppopup=true">FatCamera/E+ via Getty Images</a></span></figcaption></figure><p>Depression in young people is vastly undertreated. About two-thirds of depressed youth don’t receive <a href="https://doi.org/10.1542/peds.2016-1878">any mental health care at all</a>. Of those who do, a significant proportion rely on antidepressant medications.</p>
<p>Since 2003, however, <a href="https://doi.org/10.1176/ajp.2007.164.6.884">the U.S. Food and Drug Administration has warned</a> that young people might experience suicidal thinking and behavior during the first months of treatment with antidepressants. </p>
<p>The FDA <a href="https://doi.org/10.1176/appi.ajp.2007.07050775">issued this warning to urge</a> clinicians to monitor suicidal thoughts at the start of treatment. These warnings appear everywhere: on TV and the internet, in print ads and news stories. The most strongly worded warnings appear in black boxes on medication containers themselves. </p>
<p>We are professors and researchers at <a href="https://www.populationmedicine.org/SSoumerai">Harvard Medical School</a>, the <a href="https://ldi.upenn.edu/fellows/fellows-directory/ross-koppel-phd/">University of Pennsylvania Perelman School of Medicine</a> and University at Buffalo. For over 30 years, we have been studying the intended and unintended effects of health policies on patient safety.</p>
<p>We have found that FDA drug warnings can sometimes prevent life-threatening adverse effects, but that <a href="https://doi.org/10.2307/3350088">unintended consequences of these warnings</a> are also common. In 2013, working for the FDA itself, we published a systematic review of the <a href="https://doi.org/10.1002/pds.3480">effects of previous FDA warnings</a> on a variety of medications. We found that about a third backfired, resulting in underuse of needed care and other adverse effects. </p>
<p><a href="https://doi.org/10.1176/appi.prcp.20200012">In our more recent study</a> from 2020, we found that the FDA antidepressant warnings have led to reduced mental health care and increased suicides among youth – even though researchers <a href="https://doi.org/10.1038/sj.npp.1300996">have yet to find a clear link</a> between antidepressants and increased suicidality in young people. </p>
<p>Further, despite the warnings, monitoring by clinicians of suicidal thoughts at the start of treatment has not increased <a href="https://doi.org/10.1176/appi.ajp.2007.07010205">from its tiny rate of less than 5%</a>.</p>
<h2>Youth suicides rose following FDA warnings</h2>
<p>For <a href="https://doi.org/10.1176/appi.prcp.20200012">our 2020 study</a>, we obtained 28 years of data, between 1990 and 2017, on actual suicide deaths in the U.S. among adolescents and young adults. We used data from <a href="https://wonder.cdc.gov/">the WONDER Database</a>, maintained by the U.S. Centers for Disease Control and Prevention, which contains mortality counts based on death certificates for U.S. residents and population counts for all U.S. counties.</p>
<p>We found that during the pre-warning period, there was a 13-year stable downward trend in youth suicides, following availability of new and safer antidepressants. </p>
<p><a href="https://doi.org/10.1176/appi.prcp.20200012">That trend reversed</a>, we found, soon after the FDA began antidepressant warnings in late 2003. Youth suicide deaths increased significantly.</p>
<p>Then we applied our findings to the whole U.S. population of adolescents and young adults. The results of that analysis suggest that there were almost 6,000 additional suicide deaths in just the first six years after the FDA issued the boxed warnings, from 2005 through 2010. The rates also continued to rise thereafter.</p>
<p>Over this same time period, older adults – whose depression is not targeted by the warnings – experienced much lower increases in suicide.</p>
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<h2>Fewer depressed youths got treatment</h2>
<p>Our findings align with a growing body of research that confirms these warnings have had serious unintended effects: <a href="https://doi.org/10.1056/NEJMp1408480">scaring many patients</a>, as well as their parents and doctors, away from both <a href="https://doi.org/10.1136/bmj.g3596">antidepressant medications</a> and <a href="https://doi.org/10.1001/archgenpsychiatry.2009.46">psychotherapy</a> that can reduce major symptoms of depression. </p>
<p>These studies include a rigorous 2017 study that <a href="https://doi.org/10.1002/da.22681">analyzed mental health care trends</a> among 11 million youths who rely on Medicaid for insurance coverage. This research documented that immediately after the FDA warnings began in 2003, there was a sudden and sustained 30%-40% drop in youth visits to doctors for all depression care, including antidepressant prescriptions. </p>
<p>Seven years after the first FDA warning, doctor visits for depression by young people had dropped by around 50%, compared with the pre-warning trend, thus <a href="https://www.nimh.nih.gov/health/statistics/major-depression">severely reducing treatment and suicide prevention</a>. </p>
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<p>That trend included Black and Latino youths, who have already <a href="https://www.dovepress.com/racial-and-ethnic-differences-in-depression-current-perspectives-peer-reviewed-fulltext-article-ND">long suffered from undertreatment</a>. </p>
<p>Almost simultaneously, youth poisonings via prescription drugs, such as sleeping pills, went up. <a href="https://doi.org/10.1136/bmj.g3596">Research has shown</a> that prescribed medications are a widespread method by which young people attempt suicide. This finding adds to the evidence that the antidepressant warnings increased suicidal behavior. </p>
<figure class="align-center ">
<img alt="A tattooed teenage girl speaks to a therapist during a group psychotherapy meeting. Three other young people, sitting in the background, are listening." src="https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436824/original/file-20211209-23-1nkokvf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">About two-thirds of depressed young people in the U.S. receive no mental health treatment at all.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/tattooed-rebel-teenage-girl-sitting-in-front-of-a-royalty-free-image/1006550718?adppopup=true">Katarzyna Bialasiewicz/iStock via Getty Images</a></span>
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<p><a href="https://doi.org/10.3389/fpsyt.2019.00294">In 2018, researchers reported on two patients in their 20s</a> whose experiences illustrate the potential real-life impacts of the black-box warnings. Both young adults had been prescribed antidepressants for major depression and severe panic attacks, but they refused to take them because of the FDA’s message. </p>
<p>Their conditions worsened, and eventually both attempted suicide. Fortunately, family members were able to intervene in time, and each young adult was then hospitalized.</p>
<p>After they accepted the reassurances of hospital psychiatrists that the benefits of the medications would likely exceed any risks, both patients began to take their prescribed antidepressants. These medications, combined with talk therapy, alleviated their symptoms without intensifying suicidal thoughts. </p>
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<h2>Reevaluating the warnings</h2>
<p>As scientists, we are trained to always seek potential alternative explanations – some additional factor not included in the research – that could explain the reduction in care or increase in suicides that we and others have recorded in our studies. </p>
<p>However, the sudden, simultaneous and large effects – all of which directly reduced treatment and increased suicidal behavior – strongly suggest this is not a coincidence. It is unlikely that any outside factor can account for the multiple parallel effects on depression care, suicidal behavior and suicide deaths.</p>
<p>A large and growing body of evidence shows that the FDA’s black-box warnings on antidepressants need to be reevaluated.</p>
<p>More generally, there’s a need for independent researchers to monitor the effects of FDA warnings on public health – both intended and unintended.</p><img src="https://counter.theconversation.com/content/171008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Soumerai receives funding from the NIH.. </span></em></p><p class="fine-print"><em><span>Ross Koppel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A well-intentioned public health message has had serious negative impacts on the treatment of young people for depression.Stephen Soumerai, Professor of Population Medicine, Harvard Medical School, Harvard UniversityRoss Koppel, Professor of Medical Informatics and Adjunct Professor of Sociology, University of Pennsylvania; Professor of Biomedical Informatics, University at BuffaloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1741182022-01-12T20:28:46Z2022-01-12T20:28:46ZTexting for wellness: Using digital mental health tools for support in another COVID-19 winter<figure><img src="https://images.theconversation.com/files/440096/original/file-20220110-27-1y5q4ck.jpg?ixlib=rb-1.1.0&rect=1064%2C765%2C3734%2C2927&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">SaskWell is a texting-based service that connects users with established and evidence-based digital mental health tools, and offers weekly wellness tips and resources.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The Omicron variant may be testing your resolve to begin 2022 with a commitment to wellness. Certainly, it seems there is a shared sense of <a href="https://www.ctvnews.ca/health/coronavirus/had-enough-yet-omicron-pushes-canadians-deeper-into-pandemic-fatigue-1.5691371">frustration and fatigue</a> across the country in the face of <a href="https://www.ctvnews.ca/health/coronavirus/slim-majority-support-government-lockdowns-restrictions-in-response-to-omicron-poll-1.5735159">yet another pandemic surge</a>. Evidence-based digital tools can help support mental health and well-being during another COVID-19 winter.</p>
<p>For many Canadians, COVID-19 has already taken a toll on their mental health, with one in four reporting symptoms of depression, anxiety or post-traumatic stress in 2021, <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/210927/dq210927a-eng.htm">according to Statistics Canada</a>. This is an increase from one in five the previous year. </p>
<p>Of those who reported symptoms of one or more of these mental health challenges — including a higher proportion of young people managing depression and/or anxiety — 94 per cent indicated they had been negatively affected by the pandemic. </p>
<p>Even before the pandemic <a href="https://assets.kpmg/content/dam/kpmg/ca/pdf/2018/11/ca-en-putting-the-pieces-together-volume-1.pdf">there were barriers for many Canadians seeking mental health care within strained systems</a>. The combination of increased patient numbers with constraints to care due to COVID-19 resulted in calls for Canada to <a href="https://pm.gc.ca/en/news/news-releases/2020/05/03/prime-minister-announces-virtual-care-and-mental-health-tools">increase access to digital tools for mental health support and wellness</a>.</p>
<p>As part of its annual digital health survey, <a href="https://www.infoway-inforoute.ca/en/component/edocman/4011-canadian-digital-health-survey-2021-what-canadians-think/view-document">Canada Health Infoway</a> reported 51 per cent of people surveyed were interested in having access to e-mental health services in 2021.</p>
<h2>Digital resources</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/440485/original/file-20220112-27-j4ex8a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A basic mobile phone indicating a message received" src="https://images.theconversation.com/files/440485/original/file-20220112-27-j4ex8a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/440485/original/file-20220112-27-j4ex8a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440485/original/file-20220112-27-j4ex8a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440485/original/file-20220112-27-j4ex8a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440485/original/file-20220112-27-j4ex8a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440485/original/file-20220112-27-j4ex8a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440485/original/file-20220112-27-j4ex8a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mobile phones are a relatively low-tech intervention with widespread reach. SaskWell’s texting-based service is accessible in areas where internet connectivity may be sparse or unreliable.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In a digital world that increasingly features an “app for that” it is important to have good information about the quality, cost and intended use of digital mental health and wellness tools. </p>
<p>As part of our work to connect Canadians to evidence-based digital health and wellness resources, Gillian Strudwick led a <a href="https://mental.jmir.org/2021/3/e26550/">review of digital interventions</a> that could be used to support mental health across the country during the pandemic. With this information we went on to <a href="http://dx.doi.org/10.1136/bmjopen-2021-052259">explore how the use of text messaging could be used to connect those in search of mental health and wellness supports</a> to these curated resources. </p>
<p>The result was SaskWell, a texting service for residents of Saskatchewan that provides 10 weeks of mental health and wellness prompts. SaskWell was designed in partnership with a patient and community advisory committee, bringing the voices and needs of Saskatchewan residents into this text-based service. </p>
<p>The service aims to connect individuals across the province with needed supports through the most commonly accessible technology. Mobile phones are a relatively low-tech intervention with widespread reach, especially in areas where internet connectivity may be sparse or unreliable. </p>
<figure class="align-center ">
<img alt="A man in profile looking at his mobile phone" src="https://images.theconversation.com/files/440126/original/file-20220110-15-11tpil6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440126/original/file-20220110-15-11tpil6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440126/original/file-20220110-15-11tpil6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440126/original/file-20220110-15-11tpil6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440126/original/file-20220110-15-11tpil6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440126/original/file-20220110-15-11tpil6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440126/original/file-20220110-15-11tpil6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">SaskWell aims to connect individuals across the wide geographic reach of the province with needed supports through the most commonly accessible technology.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
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<p>Users who sign up for the service are connected with established and evidence-based digital mental health tools along with weekly wellness tips and resources, providing users with skills to manage their self care and well-being. Residents of Saskatchewan may <a href="https://besaskwell.memotext.com/">sign up for SaskWell</a> at any time by texting “JOIN” to 759355.</p>
<p>SaskWell is not a crisis support tool, nor is it a clinical mental health intervention. It is, however, a point of connectivity and a reminder about the importance of investing time in personal wellness, especially as we face the challenges of this winter season. </p>
<h2>Weekly wellness messages</h2>
<p>Feelings of loneliness or isolation are one of the primary effects of the pandemic for Canadians who are managing mental health concerns. Statistics Canada found that “<a href="https://www150.statcan.gc.ca/n1/daily-quotidien/210927/dq210927a-eng.htm">a higher proportion of younger Canadians reported experiencing at least one of the impacts, such as feelings of loneliness or an increase in physical health problems</a>” in 2021. Nearly <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/210924/dq210924a-eng.htm">half of all Canadians have noted increasing stress levels</a>. </p>
<p>SaskWell users have identified weekly messages as a positive point of connectivity in their wellness efforts. These messages arrive a few times a week, and per user recommendations can now be scheduled for certain days and times via text. </p>
<p>If you are in Saskatchewan, now is the time to text JOIN, and give yourself 10 weeks of support in your wellness efforts. One benefit of the service is that the messaging is tailored to address the current needs of users, and right now we are collaborating on messaging to see us all through another COVID-19 winter. </p>
<figure class="align-center ">
<img alt="A man with a dog looking at his mobile phone in front of a window." src="https://images.theconversation.com/files/440124/original/file-20220110-15-r6kara.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440124/original/file-20220110-15-r6kara.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440124/original/file-20220110-15-r6kara.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440124/original/file-20220110-15-r6kara.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440124/original/file-20220110-15-r6kara.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440124/original/file-20220110-15-r6kara.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440124/original/file-20220110-15-r6kara.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">SaskWell messaging is tailored to address the current needs of users, so right now messaging if focused on seeing people through another COVID winter.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This includes a partnership with the <a href="https://sess.usask.ca">University of Saskatchewan College of Engineering students’ society</a>. As students continue to navigate shifts in their learning landscape, in addition to managing the many other disruptions in their pandemic lives, we hope easy access to digital mental health and wellness tools provides positive support. </p>
<p>If you are not in Saskatchewan, you can find mental health resources through most provincial <a href="https://211.ca/about-211/">211 programs</a>, or <a href="https://view.genial.ly/5f199d85c68a2d0d434bfc56/dossier-reporting-digital-mental-health-intervention-documen">you can use this link to review a curated list of websites and apps</a>.</p>
<p>No matter how you plan to support your own wellness in the weeks ahead, remember that any effort — even a small and seemingly most basic step — is still worthwhile. Even if you feel as though you have had many of these tools or positive coping mechanisms on repeat for months, they are still essential.</p><img src="https://counter.theconversation.com/content/174118/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracie Risling receives funding from the Canadian Institutes of Health Research* (CIHR), the Social Sciences and Humanities Research Council (SSHRC) and the Saskatchewan Health Research Foundation* (SHRF) *funders of SaskWell. </span></em></p><p class="fine-print"><em><span>Gillian Strudwick receives funding from the Canadian Institutes of Health Research.</span></em></p>Research on how text messaging could provide mental health resources resulted in SaskWell, a texting service for people in Saskatchewan that provides 10 weeks of mental health and wellness prompts.Tracie Risling, Associate Professor, Faculty of Nursing, University of CalgaryGillian Strudwick, Scientist and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1744402022-01-07T10:21:44Z2022-01-07T10:21:44ZCOVID fallout hit farmers hard – they need better mental health support<figure><img src="https://images.theconversation.com/files/439696/original/file-20220106-27-1898u5p.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5708%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woodbridge-suffolk-uk-february-07-2021-2070593393">Simon Collins/Shutterstock</a></span></figcaption></figure><p>A farmer’s lot is not an easy one. A difficult and demanding way of life, farming involves a huge range of <a href="https://www.mdpi.com/1660-4601/16/23/4849">challenges and stresses</a> – among them isolation, climate change, and disease outbreaks in crops and livestock.</p>
<p>A recent <a href="https://rabi.org.uk/wp-content/uploads/2021/10/RABI-Big-Farming-Survey-FINAL-single-pages-No-embargo-APP-min.pdf">survey</a> of 15,296 farmers across England and Wales by the <a href="https://rabi.org.uk/about/">Royal Agricultural Benevolent Institution</a> (Rabi) found that 36% of the farming community were probably or possibly depressed.</p>
<p>The pandemic has struck during an uncertain post-Brexit agricultural transition which will see a <a href="https://theconversation.com/agriculture-bill-heres-what-it-means-for-farming-and-the-environment-after-brexit-130091">radical shift</a> in how farmers are paid to manage land and produce food. It has also brought into sharp focus the role of farmers as <a href="https://www.thegrocer.co.uk/morrisons/morrisons-pays-tribute-to-key-workers-with-farmer-christmas-festive-ad/661805.article">essential workers</a>.</p>
<p>We began a <a href="https://research.reading.ac.uk/landscapes-of-support/">research project</a> in March 2021 to explore how the pandemic has affected the mental health of farming families in the UK, focusing particularly on the organisations and people who support them.</p>
<p>Pastoral support for farmers is provided by agricultural organisations, mental health charities, agricultural chaplains, and advisers in rural communities. Some of it is focused on mental health and wellbeing, but much of it is not. Rather, it is the support provided by friends and neighbours in rural pubs, auction markets and agricultural shows that improves mental health through mixing socially and fostering a sense of community.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/439539/original/file-20220105-15-16rcb5a.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram showing the mental health support networks available to farmers." src="https://images.theconversation.com/files/439539/original/file-20220105-15-16rcb5a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439539/original/file-20220105-15-16rcb5a.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=370&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439539/original/file-20220105-15-16rcb5a.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=370&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439539/original/file-20220105-15-16rcb5a.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=370&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439539/original/file-20220105-15-16rcb5a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=465&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439539/original/file-20220105-15-16rcb5a.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=465&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439539/original/file-20220105-15-16rcb5a.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=465&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">David Rose/University of Reading</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>The ‘Landscapes of Support’ project</h2>
<p>Though more research is starting to highlight what drives poor mental health in farming, there is little exploration of the support networks providing help to struggling farmers in the UK, or how that support works.</p>
<p>We interviewed 22 people who provide mental health support to farmers in the UK, followed by a survey of 93 support providers and 207 farmers. Our <a href="https://research.reading.ac.uk/landscapes-of-support/wp-content/uploads/sites/204/2022/01/Brief.pdf">results</a> showed that 67% of farmers surveyed reported feeling more stressed during the pandemic than before it, 63% felt more anxious and 38% felt more depressed.</p>
<p>While a lower, but still worrying, number (12%) felt more suicidal, there is a <a href="https://www.centreformentalhealth.org.uk/blogs/mental-health-all-working-across-spectrum">spectrum</a> of mental ill-health, from initial feelings of stress and anxiety, to clinical depression up to thoughts or acts of suicide. We believe the pandemic is storing up problems that will manifest themselves more seriously later.</p>
<p>We found that the primary reasons for worsening mental health ranged from having less social contact as a result of lockdowns and social distancing, to issues with the public on private land, and social events moving online – which was a particular challenge for families with poor internet connections.</p>
<p>According to those who provide help and support, the five main reasons farmers contacted them during the pandemic were loneliness, family or relationship issues, financial problems, illness, and pressure of regulations and inspections from the government. Barriers to support included the perceived stigma of asking for help, lack of knowledge about available support, the travelling distance involved and lack of time to attend sessions.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/uR_RUgr6wrw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Besides the pandemic’s effect on their business, lockdown and social distancing have clearly contributed to worsening mental health in some farming families. But the story for farmers has not been entirely negative.</p>
<p>Participants in our study spoke about feeling more valued knowing they were doing important work keeping people fed. The comfort and support of having family members at home was also reported – although for some this was regarded as stressful. Quieter rural roads during periods of lockdown were also seen as an upside. Some farmers were also encouraged to try communicating online, which improved the skills of those who had good internet connectivity.</p>
<p>Those providing support themselves have struggled to offer the same service during the pandemic. They spoke about the importance of face-to-face interaction and how it is key for effective mental-health support. Farmers have always tended to be more geographically isolated from services such as healthcare, but this was exacerbated during the pandemic.</p>
<p>While supporters adapted by providing advice by phone or video call, this was not accessible to all and not always felt to be as effective. The pandemic also challenged the ability of some local-level farming organisations to raise funds and provide enough staff. For example, Young Farmers clubs – farming community groups that support young people working in the countryside – <a href="https://www.fginsight.com/news/news/covid-19-crisis-leaves-young-farmers-clubs-facing-1m-black-hole-113449">reported</a> a £1m funding shortfall in 2020.</p>
<p>Our study, alongside Rabi’s <a href="https://rabi.org.uk/wp-content/uploads/2021/10/RABI-Big-Farming-Survey-FINAL-single-pages-No-embargo-APP-min.pdf">Big Farming Survey</a> and other studies showing the <a href="https://www.princescountrysidefund.org.uk/news/new-research-shows-vital-importance-of-auction-marts/">value of rural auction markets</a>, makes several recommendations on how to address both the causes of, and support for poor mental health among farmers. Improving support without addressing the underlying reasons for this poor mental health is unlikely to be effective.</p>
<figure class="align-center ">
<img alt="A group of farmers seen from the back looking over a sheep pen at an agricultural show." src="https://images.theconversation.com/files/439697/original/file-20220106-21-1m424vk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439697/original/file-20220106-21-1m424vk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439697/original/file-20220106-21-1m424vk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439697/original/file-20220106-21-1m424vk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439697/original/file-20220106-21-1m424vk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439697/original/file-20220106-21-1m424vk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439697/original/file-20220106-21-1m424vk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID denied farmers the social events and enjoyable meeting places like agricultural shows.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gower-wales-uk-august-03-2014-790638325">jax10989/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What needs to happen</h2>
<p>First, given that a huge range of people come into regular contact with farmers – from vets, inspectors and bank managers to other people living in rural communities – basic <a href="https://fcn.org.uk/blog/2021/11/18/new-study-calls-for-culture-change-in-farming-to-address-loneliness-isolation-and-mental-ill-health/">mental health first-aid training</a> could be provided more widely. This could include improving community knowledge about available support for farmers, which would help to normalise conversations about mental health and encourage people to get help.</p>
<p>Second, more work is needed to understand how to connect the support services used by farming communities. Services such as healthcare, mental health charities and social groups are not always coordinated; it can be difficult for people to know the best way to get support.</p>
<p>Lastly, the benefit of strong links to the community cannot be underestimated when it comes to mental health and wellbeing. The importance of the meeting places that farmers enjoy is key to this community. These are the vital and life-affirming agricultural events and places that COVID denied farmers over the last two years, some of which now face an <a href="https://www.countryside-alliance.org/news/2021/1/ca-survey-reveals-rural-pubs-on-brink-of-closure">uncertain future</a>, such as rural pubs. The government needs long-term policies that will help maintain the thriving rural communities that enhance farming life.</p><img src="https://counter.theconversation.com/content/174440/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Rose receives funding from the Economic and Social Research Council.</span></em></p><p class="fine-print"><em><span>Faye Shortland receives funding from the Economic and Social Research Council. </span></em></p>Two profoundly disruptive events combined to make life even more challenging for UK farmers, and now their mental health is suffering. Here’s what can be done.David Rose, Elizabeth Creak Associate Professor of Agricultural Innovation and Extension, University of ReadingFaye Shortland, Postdoctoral Researcher, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1731822021-12-22T20:05:10Z2021-12-22T20:05:10ZAmid COVID-19 stressors, international students and their university communities should prioritize mental health supports<figure><img src="https://images.theconversation.com/files/438854/original/file-20211222-19-rnf9di.jpg?ixlib=rb-1.1.0&rect=0%2C550%2C7073%2C3933&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">International students living abroad who face unpredictable pandemic travel restrictions during holidays may be feeling vulnerable, and reaching out is important.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/amid-covid-19-stressors--international-students-and-their-university-communities-should-prioritize-mental-health-supports" width="100%" height="400"></iframe>
<p>After experiencing weeks or months of excitement building up before you left your home for the thrill of a North American education, you might now be feeling vulnerable in a foreign country, especially with news of <a href="https://globalnews.ca/news/8461227/covid-19-cases-canada-omicron-variant-threat/">the new omicron variant</a>.</p>
<p>You may feel lonely and wondering what to do during this holiday as your friends are spending time with their families, a luxury you may not have due to <a href="https://yaledailynews.com/blog/2021/12/07/i-just-want-to-go-home-omicron-variant-casts-doubt-on-international-students-travel-plans/">complicated international travel restrictions</a>. In addition, as some campus and university services have been restricted due to COVID-19 and many will be on holiday hours, you may face isolation which can evoke emotional memories and hardships.</p>
<p>So, here we <a href="https://www.concordia.ca/sgs/public-scholars/profiles/ezgi-ozyonum.html">are, Ezgi</a> <a href="https://education.jhu.edu/directory/qiyang-zhang/">and Qiyang</a>, two international students. Our research expertise is respectively in critical analyses of international education, and student well-being and school-based mental health intervention. We study at Concordia University in Montreal (Ezgi) and at Johns Hopkins University in Baltimore (Qiyang). We offer suggestions to you — and your communities — on how to better support your mental health and wellness.</p>
<figure class="align-center ">
<img alt="A young man on the phone outdoors in a snowstorm and snowflake earmuffs smiling" src="https://images.theconversation.com/files/438773/original/file-20211222-19-ipsajz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438773/original/file-20211222-19-ipsajz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438773/original/file-20211222-19-ipsajz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438773/original/file-20211222-19-ipsajz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438773/original/file-20211222-19-ipsajz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438773/original/file-20211222-19-ipsajz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438773/original/file-20211222-19-ipsajz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It is important to take steps to stay connected and find support when facing obstacles.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Managing elevated pandemic stressors</h2>
<p>On top of the obstacles you have probably faced, such as <a href="https://www.researchgate.net/publication/354061768_Approaches_to_Internationalize_A_review_on_international_students_and_the_internationalization_of_the_curriculum">adjusting to the drastic change of food, weather, language and culture</a>, the pandemic has <a href="https://doi.org/10.1371/journal.pone.0247999">disconnected you socially</a>, <a href="https://doi.org/10.2991/jegh.k.201016.001">applied severe economic pressure on you</a> and <a href="https://www.macleans.ca/education/how-the-pandemic-has-disrupted-the-lives-of-international-students-in-canada/">made immigrating much more challenging</a>. </p>
<p>Additionally, if you are an Asian international student, you have likely been coping with <a href="https://doi.org/10.1037/sah0000275">the stressors of elevated racial discrimination</a>. Research in the U.S. shows this discrimination in the pandemic has included hate crimes and vicarious discrimination (seeing or hearing about hate crimes and discrimination and worrying about them), and that these experiences are associated with poorer self-reported mental and physical health. In Canada, researchers similarly documented a <a href="https://www.covidracism.ca/resources">surge of COVID-19 anti-Asian racism</a>; hate crimes <a href="https://globalnews.ca/news/8063163/hate-crimes-rise-canada-2020">targeting East or Southeast Asian</a> descent people rose by 301 per cent in 2020. </p>
<p>Studying under these circumstances is challenging. Therefore, we consider your psychological, social, and emotional well-being as we write this holiday letter to you. </p>
<h2>Mental health stigma</h2>
<p>We care about you, not only because of the obstacles you face, but also because of the lack of help-seeking behaviours among international students. <a href="https://doi.org/10.1111/imig.12388">Almost half</a> of the international students in the U.S. and Canada come from India and China. Researchers with the China-India Mental Health Alliance have found <a href="https://www.thelancet.com/series/china-india-mental-health">that people often associate mental health counselling with negative connotations</a> in these countries. <a href="https://www.theguardian.com/society/2016/may/18/millions-people-mental-illness-china-india-untreated-study-lancet">Social stigma</a> can burden you heavily, especially when we consider that your host institutions may be unaware of these cultural barriers.</p>
<p>Therefore, mental health may not be a topic you have previously been encouraged to reflect on. Maybe you’ve been told to keep your head down and just get good grades. Or perhaps you think that it is only you who is struggling, and everyone else has it together.</p>
<h2>Peer-support groups</h2>
<p>Have you previously tried peer support groups? These groups provide <a href="https://doi.org/10.1016/j.apnu.2012.12.005">informational and emotional support</a> and expand your network. While socializing with your peers, you can <a href="https://doi.org/10.1186/s13033-021-00479-7">reduce a sense of alienation, improve your self-esteem and have feelings of empowerment</a>. </p>
<p>For example, <a href="https://www.concordia.ca/students/life/all-groups.html">Concordia University offers various student groups,</a> including the Canadian Asian society, that help students with <a href="https://www.concordia.ca/cunews/offices/vprgs/gradproskills/blogs/2021/10/07/essential-skills-for-building-strong-professional-communities.html">essential skills for building strong professional communities</a>. There are also <a href="https://www.concordia.ca/health/zen-dens/calendar/active-listening.html">peer wellness ambassadors</a> trained in active listening and providing peer support. Search for your institution’s social support opportunities to get involved and benefit.</p>
<figure class="align-center ">
<img alt="Two students seen wearing masks walking outside." src="https://images.theconversation.com/files/438779/original/file-20211222-129369-qzzzxe.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4302%2C2228&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438779/original/file-20211222-129369-qzzzxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438779/original/file-20211222-129369-qzzzxe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438779/original/file-20211222-129369-qzzzxe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438779/original/file-20211222-129369-qzzzxe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438779/original/file-20211222-129369-qzzzxe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438779/original/file-20211222-129369-qzzzxe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Peer wellness ambassadors can be one source of support.</span>
<span class="attribution"><span class="source">(Pexels/Charlotte may)</span></span>
</figcaption>
</figure>
<h2>Combatting systemic racism and cultural biases</h2>
<p>Experiencing discrimination could <a href="https://theconversation.com/racism-impacts-your-health-84112">undermine both mental and physical health</a>. You are likely frustrated by injustices and would like to take action against racism. It is necessary to combat anti-Asian racism and other <a href="https://www.concordia.ca/cunews/offices/vprgs/sgs/public-scholars-21/2021/08/30/a-warm-welcome-to-international-students.html">systemic problems on and off-campus</a>. </p>
<p>Princeton University <a href="https://www.dailyprincetonian.com/article/2021/09/princeton-history-racism-activism-orientation">began offering a workshop during new first-year student orientations on its racist history and the power of student activism</a>. We advise you to keep your eyes open for similar workshops.</p>
<p>Participating in unconscious bias <a href="https://hbr.org/2021/09/unconscious-bias-training-that-works">workshops is essential to empower us to become agents for change, equipped with concrete tools</a>. The most effective training does more than help students become aware of their own biases in a new environment, but also to build stronger networks with other students concerned with bias, discrimination or systemic racism <a href="https://theconversation.com/what-is-intersectionality-all-of-who-i-am-105639">from intersectional perspectives</a>.</p>
<p>Although we encourage you to find these workshops, your institutions may not offer or tailor them to your needs. We suggest seeking ways to have your own racial justice task force and build bridges with fellow students <a href="https://cfs-fcee.ca/wp-content/uploads/2019/07/Anti-Racism-Toolkit-Final-1.pdf">engaged in countering systemic racism</a>. Raise your voice and share <a href="https://www.concordia.ca/cunews/offices/vprgs/sgs/public-scholars-21/2021/08/30/a-warm-welcome-to-international-students.html">your perspective while learning from others, broadening your vision and widening your social network.</a> This engagement is essential.</p>
<h2>Culturally responsive counselling services</h2>
<p>It is OK not to be OK. University counselling services are available to help. Please do not worry about privacy issues, as all conversations will remain confidential. We encourage you to try at least one session, especially if you have doubts.</p>
<p>Having said this, we know that mental health and student support campus programs tailored to <a href="https://thewalrus.ca/inside-the-mental-health-crisis-facing-college-and-university-students/">specific communities are critical</a>. Research proposes that one reason for <a href="https://doi.org/10.1080/016128498249042">Asian Americans’ under-use of mental health services is existing services aren’t culturally competent</a>. <a href="https://uwaterloo.ca/campus-wellness/services/base-peer-leaders">Peer leaders may help you navigate</a> what culturally relevant services are available at your campus.</p>
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Read more:
<a href="https://theconversation.com/how-mental-health-issues-get-stigmatized-in-south-asian-communities-culturally-diverse-therapy-needed-164913">How mental health issues get stigmatized in South Asian communities: Culturally diverse therapy needed</a>
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<p>Some universities have counsellors and therapists who are proficient in foreign languages or have international backgrounds. For example, Tufts University’s counselling and mental health team hires a culturally sensitive generalist clinician who is bilingual in English and Mandarin <a href="https://www.universityworldnews.com/post.php?story=20211025095928462">and has expertise in counselling international students on life transitions, cultural adaptation and racial dilemmas</a>.</p>
<p>We worry about your well-being and encourage you to take steps to take care of yourselves. For students, this might mean stepping forward to ask for help or pinpoint what social supports, engagement and institutional supports you need, or sharing this article with your peers, communities and institutions so that they can become aware of your needs and support you better. </p>
<p>For people in university communities, it might mean making an extra effort to reach out to international students on or off campus they know over the holidays. In the longer term, what’s critical is prioritizing hiring counsellors of diverse backgrounds, providing more social chances for international students to bond and organizing workshops to discuss international students’ needs and concerns.</p><img src="https://counter.theconversation.com/content/173182/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Peer support, opportunities to engage in responses to combat racism and bias and culturally responsive counselling are important for the mental health and well-being of international students.Ezgi Ozyonum, PhD Candidate, Education, Concordia UniversityQiyang Zhang, PhD Student, School of Education, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1720482021-11-19T01:06:15Z2021-11-19T01:06:15Z9 ways to support your teen’s mental health as restrictions ease<figure><img src="https://images.theconversation.com/files/432548/original/file-20211118-24-g6fx8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mixed-race-african-american-biracial-teenager-1907943571">Shutterstock</a></span></figcaption></figure><p>Headlines about the <a href="https://www.aihw.gov.au/reports/children-youth/covid-19-and-young-people">impact of the pandemic on youth mental health</a> have left many parents worried about their children and unsure what they can do to help. </p>
<p>Now, as restrictions are eased – and school, home and social lives return to something resembling normal – young people are having to make significant adjustments as they face new pressures. </p>
<p>Parents need clear, evidence-based, practical strategies to support their teen’s mental health. But this can be hard to find.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/treating-a-childs-mental-illness-sometimes-means-getting-the-whole-family-involved-169729">Treating a child's mental illness sometimes means getting the whole family involved</a>
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<p>To fill this gap, our yet-to-be-published study asked 35 international experts (researchers, health professionals and parent advocates) what parents can do to support their teenager’s mental health during the pandemic. </p>
<p>Here are their nine key tips:</p>
<h2>1. Parents, look after yourselves</h2>
<p>While parents’ natural instincts are to be concerned about their children (and possibly ageing parents), looking after your own needs will put you in a better position to support those you care about.</p>
<h2>2. Keep the conversation open</h2>
<p>Constantly changing local regulations and restrictions, and rules around reopening, can make teens more anxious. </p>
<p>Help your teen feel more in control by providing them with clear, up-to-date and age-appropriate information about the pandemic and restrictions when the situation changes. </p>
<p>Teenagers are likely to seek answers from their peers, online, and from social media. Help your teen get information from reliable and credible sources, such as government websites or the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports">World Health Organization</a>. </p>
<p>Talking about the pandemic and easing of restrictions can help them understand and cope with what they’re hearing. </p>
<figure class="align-center ">
<img alt="Father and daughter look at a laptop together." src="https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432550/original/file-20211118-18-ft8gdh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Direct your teen to reliable information.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-indian-father-helping-school-child-1951471369">Shutterstock</a></span>
</figcaption>
</figure>
<h2>3. Support teens to follow the local rules and restrictions</h2>
<p>Be a good role model by following the local regulations and restrictions yourself. </p>
<p>Model flexibility and problem-solving by showing your teen how you adjust your daily life in response to changing regulations and restrictions.</p>
<h2>4. Accept your teen’s emotions</h2>
<p>It’s normal for teens to feel a wide range of strong emotions at different points during the pandemic: angry, scared, sad, frustrated, grief, worried, bored, confused, isolated, concerned. </p>
<p>You can help your teen cope with these by: </p>
<p><strong>Asking and listening</strong>. Ask how they’re feeling and coping, especially as the situation changes. When they open up, focus on listening – what they need most is empathy, compassion and comfort. </p>
<p><strong>Showing them how you do it</strong>. Teens look to their parents to see how to respond and how worried they should be. Try to set a good example by appearing as calm as you can, and using healthy coping strategies yourself. </p>
<p><strong>Being patient</strong>, perhaps more than usual. </p>
<p><strong>Being reassuring but realistic</strong>. Despite negative news they may be hearing, teens need their parents’ reassurance their family will get through the pandemic together and things will improve over time. But be careful not to make unrealistic promises.</p>
<p><strong>Monitoring</strong>. Keep an eye on your teen’s stress levels – look for changes in their behaviour, health and how they’re thinking and feeling. Encourage them to do things that have helped them cope with stressful times in the past.</p>
<h2>5. Help your teen work out what they can and can’t control</h2>
<p>Encourage them to focus on what they can control. For example, young people can control their own COVID-safe behaviours (such as wearing masks and following local restrictions), but need to accept they can’t control the behaviour of others.</p>
<p>Model helpful ways of dealing with uncertainty by showing them how you accept what is outside your control and focus your effort on things you can control. </p>
<p>Show appreciation for their efforts to adjust to pandemic challenges, big or small. </p>
<h2>6. Provide support as needed</h2>
<p>The ongoing uncertainties during the pandemic can affect teens many months after local restrictions have eased. </p>
<p>So be prepared to provide ongoing emotional support as needed, rather than assume all will be well because life is “back to normal”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-in-4-people-with-a-mental-illness-develop-symptoms-before-age-25-we-need-a-stronger-focus-on-prevention-126180">3 in 4 people with a mental illness develop symptoms before age 25. We need a stronger focus on prevention</a>
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</p>
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<h2>7. Establish routines</h2>
<p>Routines help teens feel more organised, in control, safe and secure and less stressed – this can help protect their mental health. </p>
<p>Ensure your teen’s routine includes set times for homework, meals and snacks, physical activity, free time for fun and relaxation, and time for socialising. </p>
<figure class="align-center ">
<img alt="Four older teens in masks look down at a notebook." src="https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432552/original/file-20211118-25-1hyz9ff.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Make sure your teen has time for fun and socialising.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-young-people-meeting-outdoors-wearing-1838916244">Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079221000149">Regular sleep routines</a> are also important. This means having a regular bed time and wake time, and minimising the use of electronic devices before bed. Review and adjust this routine with your teen as needed, such as when local restrictions change.</p>
<h2>8. Adjust your expectations</h2>
<p>With the changes and uncertainty caused by the pandemic, you may need to adjust some expectations of your teenager and of yourself. Focus on emotional and physical well-being rather than perfection or high productivity. </p>
<p>Try to practice self-compassion and forgiveness towards your teen and yourself if either of you don’t meet your expectations.</p>
<h2>9. Look for silver linings</h2>
<p>Try to convey a sense of confidence to your teen that things will improve over time. Encourage any optimism or hope your teen shows. </p>
<p>Showing compassion, empathy and kindness to others can also benefit your teen. It can help them gain perspective, give a sense of achievement and pride, and give opportunities for social interaction. Encourage your teen to take up opportunities to help others when they can. </p>
<h2>When to get help</h2>
<p>Seek professional mental health support if your teen has major difficulties adjusting to challenges of the pandemic or reopening, or you are struggling with your own mental health. </p>
<p>Some signs you or your teen might need professional support include changes in mood or behaviour that impact school, work or relationships, withdrawal from friends or family, intense distress, and problems that don’t seem to be improving with time. </p>
<p>Remember, by seeking support for yourself when needed, you are also setting a good example for your teen.</p>
<p>For more helpful tips, see the <a href="https://www.parentingstrategies.net/">Parenting Strategies</a> website. Parents across Australia can also access the evidence-based <a href="https://partnersinparenting.com.au/">Partners in Parenting</a> online program for free. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/anorexia-spiked-during-the-pandemic-as-adolescents-felt-the-impact-of-covid-restrictions-169466">Anorexia spiked during the pandemic, as adolescents felt the impact of COVID restrictions</a>
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</em>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/172048/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie Yap receives funding from the Department of Health, National Health and Medical Research Council, and Suicide Prevention Australia. She is a member of the Parenting and Family Research Alliance, Treasurer for the Alliance for the Prevention of Mental Disorders, Deputy Editor of Mental Health & Prevention, and co-chair of the Scientific Committee and member of the Steering Committee of Growing Minds Australia. </span></em></p><p class="fine-print"><em><span>Anthony Jorm receives funding from the National Health and Medical Research Council. He is a member of the Board of Mental Health First Aid International, Chair of the Scientific Advisory Committee of Prevention United, Editor-in-Chief of Mental Health & Prevention and a member of the Association for Psychological Science.</span></em></p><p class="fine-print"><em><span>Mairead Cardamone-Breen receives funding from the the National Health and Medical Research Council. </span></em></p>Teens have been through a lot in the pandemic and things won’t simply go back to normal as the nation opens up. Here’s how to support their mental health during the transition.Marie Yap, Associate Professor, Psychology, Monash UniversityAnthony Jorm, Professor emeritus, The University of MelbourneMairead Cardamone-Breen, Research Fellow & Psychologist, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1698282021-11-11T18:57:27Z2021-11-11T18:57:27ZWe studied suicide notes to learn about the language of despair – and we’re training AI chatbots to do the same<figure><img src="https://images.theconversation.com/files/431426/original/file-20211111-21-cbuohc.jpeg?ixlib=rb-1.1.0&rect=54%2C54%2C5952%2C3953&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>While the art of conversation in machines is limited, there are improvements with every iteration. As machines are developed to navigate complex conversations, there will be technical and ethical challenges in how they detect and respond to sensitive human issues. </p>
<p>Our work involves building chatbots for a range of uses in health care. Our system, which incorporates multiple algorithms used in artificial intelligence (AI) and natural language processing, has been in development at the <a href="https://aehrc.csiro.au/">Australian e-Health Research Centre</a> since 2014. </p>
<p>The system has generated several chatbot apps which are being trialled among selected individuals, usually with an underlying medical condition or who require reliable health-related information. </p>
<p>They include <a href="https://theconversation.com/new-app-helps-people-with-neurological-conditions-practise-speech-51665">HARLIE</a> for Parkinson’s disease and <a href="https://theconversation.com/the-future-of-chatbots-is-more-than-just-small-talk-53293">Autism Spectrum Disorder</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/33234441/">Edna</a> for people undergoing genetic counselling, Dolores for people living with chronic pain, and Quin for people who want to quit smoking. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1394776246525960195"}"></div></p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%28suicide%29+AND+%28%28autism%29+OR+%28smoking%29+OR+%28chronic+pain%29+OR+%28parkinson%27s+disease%29%29&sort=">Research</a> has shown those people with certain underlying medical conditions are more likely to think about suicide than the general public. We have to make sure our chatbots take this into account.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431393/original/file-20211110-6892-12wzwoz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Siri often doesn’t understand the sentiment behind and context of phrases.</span>
<span class="attribution"><span class="source">Screenshot/Author provided</span></span>
</figcaption>
</figure>
<p>We believe the safest approach to understanding the language patterns of people with suicidal thoughts is to study their messages. The choice and arrangement of their words, the sentiment and the rationale all offer insight into the author’s thoughts. </p>
<p>For our <a href="https://ebooks.iospress.nl/volumearticle/56629">recent work</a> we examined more than 100 suicide notes from various <a href="https://www.amazon.com/Suicide-Notes-Predictive-Clues-Patterns/dp/0898853990">texts</a> and identified four relevant language patterns: negative sentiment, constrictive thinking, idioms and logical fallacies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/introducing-edna-the-chatbot-trained-to-help-patients-make-a-difficult-medical-decision-150847">Introducing Edna: the chatbot trained to help patients make a difficult medical decision</a>
</strong>
</em>
</p>
<hr>
<h2>Negative sentiment and constrictive thinking</h2>
<p>As one would expect, many phrases in the notes we analysed expressed negative sentiment such as:</p>
<blockquote>
<p>…just this heavy, overwhelming despair…</p>
</blockquote>
<p>There was also language that pointed to constrictive thinking. For example:</p>
<blockquote>
<p>I will <em>never</em> escape the darkness or misery…</p>
</blockquote>
<p>The phenomenon of constrictive thoughts and language is <a href="http://www.suicidology-online.com/pdf/SOL-2010-1-5-18.pdf">well documented</a>. Constrictive thinking considers the absolute when dealing with a prolonged source of distress. </p>
<p>For the author in question, there is no compromise. The language that manifests as a result often contains terms such as <em>either/or, always, never, forever, nothing, totally, all</em> and <em>only</em>.</p>
<h2>Language idioms</h2>
<p>Idioms such as “the grass is greener on the other side” were also common — although not directly linked to suicidal ideation. Idioms are often colloquial and culturally derived, with the real meaning being vastly different from the literal interpretation. </p>
<p>Such idioms are problematic for chatbots to understand. Unless a bot has been programmed with the intended meaning, it will operate under the assumption of a literal meaning. </p>
<p>Chatbots can make some disastrous mistakes if they’re not encoded with knowledge of the real meaning behind certain idioms. In the example below, a more suitable response from Siri would have been to redirect the user to a crisis hotline.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429473/original/file-20211031-21-eduz7j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An example of Apple’s Siri giving an inappropriate response to the search query: ‘How do I tie a hangman’s noose it’s time to bite the dust’?</span>
<span class="attribution"><span class="source">Author provided</span></span>
</figcaption>
</figure>
<h2>The fallacies in reasoning</h2>
<p>Words such as <em>therefore, ought</em> and their various synonyms require special attention from chatbots. That’s because these are often bridge words between a thought and action. Behind them is some logic consisting of a premise that reaches a conclusion, <a href="https://www.goodreads.com/book/show/22920682-the-burning-brand">such as</a>:</p>
<blockquote>
<p>If I were dead, she would go on living, laughing, trying her luck. But she has thrown me over and still does all those things. <em>Therefore</em>, I am as dead.</p>
</blockquote>
<p>This closely resemblances a common fallacy (an example of faulty reasoning) called <a href="https://en.wikipedia.org/wiki/Affirming_the_consequent">affirming the consequent</a>. Below is a more pathological example of this, which has been called <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1943-278X.1981.tb01006.x">catastrophic logic</a>:</p>
<blockquote>
<p>I have failed at everything. If I do this, I will succeed.</p>
</blockquote>
<p>This is an example of a semantic <a href="https://plato.stanford.edu/entries/fallacies/">fallacy</a> (and constrictive thinking) concerning the meaning of <em>I</em>, which changes between the two clauses that make up the second sentence.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/6757205/">This fallacy</a> occurs when the author expresses they will experience feelings such as happiness or success after completing suicide — which is what <em>this</em> refers to in the note above. This kind of <a href="https://www.amazon.com/Voices-Death-Edwin-S-Shneidman/dp/0060140232">“autopilot” mode</a> was often described by people who gave psychological recounts in interviews after attempting suicide.</p>
<h2>Preparing future chatbots</h2>
<p>The good news is detecting negative sentiment and constrictive language can be achieved with off-the-shelf algorithms and publicly available data. Chatbot developers can (and should) implement these algorithms.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=545&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=545&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=545&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=684&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=684&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429547/original/file-20211101-19-1t1eq8d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=684&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Our smoking cessation chatbot Quin can detect general negative statements with constrictive thinking.</span>
<span class="attribution"><span class="source">Author provided</span></span>
</figcaption>
</figure>
<p>Generally speaking, the bot’s performance and detection accuracy will depend on the quality and size of the training data. As such, there should never be just one algorithm involved in detecting language related to poor mental health. </p>
<p>Detecting logic reasoning styles is a <a href="https://ebooks.iospress.nl/volumearticle/56629">new and promising area of research</a>. Formal logic is well established in mathematics and computer science, but to establish a machine logic for commonsense reasoning that would detect these fallacies is no small feat. </p>
<p>Here’s an example of our system thinking about a brief conversation that included a semantic fallacy mentioned earlier. Notice it first hypothesises what <em>this</em> could refer to, based on its interactions with the user.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=580&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=580&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429549/original/file-20211101-19-u942i8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=580&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Our chatbots use a logic system in which a stream of ‘thoughts’ can be used to form hypothesises, predictions and presuppositions. But just like a human, the reasoning is fallible.</span>
<span class="attribution"><span class="source">Author provided</span></span>
</figcaption>
</figure>
<p>Although this technology still requires further research and development, it provides machines a necessary — albeit primitive — understanding of how words can relate to complex real-world scenarios (which is basically what semantics is about). </p>
<p>And machines will need this capability if they are to ultimately address sensitive human affairs — first by detecting warning signs, and then delivering the appropriate response. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-future-of-chatbots-is-more-than-just-small-talk-53293">The future of chatbots is more than just small-talk</a>
</strong>
</em>
</p>
<hr>
<p><strong><em>If you or someone you know needs support, you can call Lifeline at any time on 13 11 14. If someone’s life is in danger, call 000 immediately.</em></strong></p><img src="https://counter.theconversation.com/content/169828/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Individuals who experience suicidal thoughts can show signs of this in the language they use. We analysed more than 100 suicide notes to find these language patterns.David Ireland, Senior Research Scientist at the Australian E-Health Research Centre., CSIRODana Kai Bradford, Principal Research Scientist, Australian eHealth Research Centre, CSIROLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1677872021-10-20T19:12:49Z2021-10-20T19:12:49ZCOVID has increased anxiety and depression rates among university students. And they were already higher than average<figure><img src="https://images.theconversation.com/files/427381/original/file-20211019-20-1pw26zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-sad-adult-man-sitting-alone-1743063953">Shutterstock</a></span></figcaption></figure><p>Before COVID, university and vocational education students were at high risk of developing mental disorders, such as depression and anxiety. This is because they already <a href="https://aps.onlinelibrary.wiley.com/doi/10.1080/00050067.2010.482109">experience much higher levels</a> of psychological distress than the general population.</p>
<p>But since COVID, this group is even more at risk. Our study has found the percentage of university and vocational education students reporting extremely high levels of distress during the pandemic (23%) was higher than before the pandemic (19%).</p>
<p>We also compared the percentage of Australian adults in the general population reporting extremely high levels of distress before (3%) and during (13%) COVID. In this population too, distress levels have increased significantly. </p>
<p>So, overall, the percentage of tertiary students reporting extremely high levels of distress (23%) has remained much higher than for adults in the general population (13%). </p>
<h2>Women and international students among worst affected</h2>
<p>Pandemics <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00624-w">increase the amount of stressors</a> people are subjected to for a number of reasons. In <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247999">university students</a>, these include health impacts associated with illness, worrying about becoming ill, being unable to work, having to study online and being separated from friends and family. </p>
<p>Results of studies conducted in the <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245327">United States</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102633/">China</a> have also shown COVID has increased levels of distress and mental health problems in university students.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/most-of-us-will-recover-our-mental-health-after-lockdown-but-some-will-find-it-harder-to-bounce-back-169029">Most of us will recover our mental health after lockdown. But some will find it harder to bounce back</a>
</strong>
</em>
</p>
<hr>
<p>In our yet-to-be-published study, we measured distress in 1,072 students enrolled in university and vocational education and training across Australia. We did this using an online survey consisting of demographic questions and the Kessler 10 Item Psychological Distress Scale (K10) — a global measure of distress and symptoms of depression and anxiety.</p>
<p>The survey asks ten questions such as “in the past four weeks, about how often did you feel hopeless?” and “in the past four weeks, about how often did you feel so restless you could not sit still?”</p>
<p>For each question, respondents have to signify whether this is “all of the time”, “most of the time”, “some of the time”, “a little of the time” or “none of the time”.</p>
<p>In part one of the study, we compared current levels of student distress to distress in students before the pandemic, also measured using the K10, and found current levels were higher.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427427/original/file-20211020-16-n14hfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Group of diverse university students walking." src="https://images.theconversation.com/files/427427/original/file-20211020-16-n14hfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427427/original/file-20211020-16-n14hfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427427/original/file-20211020-16-n14hfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427427/original/file-20211020-16-n14hfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427427/original/file-20211020-16-n14hfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427427/original/file-20211020-16-n14hfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427427/original/file-20211020-16-n14hfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Women, international students and students with a history of mental health issues had the highest rates of depression and anxiety symptoms.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-friendship-communication-international-concept-group-572918770">Shutterstock</a></span>
</figcaption>
</figure>
<p>The groups displaying the highest levels of distress were younger students, women, international students, students living in Queensland, and those who have had a previous diagnosis of a mental disorder, as well as those receiving mental health care.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/it-takes-a-mental-toll-indian-students-tell-their-stories-of-waiting-out-the-pandemic-in-australia-169624">'It takes a mental toll': Indian students tell their stories of waiting out the pandemic in Australia</a>
</strong>
</em>
</p>
<hr>
<h2>But here’s what we know can help</h2>
<p>We recently conducted a review of studies (yet-to-be published) designed to promote mental health and stress resilience among university students. We found:</p>
<ul>
<li><p>focusing attention on the present moment was the most reliable exercise for reducing symptoms of anxiety</p></li>
<li><p>engaging in enjoyable and personally meaningful activities was the most effective exercise for reducing symptoms of depression</p></li>
<li><p>positive relations with others decreased symptoms of anxiety and paranoia, and improved positive emotions</p></li>
<li><p>humour relieved symptoms of anxiety</p></li>
<li><p>keeping a journal relieved symptoms of anxiety. Doing this may also improve positive emotions</p></li>
<li><p>acceptance during difficult circumstances also relieved symptoms of anxiety, but not as effectively as focusing attention on the present moment, humour, journaling or positive relationships</p></li>
<li><p>gratitude, optimism, self-compassion, being aware of emotions and taking probiotics all helped to improve mental health, but not as effectively as the other exercises outlined above</p></li>
<li><p>exercise relieves symptoms of depression and anxiety and can also improve positive emotions if the participant does not push too far beyond their ability level.</p></li>
</ul>
<h2>Preventive measures are important</h2>
<p>Most Australian universities already offer mental health support programs to students. But these are typically focused on treating distress rather than preventing it. Where stress management training does exist, this generally occurs through isolated programs.</p>
<p>This is in contrast to national medical health strategies that rely heavily on <a href="https://www.health.gov.au/health-topics/preventive-health/about">preventive health initiatives</a>. These are generally educational campaigns that teach people how to look after their health instead of waiting for them to turn up at hospital emergency departments. Campaigns start in early school years and continue throughout life. </p>
<p>Australia’s <a href="https://www.mentalhealthcommission.gov.au/getmedia/0209d27b-1873-4245-b6e5-49e770084b81/Fifth-National-Mental-Health-and-Suicide-Prevention-Plan">national mental health plan</a> also includes preventive strategies but it doesn’t involve educating people on how to look after their own mental health in the same way preventive medical health training does.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stressed-out-dropping-out-covid-has-taken-its-toll-on-uni-students-152004">Stressed out, dropping out: COVID has taken its toll on uni students</a>
</strong>
</em>
</p>
<hr>
<p>Research shows <a href="https://www.jstor.org/stable/10.7249/j.ctt19w719q.1?refreqid=excelsior%3A715f91ffc76248ce7f85f27ffbea9eab&seq=1#metadata_info_tab_contents">every $1 universities spend</a> on preventive mental health programs saves more than $6 in health-care costs and waste from non-completion of courses. </p>
<p>In vocational education and training, this amount increases to more than $11 saved for every $1 spent. This is due to fewer on-campus mental health resources and training in these institutions compared to universities. </p>
<p>The Productivity Commission <a href="https://www.pc.gov.au/inquiries/completed/mental-health/report">has recommended</a> preventive mental health programs be mandated at universities and other tertiary training institutions. There is an even greater need for this now due to the negative impact of the pandemic.</p>
<p>If you are experiencing extreme levels of distress that you cannot manage, it’s advisable to talk to your GP about creating a mental health plan, or contact the counselling service of your educational institution.</p>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/167787/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Tuck receives funding from an Australian Goverment Research Training Grant.</span></em></p><p class="fine-print"><em><span>Joshua Wiley receives funding from the National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Emily Berger and Lefteris Patlamazoglou do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our study shows almost one in four university and vocational education students report extremely high levels of distress during the pandemic.David Tuck, PhD Student, Monash UniversityEmily Berger, Senior lecturer, Monash UniversityJoshua F. Wiley, Senior Lecturer, Monash UniversityLefteris Patlamazoglou, Lecturer, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1630352021-06-29T12:42:48Z2021-06-29T12:42:48ZMany of us feel ‘empty’ – understanding what it means is important for improving our mental health<figure><img src="https://images.theconversation.com/files/408839/original/file-20210629-17-71tye3.jpg?ixlib=rb-1.1.0&rect=7%2C14%2C4937%2C3276&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many of us may have described feeling 'empty' before.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thoughtful-girl-sitting-on-sill-embracing-793940824">fizkes/ Shutterstock</a></span></figcaption></figure><p>It’s likely you have felt “empty” at some point in your life – or perhaps you’ve heard someone else describe themselves in that way. But while this might be a relatively common feeling, it’s often not spoken about as a symptom of mental health difficulties. Typically, “feelings of emptiness” are only considered as a symptom of borderline personality disorder – a mental health condition characterised by challenges with emotions, relationships to others, and feelings of chronic emptiness.</p>
<p>But, after coming across many people who reported “feeling empty” when accessing mental health services in Scotland, our research team wanted to know more about the feeling, which was rarely mentioned in mental health research. We began asking the people we interviewed whether they had ever felt this way.</p>
<p>This began a <a href="https://www.tandfonline.com/doi/full/10.1080/09638237.2021.1922645">four-year project</a> which involved listening to the perspectives of more than 400 people. We wanted to shed light on how common it is for people to feel empty, and why it’s important for researchers and clinicians to start paying attention to this feeling. Our research has allowed us to provide the first ever definition of emptiness based on the descriptions of people who experienced it first hand. This has not only shown the importance of this feeling, but also makes future research possible.</p>
<h2>‘A bottomless jug’</h2>
<p>We spoke to more than 400 people aged 18 to 80 who had reported feeling empty at some point in their lives – some rarely, some all the time. We asked them to complete an online survey where they described what it was like to feel this way.</p>
<p>This resulted in hundreds of emotive, first-hand accounts. Some described feeling empty as being “a kind of bottomless jug that can never be filled” and “a feeling of othering and separation from society” that “sucks all of the life and energy out of you”.</p>
<p>As one participant told us, emptiness is:</p>
<blockquote>
<p>When you feel like everything you do is pointless and you’re just going through the motions. Just trying to fill in the time until you die. Sometimes you have fun or something good happens which can distract you for a while, but ultimately there is a hollowness inside which never goes away. It’s as if you’re transparent and anything positive like love or joy just passes right through you without sticking and afterwards it feels like it was never there at all.</p>
</blockquote>
<p>Others spoke of motivation levels “at complete zero”, and another said:</p>
<blockquote>
<p>It felt as though I wasn’t fully part of the world, I couldn’t feel anything and nothing I did made an impact on events or other people, I ‘existed’ but I wasn’t ‘alive’.</p>
</blockquote>
<p>Interestingly, half of participants had never struggled with a mental health difficulty – showing us that emptiness is not only experienced by people who have received a diagnosis of borderline personality disorder, but that it can be experienced by people with and without mental health problems.</p>
<p>We also identified a strong link between feeling empty often and suicidal thoughts and behaviours, with those who felt empty all of the time more likely to have thought about or attempted suicide. </p>
<p>And, despite never having been given a definition of what was meant by emptiness – and instead asked to speak from their own perspective – hundreds of participants described the same feeling. We found that emptiness was characterised by a sense of inner void, coupled with lack of purpose in life and a sense of disconnection to the people in their lives and the world around them. This left people feeling that they were “going through the motions”, and not able to contribute to the world and their lives as they would like. </p>
<figure class="align-center ">
<img alt="Elderly man sitting at a table, looking tired and depressed." src="https://images.theconversation.com/files/408840/original/file-20210629-20-dbswyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408840/original/file-20210629-20-dbswyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408840/original/file-20210629-20-dbswyg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408840/original/file-20210629-20-dbswyg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408840/original/file-20210629-20-dbswyg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408840/original/file-20210629-20-dbswyg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408840/original/file-20210629-20-dbswyg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Having a definition for emptiness will make it easier to help those with this feeling.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-age-man-feel-lonely-depressed-253039792">Photographee.eu/ Shutterstock</a></span>
</figcaption>
</figure>
<p>This research has now resulted in the first definition of emptiness based on people’s personal accounts which has been published in a scientific journal. Our hope is that this will make it easier for clinicians to ask people about emptiness, and for researchers to start investigating this feeling which has previously been neglected in our conversations about mental health.</p>
<h2>Widespread feeling</h2>
<p>Our findings lead us to believe emptiness is far more widespread than previously recognised. Feelings of emptiness can be experienced by anyone, regardless of their mental health history – and for some it can be chronic and life threatening. This experience is clearly complex, impacting every aspect of a person’s life and relationships. </p>
<p>Until now, emptiness has received little attention from mental health researchers. But our research has now given a new definition to this feeling, and has highlighted the seriousness of this experience for the people who are effected. Our research also suggests that it might be time to change the way we think about mental health, distress and the support offered – as many people struggle with emptiness, regardless of whether they’ve been diagnosed with a mental health condition or not.</p>
<p>But there’s still lots we don’t know. For example, why do people feel empty – and why do some feel more empty than others? What can we do about it? Answering these questions is likely to have a big impact for many people. By understanding what emptiness is, how it develops, and how to support people who feel this way, lives may be made more meaningful and deaths by suicide prevented.</p>
<p>The next step of this research will involve developing a way of accurately measuring peoples’ experiences of emptiness, which help us in studying it, and may ultimately help reduce the suffering caused by this complex feeling. </p>
<p><em>If you’ve been affected by anything in this article there are free helplines available to support you:</em></p>
<p><em>In the UK, Samaritans can be contacted on 116 123 or email jo@samaritans.org. You can contact the mental health charity Mind by calling 0300 123 3393 or visiting <a href="https://www.mind.org.uk/">mind.org.uk</a></em></p>
<p><em>In other countries – visit IASP or Suicide.org to find a helpline in your country.</em></p><img src="https://counter.theconversation.com/content/163035/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fabio Sani previously received funding from the Economic & Social Research Council (ESRC) for a number of projects broadly concerning social identity, group processes, and health. He is currently receiving funding from the Scottish Government for a project on the psychosocial determinants of non-fatal overdose among people who use drugs. </span></em></p><p class="fine-print"><em><span>Shona Joyce Herron does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Newly published research provides the first ever definition of what it means to feel ‘empty’ — a common struggle rarely recognised by health professionals.Shona Joyce Herron, Trainee Clinical Psychologist, UCLFabio Sani, Professor of Psychology, University of DundeeLicensed as Creative Commons – attribution, no derivatives.