tag:theconversation.com,2011:/nz/topics/e-mental-health-67221/articlese-Mental health – The Conversation2022-10-20T00:07:30Ztag:theconversation.com,2011:article/1922472022-10-20T00:07:30Z2022-10-20T00:07:30ZPixels are not people: mental health apps are increasingly popular but human connection is still key<figure><img src="https://images.theconversation.com/files/490757/original/file-20221019-19-riudhf.jpg?ixlib=rb-1.1.0&rect=75%2C33%2C5499%2C3671&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>Technological solutions to fill the gap in mental health care are alluring. They can appear to be a cheap, scalable way to solve the knotty problem of mental distress, <a href="https://www.newsroom.co.nz/ideasroom/apps-wont-save-us-from-mental-health-crisis">without requiring</a> investment in people, communities and broader causes of mental ill-health such as racism, poverty or the way we design our cities. </p>
<p>Consequently, there has been huge growth in what’s now termed “e-mental health care” – mental health services and information delivered or enhanced through the internet and related technologies. In 2021, we saw a 6,500% increase in <a href="https://www.hinz.org.nz/news/590024/My-View-Growing-challenges-and-exciting-solutions-in-eMental-Health.htm">doctors recommending apps to patients</a>. </p>
<p>This growth is a response to growing problems of <a href="https://www.nzdoctor.co.nz/article/undoctored/mental-health-tsunami-unmet-need">unmet mental health needs</a>, shortage of clinicians, and a <a href="https://www.newshub.co.nz/home/politics/2022/03/review-finds-no-change-in-access-to-specialist-mental-health-services-in-5-years-despite-1-9-billion-funding-boost.html">lack of access to mental health care</a> in Aotearoa New Zealand.</p>
<p>But the increasing investment in e-mental health apps can ignore the shortcomings of technology. </p>
<p>As both a practitioner and researcher promoting mental health in communities, I see policy makers and funders dazzled by shiny new apps, which can divert the government’s investment in traditional – but costly – mental health care. </p>
<p>Here’s why we need more conversation and rigorous evaluation of e-mental health.</p>
<h2>Technology to help mental health</h2>
<p>There are 33 mental health apps listed on Aotearoa’s <a href="https://www.healthnavigator.org.nz/apps/m/mental-health-and-wellbeing-apps-overview/">Health Navigator</a> site. </p>
<p>App development has accelerated since the pandemic, with three funded through the NZ$500 million <a href="https://www.beehive.govt.nz/release/apps-e-therapy-offer-practical-mental-health-support">COVID-19 response</a> health package in 2020. </p>
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Read more:
<a href="https://theconversation.com/covid-19-mental-health-telemedicine-was-off-to-a-slow-start-then-the-pandemic-happened-177670">COVID-19: Mental health telemedicine was off to a slow start – then the pandemic happened</a>
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<p>Digital infrastructure and e-medicine is a key priority nationally: this year alone, the New Zealand government earmarked over $600 million to invest in <a href="https://www.healthcareitnews.com/news/anz/budget-2022-new-zealand-earmarks-nearly-400m-health-system-data-digital-infra">data and digital infrastructure</a> in the health system. </p>
<p>Supporters claim technology can counter isolation, anxiety, provide therapy and <a href="https://mental.jmir.org/2020/3/e18848/">accelerate access and quality of care</a>. And while there are some who benefit from <a href="https://www.sciencedirect.com/science/article/pii/S2352250X2030052X">e-mental health innovations</a>, <a href="https://link.springer.com/article/10.1007/s11920-021-01300-5">more research is needed</a> to develop and test e-mental health interventions.</p>
<p>A key challenge is that individual technological solutions build on the underlying assumption that individuals are responsible for their own health outcomes, without addressing the structural, political and social causes of ill-health. </p>
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<h2>Dependent on access to technology</h2>
<p><a href="https://www.healthline.com/health/mental-health/chatbots-reviews#Takeaway">Convenience and affordability</a> are described as the most obvious advantages of local and international apps like Aroha Chatbot, Mentemia and Happify. </p>
<p>Yet while mental health apps might be affordable for a middle class resident of Auckland, Ahmedabad or Apia, e-mental health solutions depend on people being able to afford technology platforms (like smart phones) and data plans to drive them.</p>
<p>Digital technologies <a href="https://www.tandfonline.com/doi/full/10.1080/21507740.2021.1918284?casa_token=Oo1hQMplSOoAAAAA%3AAVAF8S-d6jILVK0CYr_UNBDHNTMVOssrwQIWUXI4E9cOhaIQ5mbrTR4bIhUQbwlIjHvNsg9diLt76p4">risk increasing disparities</a> and often exclude the people who most need mental health support – <a href="https://journals.sagepub.com/doi/full/10.1177/00469580221096272">older people</a>, people with low incomes, and those with severe mental health problems. These high-need groups have been identified as those <a href="https://link.springer.com/article/10.1007/s11920-021-01274-4">least likely to use e-mental health care</a>.</p>
<p>Even when e-health solutions are provided free to the user through government health funding and investment, <a href="https://link.springer.com/article/10.1007/s11920-021-01300-5">the research and development costs for digital health are high</a>. This means mental health funding supports graphic design and tech companies instead of those who provide person-to-person care, which we already know is central for good mental health.</p>
<p>Other challenges that have emerged for large-scale implementation of e-mental health options include <a href="https://link.springer.com/article/10.1007/s11920-021-01300-5">complex regulatory issues</a> such as ensuring apps meet quality standards, and how such apps can be used across national borders. Apps also may not keep pace with new evidence and <a href="https://link.springer.com/article/10.1007/s11920-021-01300-5">advances in mental health</a> as well as clinicians can. And while there is often strong initial uptake and use, <a href="https://www.sciencedirect.com/science/article/pii/S2352250X2030052X">ongoing use of apps is less common</a>. </p>
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<h2>Do the apps actually work?</h2>
<p>Beyond the issues of access, other key questions need to be asked: do mental health apps work, and who do they work for? </p>
<p>There are clearly benefits for some people to have access to some form of immediate assistance via their phone or computer. But most research evaluating e-mental health care only looks at whether apps are <a href="https://mental.jmir.org/2021/12/e32948/PDF">appealing and easy to use</a>. </p>
<p>Fewer studies assess whether e-mental health interventions <a href="https://www.sciencedirect.com/science/article/pii/S0022395618308288?casa_token=Yel8Penk9pcAAAAA:DmSOz7XXzR4GZEn45XB1xTAvBh2i6esd1_V9FcoiIPblvpDD1rQ0K8THUvZwljvLH0rqbHj9QUY">improve mental health status</a> or strengthen mental health long term. When e-mental health interventions are evaluated rigorously, usage in a trial setting is <a href="https://www.jmir.org/2018/6/e199?utm_source=TrendMD&utm_medium=cpc&utm_campaign=JMIR_TrendMD_1">often over-reported</a> compared to usage in the real world. </p>
<p>However pixels are not people, and e-mental health care is not a substitute for the genuine human connection that is core to mental health recovery. Human connection was identified as <a href="https://www.sciencedirect.com/science/article/pii/S221242092100399X?casa_token=tkH_kWVWsT8AAAAA:GZbxbeWRRi2Dzgd11v9rOsP4esq6B2MsidgkPkBJZTf_52wIlF-iL3JzTQubw3j7V8vDwqbqaoY">key in the post-earthquake</a> period for Ōtautahi Christchurch, and <a href="https://journals.sagepub.com/doi/full/10.1177/17456916211029964">globally during the COVID-19 pandemic</a>. </p>
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Read more:
<a href="https://theconversation.com/coronavirus-new-technologies-can-help-maintain-mental-health-in-times-of-crisis-136576">Coronavirus: New technologies can help maintain mental health in times of crisis</a>
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<p>Apps are not relational and rarely support building social connections and peer friendships. <a href="https://www.tandfonline.com/doi/abs/10.1080/17441692.2019.1616798">My own research</a> has shown that, most of all, people with mental distress need support to build relationships, <a href="https://www.tandfonline.com/doi/abs/10.1080/17441692.2019.1616798">be socially included</a>, <a href="https://link.springer.com/chapter/10.1057/978-1-137-39510-8_11">participate in their communities</a> and have the opportunity to <a href="https://bmjopen.bmj.com/content/12/4/e057530.abstract">participate in and co-design</a> mental health care.</p>
<p>Addressing mental health also requires moving past the individual to the collective. It requires action to address <a href="https://linkinghub.elsevier.com/retrieve/pii/S2215036619303979">the social and political</a> factors that contribute to a person’s mental health. </p>
<p>Serious and complex global problems such as obesity, gender inequality, poor housing, colonialism, racism and barriers to social connectedness are the biggest causes of poor mental health. Apps can help some people as an adjunct to psycho-social care, but they cannot replace it.</p><img src="https://counter.theconversation.com/content/192247/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kaaren Mathias has received funding from the Economic Social Research Council and the Mariwala Health Initiative and is affiliated with Burans, a non-profit mental health provider based in North India.</span></em></p>Despite a reported 6,500% global increase in doctors recommending mental health apps to patients, research suggests they can never substitute for traditional person-to-person care.Kaaren Mathias, Senior Lecturer in public health, University of CanterburyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1776702022-04-07T12:52:16Z2022-04-07T12:52:16ZCOVID-19: Mental health telemedicine was off to a slow start – then the pandemic happened<figure><img src="https://images.theconversation.com/files/456403/original/file-20220405-16-bgijqy.jpeg?ixlib=rb-1.1.0&rect=7%2C0%2C4913%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For decades, doctors and patients have used telemedicine. But it gained wider use when the COVID-19 pandemic led to canceled appointments and closed clinics.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/face-to-face-online-psychotherapy-session-royalty-free-image/518410972">verbaska_studio/iStock via Getty Images Plus</a></span></figcaption></figure><p>In the spring of 2020, COVID-19 brought rising levels of stress, <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm">anxiety and depression</a>. But stay-at-home orders and a national emergency prompted many psychiatric and psychotherapy offices to shut down and cancel in-person appointments.</p>
<p>The country needed a robust – and fast – transition to mental health <a href="https://doi.org/10.1089/tmj.2006.0073">telemedicine</a>. And the pandemic turned out to be just the thing to make it happen.</p>
<h2>Changing tech, old idea</h2>
<p>I was skeptical of telemedicine in 2015 when I began working at Wayne State University as a <a href="https://www.starclab.org/members/arash-javanbakht">psychiatrist and researcher</a> in the medical school. At that time, the department of psychiatry and its affiliated clinics were using telemedicine in primary and emergency care and for substance use recovery.</p>
<p>But the idea of seeing patients via video had been around since long before then. In 1973, a team of behavioral scientists studied the <a href="https://doi.org/10.1176/ajp.130.8.865">two-way interactive television</a> system Massachusetts General Hospital started using in 1969. The hospital provided mental health evaluations at an off-site medical station at Logan International Airport in Boston and a Veterans Affairs hospital outside the city. “The system has proven to be feasible and acceptable to individuals and institutions in the community, providing psychiatric skills on a much wider scale, in a more accessible way, and faster than any other system,” researchers wrote in their analysis.</p>
<p>Telepsychiatry <a href="https://doi.org/10.1177/1357633x9500100104">grew in the 1990s</a>, providing remote mental health services to patients <a href="https://doi.org/10.1089/153056203763317620">in rural areas</a>, many of whom were not able to travel long distances for in-person treatment. To transmit video and sound, the systems used various technologies, including closed-circuit television, high-frequency radio waves, fiber optics, coaxial cable and phone lines.</p>
<p>The use of medical videoconferencing <a href="https://doi.org/10.1001/jama.2018.12354">grew even more</a> in the 2000s, particularly in psychiatry. By then, some patients were seeing their doctors with TV-top boxes connecting their televsions to what was then called the World Wide Web. Patients <a href="https://doi.org/10.1258/135763302320272185">were generally satisfied</a> with virtual appointments, and researchers found telepsychiatry was just as effective <a href="https://doi.org/10.1089/tmj.2006.12.341">as face-to-face visits</a>, for both adults <a href="https://doi.org/10.1258/1357633001935086">and children</a>. And even as medical teleconferencing <a href="https://doi.org/10.1016/j.cbpra.2014.04.008">raised concerns</a> about patient privacy, doctor licensing and other legal issues, researchers <a href="https://doi.org/10.1089/tmj.2006.0073">took a fresh look</a> at the idea previously dismissed as “unwieldy, unreliable and unaffordable.” </p>
<h2>Enter COVID-19</h2>
<p>As the pandemic forced lockdowns around the country, health insurance companies quickly loosened restrictions and allowed doctors to <a href="https://www.medicare.gov/coverage/telehealth">provide care remotely</a>, regardless of geographical location. A variety of software programs, such as FaceTime, Skype and Zoom, <a href="https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html">received approval for this purpose</a> under relaxed federal restrictions. </p>
<p>Acccording to a December 2021 report from the U.S. Department of Health and Human Services, the number of Medicare-covered visits conducted remotely over video rose from approximately 840,000 in 2019 to <a href="https://www.hhs.gov/about/news/2021/12/03/new-hhs-study-shows-63-fold-increase-in-medicare-telehealth-utilization-during-pandemic.html">52.7 million in 2020</a>. Furthermore, almost all U.S. states relaxed medical licensing rules, allowing physicians to virtually see patients <a href="https://www.aamc.org/news-insights/what-happens-telemedicine-after-covid-19">across state lines</a>.</p>
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<img alt="An older Black woman sits on a sofa in her living room, looking at a laptop next to her, where her therapist is on the screen." src="https://images.theconversation.com/files/456186/original/file-20220404-11-u8oatn.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456186/original/file-20220404-11-u8oatn.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456186/original/file-20220404-11-u8oatn.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456186/original/file-20220404-11-u8oatn.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456186/original/file-20220404-11-u8oatn.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456186/original/file-20220404-11-u8oatn.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456186/original/file-20220404-11-u8oatn.jpeg?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">As the pandemic made remote videoconferencing a regular part of communicating with family and friends, patients became more comfortable and skilled in using telemedicine for their mental health care.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-woman-on-a-video-call-with-her-therapist-royalty-free-image/1306154362">Marko Geber/DigitalVision via Getty Images</a></span>
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<h2>Built-in benefits</h2>
<p>Psychiatry calls for physical examination much less often than most other medical specialties, making it ideal for telemedicine. The pandemic also had a role in allaying previous concerns about patients’ being unable or unwilling to use video technology. As remote videoconferencing became a necessary and regular part of communication with workplaces, family members and friends, patients essentially trained themselves to use it in their mental health care.</p>
<p>Pandemic telehealth also solved one long-standing and seemingly intractable problem: that of patients forgetting or otherwise missing their appointments. A December 2021 study found that in pandemic-era telemedicine, the no-show rate at one Ohio clinic was only <a href="https://doi.org/10.1089/tmj.2021.0002">7.5%, compared with a 30% no-show rate</a> for in-person office visits before the pandemic. Where I work, our clinic’s own 30% missed-appointment rate dropped to almost zero. </p>
<p>The most obvious reason for that dramatic decline was that the appointments had become more convenient. Patients don’t have to take time off work, find a babysitter, fight traffic or take a bus. With a smartphone or laptop, they can see their psychiatrists or therapists from anywhere. They can have sessions while at home near their children. They can videoconference with mental health professionals during their lunch break at work, or even from their car in the parking lot. </p>
<p>This has turned out to be especially useful for people with complicated work schedules, like medical personnel and <a href="https://dx.doi.org/10.2196%2F22079">first responders</a> who are facing <a href="https://doi.org/10.3389/fpsyg.2020.02065">struggles of their own</a> during the pandemic. </p>
<h2>Here to stay</h2>
<p>Telepsychiatry has also opened a window into the home environments of patients. Seeing where and how they live gives therapists and psychiatrists important insights into a patient’s mental health needs. </p>
<p>Reaching clients at home can also be challenging: A patient of mine was a mom with a big family in a small house. She had to connect with me sitting in her bathroom in order to have privacy. With patients connecting from anywhere, there can be concerns about confidentiality, especially for those without access to private space. </p>
<p>Another issue is that for some patients, the easier access of telehealth can make their visits feel like a less serious routine task rather than treatment. My colleagues and I have had to warn patients not to connect with us while driving or shopping or while in the middle of a conversation with others. Some also had to be reminded to dress appropriately for their online appointments with us; a patient showed up onscreen in a bathrobe.</p>
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<p>And there are other glitches: Sound quality or other technical issues take time out of sessions to fix, or can’t be fixed at all. Some patients still aren’t familiar or comfortable with videoconferencing. Others did not have the necessary high-speed internet at home. For these patients, sessions often take place over the phone instead. Then we can’t see their nonverbal behavior, which is a part of assessing mental health conditions. But none of that changed the fact that telemedicine generally works for mental health care. </p>
<p>As COVID-19 restrictions have eased, some clinics are offering face-to-face visits again. Others are offering the option of in-person or video visits. I still see all my patients remotely, and only a couple have even brought up having sessions in person again. The pandemic gave telemedicine an opportunity to prove itself. And in psychiatry, at least, there’s more certainty about telemedicine’s place in the future of health care.</p><img src="https://counter.theconversation.com/content/177670/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht 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>By creating both an urgent need for mental health care and the need to prevent the spread of COVID-19, the pandemic is enabling telemedicine to go mainstream.Arash Javanbakht, Associate Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1761492022-02-14T02:53:59Z2022-02-14T02:53:59ZWant to delete your social media, but can’t bring yourself to do it? Here are some ways to take that step<figure><img src="https://images.theconversation.com/files/446155/original/file-20220214-25-44xchr.jpeg?ixlib=rb-1.1.0&rect=30%2C20%2C6858%2C4472&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>For more than a decade we’ve been deeply immersed in a love affair with social media. And the thought of ending things can be painful. But like any relationship, if social media is no longer making you happy – and if curating your online persona is exhausting instead of fun – it might be time to say goodbye. </p>
<p>Late last year, Meta (previously Facebook) came under intense scrutiny after <a href="https://www.theguardian.com/technology/2021/sep/29/facebook-hearing-latest-children-impact">leaked documents</a> revealed the company was fully aware of the negative impact its products, Instagram in particular, can have on users’ mental health. </p>
<p>Meta went straight into damage control. But it seemed no one was particularly surprised by the news – not even <a href="https://www.nytimes.com/2021/10/05/technology/teenage-girls-instagram.html">teenage girls</a>, who Meta identified as most at risk. Was the leak just confirming what we already suspected: that social media has the potential to be much more harmful than helpful? </p>
<p>How did our once carefree relationship with social media turn sour? And perhaps most importantly, can (or should) it be salvaged? </p>
<h2>Spotting the red flags</h2>
<p>Relationship counsellors will often ask troubled couples to think about what made them happy in their relationship. Social media, for all it’s annoying peccadilloes, does have some redeeming features. </p>
<p>Throughout the pandemic, the ability to stay connected to people we can’t see in person has become incredibly valuable. Social media can also help people find their tribe, particularly if the people in their offline world don’t share their values and beliefs. </p>
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<a href="https://images.theconversation.com/files/446158/original/file-20220214-13-1yhnhwe.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/446158/original/file-20220214-13-1yhnhwe.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446158/original/file-20220214-13-1yhnhwe.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446158/original/file-20220214-13-1yhnhwe.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446158/original/file-20220214-13-1yhnhwe.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446158/original/file-20220214-13-1yhnhwe.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446158/original/file-20220214-13-1yhnhwe.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446158/original/file-20220214-13-1yhnhwe.jpeg?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">With so many social platforms available – and millions (or even billions) plugged in – our FOMO can takeover.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>But if you can’t go a day without trawling through the sites, feeling compelled to “like” or be “liked”, your relationship is in trouble. </p>
<p>Though far from settled, the bulk of screen time research focuses on the detrimental effects of excessive or problematic screen use on well-being and mental health. A 2021 <a href="https://link.springer.com/article/10.1007/s12144-019-0150-6">meta-analysis</a> of 55 studies, with a combined sample size of 80,533 people, found a positive (albeit small) association between depressive symptoms and social media use. </p>
<p>An important finding was that negative consequences were more likely to come from how social media use made participants <em>feel</em>, rather than how long they used it. </p>
<h2>Information overload</h2>
<p>In trying to understand why social media can leave us feeling less than content, we can’t look past the effect of the 24/7 news (and fake news) stream on our collective psyche.</p>
<p>A 2021 Deloitte <a href="https://www2.deloitte.com/au/en/pages/technology-media-and-telecommunications/articles/digitalconsumertrends.html">survey</a> of Australians found 79% thought fake news was a problem, and only 18% felt information obtained via social media was trustworthy. Having to navigate content that deliberately aims to perpetuate fear and dissent only adds to people’s cognitive and emotional burden.</p>
<p>But here’s the rub. It seems while we’re generally concerned about technology having a negative impact on our well-being, this doesn’t translate to behaviour change on an individual level.</p>
<p>My own <a href="https://www.sciencedirect.com/science/article/abs/pii/S0747563221001710">research</a> published last year found more than two-thirds of survey participants believed excessive smartphone use can negatively impact well-being, yet individual usage was still very high, averaging 184 minutes per day. There was no relationship between the belief and the behaviour. </p>
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<strong>
Read more:
<a href="https://theconversation.com/the-privacy-paradox-we-claim-we-care-about-our-data-so-why-dont-our-actions-match-143354">The privacy paradox: we claim we care about our data, so why don't our actions match?</a>
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<p>What leads to this apparent cognitive-behavioural dissonance? The results of a long-term <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255648">study</a> by University of Amsterdam researchers might provide a clue. They found living in a “permanently online” world leads to decreased self-control over social media use and, subsequently, lower well-being. </p>
<p>In other words, we know what we’re doing might be bad for us, but we do it anyway.</p>
<h2>Simple steps you can take</h2>
<p>How do you know when it’s time to reevaluate your relationship with social media? There’s one deceptively simple question to ask yourself: how does it make you feel? </p>
<p>Think about how you feel before, during and after you use social media. If you feel like you’re wasting large chunks of your day, your week (or, dare I say, your life) on social media - that’s a clue. If you feel negative emotions such as sadness, anxiety, guilt or fear, you have your answer.</p>
<p>But if divorcing social media abruptly feels like a step too far, what else can you do to slowly break away, or potentially salvage the relationship? </p>
<p><strong>1. Start with a trial separation</strong></p>
<p>A “soft delete” lets you see how you’ll feel without your social media before committing to a hard delete. Let friends and family know you’re taking a break, remove the apps from your devices, and set yourself a goal of maybe one or two weeks where you don’t access the account/s. If the world is still turning at the end of this trial, keep going! Once you no longer feel the pull of social media, you’ll be ready to hit delete. </p>
<p><strong>2. Reduce the number of platforms you engage with</strong> </p>
<p>If you have Facebook, Instagram, Twitter, TikTok, YouTube, Snapchat, WhatsApp, Tumblr, Pinterest and Reddit on your phone, tablet and computer, you’re probably past saturation point and into drowning territory. Pick one or two apps that genuinely serve a meaningful purpose for you, and ditch the rest. Gen X’ers find it hard to say goodbye to Facebook, but Gen Zers in the US have largely <a href="https://www.theguardian.com/technology/2018/jun/01/facebook-teens-leaving-instagram-snapchat-study-user-numbers">bid it farewell</a>. If they can do it, so can you!</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-evidence-shows-half-of-australians-have-ditched-social-media-at-some-point-but-millennials-lag-behind-156128">New evidence shows half of Australians have ditched social media at some point, but millennials lag behind</a>
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</p>
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<p><strong>3. If steps 1 and 2 are still too much, try to reduce your time spent on social media</strong></p>
<p>First and foremost, turn off all your notifications (yes, all of them). If you’re conditioned to respond to every “bing”, you’ll find it almost impossible to stop. Set aside some time each day and do all your social media catching up or browsing. Set an alarm for your predetermined time allocation, and when it sounds, put the phone down until the same time tomorrow.</p>
<p>None of this will be easy, and walking away from social media might hurt at first. But if the relationship has become uncomfortable, or even abusive, it’s time to take a stand. And who knows what <a href="https://theconversation.com/a-month-at-sea-with-no-technology-taught-me-how-to-steal-my-life-back-from-my-phone-127501">untold happiness</a> you might find, beyond the four walls of your screen?</p>
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<figcaption><span class="caption">Failing to disconnect from social media can end up hurting more the alternative.</span></figcaption>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/does-social-media-make-us-more-or-less-lonely-depends-on-how-you-use-it-128468">Does social media make us more or less lonely? Depends on how you use it</a>
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<img src="https://counter.theconversation.com/content/176149/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharon Horwood 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>Social media does have some redeeming features – and its utility will depend on how you use it. But for many of us, the reward no longer outweighs the harms.Sharon Horwood, Senior lecturer in Psychology, Deakin UniversityLicensed 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>
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<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>
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<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">
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<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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</figure>
<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/1680222021-10-12T12:10:19Z2021-10-12T12:10:19ZKids and their computers: Several hours a day of screen time is OK, study suggests<figure><img src="https://images.theconversation.com/files/423404/original/file-20210927-21-1vuxvwk.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C5084%2C3382&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The findings are gleaned from the largest U.S. study ever done on the brain development of children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/native-american-boy-sitting-at-table-using-laptop-royalty-free-image/722210565?adppopup=true">Julien McRoberts via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Even when kids spend five hours a day on screen – whether computers, television or text – it doesn’t appear to be harmful. That’s what <a href="https://www.colorado.edu/ibg/katie-paulich">my colleagues and I</a> at the <a href="https://www.colorado.edu/ibg/">University of Colorado Boulder</a> discovered after analyzing data taken from nearly 12,000 participants in the <a href="https://abcdstudy.org/">Adolescent Brain Cognitive Development Study</a> – the largest long-term study of its kind ever in the U.S. </p>
<p>The participants included children between the ages of 9 to 10, from diverse backgrounds, income levels and ethnicities. We investigated how screen time was linked to some of the most critical aspects of their lives: <a href="https://doi.org/10.1016/j.smrv.2013.03.005">sleep</a>, <a href="https://doi.org/10.1146/annurev.ps.46.020195.001405">mental health</a>, <a href="https://doi.org/10.1111/j.1469-7610.1995.tb01657.x">behavior</a> and <a href="https://doi.org/10.1080/00223980.1979.9915094">friendships</a>. </p>
<p>Our results, recently published <a href="https://doi.org/10.1371/journal.pone.0256591">in the journal PLOS One</a>, found no association between screens and a child’s depression or anxiety. Greater amounts of screen time were associated with stronger peer relationships for both boys and girls – both have more male and female friends. Social screen use may drive that association; video gaming, for instance, is a social activity that seems to foster more friendships. So does social media and texting. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423427/original/file-20210927-21-7gh1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A mother and her young daughter together looking at the computer screen." src="https://images.theconversation.com/files/423427/original/file-20210927-21-7gh1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423427/original/file-20210927-21-7gh1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423427/original/file-20210927-21-7gh1y6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423427/original/file-20210927-21-7gh1y6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423427/original/file-20210927-21-7gh1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423427/original/file-20210927-21-7gh1y6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423427/original/file-20210927-21-7gh1y6.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 parents are concerned their children spend too much time on screens.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/working-from-home-royalty-free-image/900841082?adppopup=true">Radovanovic96 via Getty Images</a></span>
</figcaption>
</figure>
<h2>Why it matters</h2>
<p>U.S. children <a href="https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/">are spending more time on screens</a> than ever before. <a href="https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/">Parents often worry</a> that the technology adversely impacts youngsters, particularly those entering adolescence – <a href="https://doi.org/10.1016/j.tics.2015.07.008">a critical period of development</a>. </p>
<h2>What still isn’t known</h2>
<p><a href="https://doi.org/10.1371/journal.pone.0256591">Our study also found</a> negative correlations: More screen time predicted higher levels of attention problems, worse sleep, poorer academic performance and an increase in aggression and misbehavior. </p>
<p>Taken at face value, these contrasting positive and negative correlations are confusing. Is screen time good or bad? </p>
<p>Perhaps neither one: When looking at the strength of the correlations, we see only very modest associations. That is, any association between screen time and the various outcomes, whether good or bad, is so small it’s unlikely to be important at a clinical level. </p>
<p>Some kids scored lower than others on these outcomes, some scored higher; screen time only explained 2% of the difference in the scores. This suggests the differences are explained by many variables, not just screen time. It’s a very small piece of a much larger picture.</p>
<p>[<em>Over 115,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>Also, our study is correlational rather than causal. Correlational research shows that two seemingly related variables don’t necessarily generate changes in each other. Causal research implies that one variable did cause a direct change in the other.</p>
<p>For example, we found that adolescents who spend more time on screens may display more symptoms of aggression. But we can’t say screen time causes the symptoms; instead, maybe more aggressive children are given screen devices as an attempt <a href="https://doi.org/10.1186/1471-2458-10-593">to distract them</a> and calm their behavior.</p>
<p>The bottom line: While parents should make sure their children are using screens in appropriate ways, our early research suggests lengthy time on screen is not likely to yield dire consequences. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423410/original/file-20210927-25-7pta6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two young boys at school share a class assignment on a laptop." src="https://images.theconversation.com/files/423410/original/file-20210927-25-7pta6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423410/original/file-20210927-25-7pta6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423410/original/file-20210927-25-7pta6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423410/original/file-20210927-25-7pta6c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423410/original/file-20210927-25-7pta6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423410/original/file-20210927-25-7pta6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423410/original/file-20210927-25-7pta6c.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">The findings show that screen time may strengthen relationships between peers.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/schoolwork-royalty-free-image/1212710002?adppopup=true">Marko Geber/Digital Vision via Getty Images</a></span>
</figcaption>
</figure>
<h2>What’s next</h2>
<p>Currently, there is no established threshold for an “acceptable” amount of screen time. While <a href="https://www.apa.org/monitor/2020/04/cover-kids-screens">guidelines do exist</a> for younger kids, nothing official has been set for adolescents.</p>
<p>Additionally, our study did not include academic screen use, only recreational. So it was impossible to compare academic versus recreational screen use outcomes. </p>
<p>The ABCD Study will follow these children until they are 20 years old. Future research may examine how screen time might affect children over the course of their entire adolescence, when it’s possible more symptoms of mental health concerns will show. For the moment, however, only one thing is certain: Screens are here to stay.</p><img src="https://counter.theconversation.com/content/168022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Paulich 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>New data suggests that lots of time on screens may even improve peer relationships. But the study comes with caveats.Katie Paulich, PhD Student in Psychology, Neuroscience and Behavioral Genetics, University of Colorado BoulderLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1365762020-05-13T13:56:59Z2020-05-13T13:56:59ZCoronavirus: New technologies can help maintain mental health in times of crisis<figure><img src="https://images.theconversation.com/files/334717/original/file-20200513-156665-6i5lvj.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4623%2C2869&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are thousands of mobile phone applications to aid in mental health, but very few have been validated scientifically.</span> <span class="attribution"><span class="source">(Pexels)</span></span></figcaption></figure><p>Over the past few weeks, there has been a considerable and unprecedented increase in awareness of <a href="https://www.mentalhealthcommission.ca/English/news-article/13935/era-covid-19-mental-health-matters-more-ever">the importance of mental health</a>. In fact, no mental health awareness campaign has ever had as much impact as the one sparked by the COVID-19 crisis.</p>
<p>Nearly four billion people are confined to their homes, voluntarily or compulsorily, and are <a href="https://www.morneaushepell.com/ca-en/tips-coping-covid-19">more prone to stress</a>, anxiety, fear, sadness, frustration, irritability and anger. Government leaders talk about mental health almost every day at their news briefings.</p>
<p>“It’s normal to feel anxious or stressed,” Prime Minister Justin Trudeau said at one briefing, before thanking mental health professionals who provide services at a distance.</p>
<p>Two days earlier, Manitoba Premier Brian Pallister said he had <a href="https://www.cbc.ca/player/play/1716833859664">experienced several episodes of depression</a> in his lifetime.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/330483/original/file-20200425-163062-1xoqhe5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/330483/original/file-20200425-163062-1xoqhe5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/330483/original/file-20200425-163062-1xoqhe5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/330483/original/file-20200425-163062-1xoqhe5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/330483/original/file-20200425-163062-1xoqhe5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/330483/original/file-20200425-163062-1xoqhe5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/330483/original/file-20200425-163062-1xoqhe5.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">Manitoba Premier Brian Pallister has spoken about his own experiences with mental illness.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/John Woods</span></span>
</figcaption>
</figure>
<p>The social relevance of digital technologies in mental health has never seemed so great, whereas just a few weeks ago, e-mental health was a subject reserved for experts and technophiles.</p>
<p>Today, there is widespread mobilization to accelerate innovation and research in this field. This is evident by announcements from the <a href="https://news.gov.mb.ca/news/index.html">Government of Manitoba</a>, <a href="https://www.canada.ca/en/health-canada/news/2020/04/government-of-canada-connects-canadians-with-mental-wellness-supports-during-covid-190.html">the federal government</a> and the <a href="https://www.apa.org/news/press/releases/2020/03/mental-health-care-covid-19">American Psychological Association</a>. It’s unexpected, but it’s good news, because telepsychotherapy, for example, is lagging behind telemedicine.</p>
<h2>A young but promising field</h2>
<p>E-mental health is an area of research and intervention that emerged in the early 2000s. Telepsychotherapy is the best known form, but this field is vast and also includes access to medical information, co-ordination of care pathways, prevention and follow-up applications, self-care or mutual aid online. In short, everything that can be done with digital technologies to provide mental health care and information can be linked to <a href="https://www.cbc.ca/life/wellness/how-to-access-free-mental-health-and-emotional-support-during-the-covid-19-crisis-1.5519397">e-mental health</a>.</p>
<p>This does not mean replacing psychiatrists and psychologists with artificial intelligence systems, or abandoning face-to-face meetings for virtual consultations. Rather, the challenge is to harness the potential of digital technologies to improve access to care or effectiveness of treatment, particularly where conventional approaches are poorly accessible, failing, saturated or absent.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/334718/original/file-20200513-156675-165uxbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/334718/original/file-20200513-156675-165uxbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=801&fit=crop&dpr=1 600w, https://images.theconversation.com/files/334718/original/file-20200513-156675-165uxbr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=801&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/334718/original/file-20200513-156675-165uxbr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=801&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/334718/original/file-20200513-156675-165uxbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1006&fit=crop&dpr=1 754w, https://images.theconversation.com/files/334718/original/file-20200513-156675-165uxbr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1006&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/334718/original/file-20200513-156675-165uxbr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1006&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are digital mental health services designed to help manage stress and mood disorders.</span>
<span class="attribution"><span class="source">(Pexels)</span></span>
</figcaption>
</figure>
<p>As noted by the <a href="https://www.mentalhealthcommission.ca/English/what-we-do/e-mental-health">Mental Health Commission of Canada</a>, e-mental health services are a complementary solution to traditional care. For example, there are science-based digital services to detect and manage stress (<a href="https://apps.apple.com/ca/app/ismart/id1501355791">iSmart</a>), overcome insomnia (<a href="https://www.sleepio.com/">Sleepio</a>), support the self-management of mood disorders (<a href="https://allermieux.criusmm.net/">Aller mieux à ma façon</a>), or mitigate the impact of auditory hallucinations in schizophrenia through virtual reality (<a href="https://centreaxel.com/en/projects/avatars-and-virtual-reality/">Centre Axel</a>).</p>
<p>These types of digital mental health services offer novel non-pharmacological approaches, provided they are based — like those mentioned above — on proven research protocols.</p>
<h2>Issues of credibility and trust</h2>
<p>There are <a href="https://www.nature.com/news/mental-health-there-s-an-app-for-that-1.19694">thousands of mental health mobile phone applications</a> but very few have been scientifically validated. The supply is confusing and varied and the effectiveness of these applications is often difficult to evaluate. Added to this are <a href="https://doi.org/10.1016/j.invent.2018.12.001">concerns about privacy and security</a>, <a href="https://insights.ovid.com/crossref?an=00001504-201809000-00002">lack of availability</a> or <a href="https://mental.jmir.org/2019/1/e11334/">lack of information disseminated to the public</a>.</p>
<p>The capacity of new technologies to have a <a href="https://doi.org/10.3402/ejpt.v6.27882">large-scale impact</a> is very real, but it has not yet taken off. Very few e-mental health services meet the following four quality criteria: scientific validation, user experience, data privacy and security, and economic viability of the service.</p>
<p>For example, the mobile applications offered by <a href="https://medium.com/what-if-ventures/approaching-1-000-mental-health-startups-in-2020-d344c822f757">mental health start-ups</a> are often very user-experience oriented but have little scientific and ethical validation. Conversely, applications developed by clinical researchers are highly clinically and ethically relevant, but neglect user experience and commercialization.</p>
<h2>The teleconsultation issue</h2>
<p>The glaring lack of telemental health solutions specifically adapted to the practice of psychiatric care means the available telemedicine services will have to meet most of the demand, especially in the context of the COVID-19 crisis.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/330475/original/file-20200425-163077-15ik3hx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/330475/original/file-20200425-163077-15ik3hx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/330475/original/file-20200425-163077-15ik3hx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/330475/original/file-20200425-163077-15ik3hx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/330475/original/file-20200425-163077-15ik3hx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/330475/original/file-20200425-163077-15ik3hx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/330475/original/file-20200425-163077-15ik3hx.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">
<figcaption>
<span class="caption">There is a lack of telemental health solutions specifically adapted to psychiatric care.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>Psychologists or psychotherapists who wish to offer their services remotely have little choice but to use these generic telemedicine or videoconferencing services. In the absence of alternatives adapted to mental health, professional associations in the sector such as the <a href="https://www.apaservices.org/practice/business/technology/tech-column/telehealth-solutions">American Psychological Association</a> in the United States or the <a href="https://www.ordrepsy.qc.ca/coronavirus-covid-19-conseils-psychologiques-et-informations-au-grand-public">Ordre des psychologues du Québec</a> must rely on these. But telepsychotherapy is not telemedicine, and solutions specific to mental health are needed.</p>
<p>In a face-to-face consultation, in fact, psychologists’ offices do not resemble medical spaces at all. As my colleague Francis Levasseur has clearly shown, <a href="https://www.actualites.uqam.ca/2020/un-essai-instructif-et-divertissant-sur-les-bureaux-de-psychologues">psychologists’ offices are “relationship spaces</a>” that obey a particular style in the arrangement of furniture and objects.</p>
<p>This arrangement of space or design of place is fully part of the framework offered by psychologists and psychotherapists. What happens to it on a screen? How do you transpose the spirit of the practice into a digital interface? In terms of e-mental health, this is a major issue, which should not be trampled over in the urgency of the situation.</p>
<p>Psychotherapy is not only a treatment: it is also a user experience in which <a href="https://interactions.acm.org/archive/view/may-june-2015/beyond-interaction">technology plays a mediating role</a> between clinician and patient, whether online with screens and interfaces, or offline with the walls and purposefully arranged furniture.</p><img src="https://counter.theconversation.com/content/136576/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stéphane Vial ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The relevance of digital technologies in maintaining mental health has never been greater. However, many have not been scientifically proven and their effectiveness is unknown.Stéphane Vial, Professeur à l'École de design de l'UQAM. Chercheur au CR-IUSMM. Titulaire de la Chaire Diament, chaire de recherche stratégique en design pour la cybersanté mentale, Université du Québec à Montréal (UQAM)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1303712020-01-29T17:46:15Z2020-01-29T17:46:15ZFrom recognition to transformation: How digital technology can reduce mental illness stigma<figure><img src="https://images.theconversation.com/files/312559/original/file-20200129-92987-1k7r3xh.jpg?ixlib=rb-1.1.0&rect=1213%2C25%2C6003%2C3461&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Digital technology may help improve the effectiveness of anti-stigma education programs.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-holding-xray-human-brain-his-507958237">(Shutterstock)</a></span></figcaption></figure><p>When those with mental illness experience prejudice and discrimination in the form of stigma, it can make their suffering considerably worse. </p>
<p>Spreading awareness and understanding through education is one of the strategies used to tackle the problem. Years of public education campaigns have helped open the conversation. Yet evidence suggests that stigma against people with mental illness <a href="https://doi.org/10.1017/S1121189X00002669">remains a problem in our health-care system</a>.</p>
<p>Consider what the experience is like for a young person who seeks mental-health care. They may suffer for a long time before they eventually build up the courage to ask for help. When they share this with a family member or a friend, they may be encouraged to look for help, but encounter a <a href="https://doi.org/10.7870/cjcmh-2017-003">long waiting list</a> for treatment. Over time, they continue to struggle and things get worse. If they end up in crisis, they might need to seek emergency care. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.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">People seeking mental health care may face long waits for treatment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mental-health-concept-727793356">(Shutterstock)</a></span>
</figcaption>
</figure>
<p>The doctor, nurse or mental health professional they encounter is probably struggling within a challenging system. Health-care professionals work hard with limited resources, soaking up the suffering of others until they begin to <a href="https://psycnet.apa.org/doi/10.1037/a0030388">detach from their own humanity for self-protection</a>. They might appear rushed. They might seem distant. This can result in the patient feeling dismissed or feeling judged. </p>
<p>As a psychiatrist, I bear witness to a broken system. Mental-health care is chronically underfunded. If a parent has one child with diabetes and one with anxiety or depression and they seek help, the child with diabetes receives world-class care. The child with mental illness is given a sheet of paper and a <a href="https://www.cmho.org/news/6519906-28-000-kids-waiting-for-mental-health-services">12- to 18-month wait</a>.</p>
<h2>Encountering blame and shame</h2>
<p>As a stigma researcher, my team and I found that when individuals seek help for their mental illness in settings like hospitals or emergency departments, they frequently encounter blame and shame. We also found that many health professionals stigmatize without even <a href="http://dx.doi.org/10.1007/s40037-017-0333-5">being aware of it</a>.</p>
<p>We quickly learned that no matter how well-intentioned health professionals may be, they do not always intend to say what their patients and their families hear.</p>
<p><a href="https://link.springer.com/article/10.1007/s10459-018-9816-3">Stigma in health care is automatic</a>. It is embedded within the fabric of the system. Can we really expect training and workshops for health-care workers to solve the problem? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/bell-lets-talk-day-should-i-share-a-mental-health-story-130260">Bell Let's Talk Day: Should I share a mental health story?</a>
</strong>
</em>
</p>
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<p>One of the problems with existing stigma reduction education is that it’s delivered through in-class formats that <a href="https://www.cmaj.ca/content/168/6/710">are fairly one-dimensional</a>. Advances in digital and social media may have the potential to challenge traditional approaches to learning and provide real-time delivery of information to a huge audience. For example, medical journals that leverage social media have a much <a href="https://dx.doi.org/10.1503%2Fcmaj.150976">greater impact</a> than those that do not. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Social media can be an effective way to keep health professionals up to date.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/silhouette-man-carrying-large-hashtag-made-291168752">(Shutterstock)</a></span>
</figcaption>
</figure>
<p>Hashtag campaigns on social media are another example. Instead of educating people about mental illness in a classroom, a viral social media post can inspire a social movement. Digital tools like social media, blogs and wikis <a href="https://dx.doi.org/10.1186%2F1472-6920-6-41">provide knowledge</a> for health professionals who can use this technology to learn about a topic while deepening their engagement and promoting collaboration. </p>
<p>Research shows that social media is an <a href="https://doi.org/10.2196/jmir.2138">effective and efficient way</a> to keep health professionals up to date with the latest knowledge to improve the quality of health care for their patients. </p>
<h2>Sharing stigma-reduction tools</h2>
<p>Digital technology also makes stigma-reduction education freely available to everyone. By putting knowledge about stigma in the hands of <a href="https://doi.org/10.1097/j.pain.0000000000001327">patients and caregivers</a>, technology democratizes expertise. </p>
<p>An example of the power of digital technology to improve health care can be found in pediatric pain research. Led by clinical psychologist, Dr. Christine Chambers, #itdoesnthavetohurt is a science-media partnership that brings evidence-based information about children’s pain directly to parents.</p>
<p>Chambers found that numerous eHealth tools for pain assessment and management are developed, yet have a reduced impact because they are rarely made available to <a href="https://doi.org/10.1097/PR9.0000000000000686">patients and families</a>. She and her team targeted their digital strategy directly at caregivers, whom they empowered with knowledge on best practices for managing pediatric pain.</p>
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<a href="https://theconversation.com/is-my-child-depressed-being-moody-isnt-a-mental-illness-92789">Is my child depressed? Being moody isn't a mental illness</a>
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<p>Chambers’s work is a good example of how including the patient (or, in this case, the caregiver) in the solution can improve results. Digital technologies, including social media platforms, provide opportunities <a href="https://link.springer.com/article/10.1186/s13012-017-0696-3">to include</a> people affected by mental health stigma in new solutions to address it. </p>
<p>As stigma researchers, my team and I recognize the potential value in providing stigma-reducing tools directly to patients and caregivers, as well as to the health professionals those tools are targeting. Bringing those groups together may provide better ways to tackle the stigmatizing practices and policies that still exist in health care.</p><img src="https://counter.theconversation.com/content/130371/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Javeed Sukhera receives funding from Associated Medical Services, the Academic Medical Organization of Southwestern Ontario, and Physician Services Incorporated.</span></em></p>People seeking mental health care still encounter stigma, even within the health system. New tools for teaching and sharing information may help address it.Javeed Sukhera, Associate professor, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1302602020-01-26T13:15:28Z2020-01-26T13:15:28ZBell Let’s Talk Day: Should I share a mental health story?<figure><img src="https://images.theconversation.com/files/311623/original/file-20200123-162228-1vkr9yv.jpg?ixlib=rb-1.1.0&rect=291%2C119%2C4520%2C2574&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Everyone has a different reason for sharing a mental health story.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p><a href="https://letstalk.bell.ca/en/">Bell Let’s Talk Day</a> has become an opportunity for individuals to share their personal mental health stories, and for organizations to raise awareness about mental health and mental illness. </p>
<p>As an anti-stigma advocate, <a href="https://youtu.be/ruxiJ_6_28Y">storyteller</a> and researcher, I am inspired by the people who share their personal stories, and by those <a href="https://www.thestar.com/opinion/contributors/2019/01/30/how-bells-lets-talk-campaign-harms-people-it-aims-to-help.html">who call on corporations like Bell to do more for people living with mental illness</a>. </p>
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<p>My <a href="https://ir.lib.uwo.ca/etd/4051/">PhD research investigated why and how youth living with mental illness decide to share their personal mental health story</a> to teach about mental health and reduce the stigma of mental illness. For some, a mental health story represents a day in the life of a person who lives with a mental illness. For others, a mental health story is a moment in time when an individual struggled with their mental health. </p>
<p>This Bell Let’s Talk Day, you might be part of an organization, business or community that is considering creating space for people to share their personal mental health stories. When done well, it has the potential to be a community-building experience that promotes mental health awareness in your milieu. If this is your goal, here are some questions for you to ask — and answer — before you get started.</p>
<h2>Decreasing stigma</h2>
<p>Sharing a mental health story can be a powerful way to <a href="https://doi.org/10.1176/appi.ps.201700478">decrease the stigma of mental illness</a>, but it’s not the only way. </p>
<p>Spend some time with the leadership in your organization exploring and agreeing on why sharing mental health stories is the right approach now. Consult with people who have expertise in best practices for <a href="https://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-12-120">mental health education through story sharing and personal experience</a> and who advocate for employee rights, including the right to privacy. </p>
<p>Seek feedback on how you can ask for contributions from storytellers without anyone feeling compelled to participate. </p>
<p>Lean into difficult conversations about any potential impacts on the storyteller, and articulate how the organization will avoid discriminating against people who agree to share their mental health story.</p>
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<img alt="" src="https://images.theconversation.com/files/311629/original/file-20200123-162221-1ojlyv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/311629/original/file-20200123-162221-1ojlyv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/311629/original/file-20200123-162221-1ojlyv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/311629/original/file-20200123-162221-1ojlyv8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/311629/original/file-20200123-162221-1ojlyv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=541&fit=crop&dpr=1 754w, https://images.theconversation.com/files/311629/original/file-20200123-162221-1ojlyv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=541&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/311629/original/file-20200123-162221-1ojlyv8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=541&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">Where will the story be shared, and for how long?</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<h2>How will you honour the storyteller?</h2>
<p>When you and the storyteller freely agree to share their mental health story, you enter into a relationship that must be governed by respect and reciprocity. It’s important to engage in a frank dialogue with the storyteller about how your organization might benefit from that person’s story. </p>
<p>If you can imagine a financial or public relations benefit from including this person’s story, how will you pass on those benefits to the storyteller?</p>
<p>Set aside time to communicate and agree on mutual expectations and parameters on how the organization or community will share the story. For example, where will you share it and for how long? If you’ll share on social media, determine precisely where it will be shared and who can access it. If the storyteller later changes their mind and wants to withdraw their story, what will you do?</p>
<p>The moments, days and weeks after someone shares their story with a community can feel like an emotional rollercoaster. The youth who participated in my research explained these mixed emotions to me. </p>
<p>On one hand, it can feel incredibly liberating for the storyteller to finally share their story in the way they intended. <a href="https://doi.org/10.1177%2F1049732316673581">At the same time</a>, it can also be distressing to relive moments of great struggle, deal with ignorant feedback and questions, or absorb the difficult stories of others who feel compelled to share their own experiences.</p>
<h2>Supports needed</h2>
<p>If you are part of a community or organization that is sharing a mental health story on behalf of someone who has freely consented to participate, ask the storyteller what kind of supports they may need during and after their story is shared. </p>
<p>People listening to or reading the mental health story you’ve shared might need mental health support too. When you prepare a list of mental health resources to accompany the story, go the extra mile to understand what happens when the person calls that number or approaches that service. </p>
<p>For example, is the resource an information service or does it also provide direct counselling? Is there a cost to the service? What languages and culturally relevant approaches are available? If the person needs more support than what’s available at that resource, what’s their next step?</p>
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<img alt="" src="https://images.theconversation.com/files/311632/original/file-20200123-162190-17ruw74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/311632/original/file-20200123-162190-17ruw74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/311632/original/file-20200123-162190-17ruw74.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/311632/original/file-20200123-162190-17ruw74.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/311632/original/file-20200123-162190-17ruw74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/311632/original/file-20200123-162190-17ruw74.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/311632/original/file-20200123-162190-17ruw74.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&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">After asking someone to share, have supports available.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<h2>Why that storyteller, and why their story?</h2>
<p>You — or the organization you represent — may have different goals than the storyteller who has given you permission to share their story. It’s important to spend time understanding what I call “the why.”</p>
<p>Everyone has a different reason for sharing a mental health story. For the storyteller, <a href="http://dx.doi.org/10.1037/ort0000250">the reasons for sharing can change every time they tell it</a>. Many people with lived experience have already had their personal story shared in a way or at a time they didn’t predict or intend. In my case, I shared my mental health story for the first time out of necessity, to access the support I needed.</p>
<p>Work with the storyteller to understand on a deeper level why they have shared their story with your organization, and how they want it to be used. </p>
<h2>How will you honour the story?</h2>
<p>People with mental illness want to tell the truth about their lived experience. The truth includes moments of suffering and discrimination, but also many moments of strength and resilience. How will you present their mental health <a href="https://doi.org/10.1177%2F0018726717716752">story in a way that doesn’t increase stigma towards the storyteller or the mental illness</a> described? </p>
<p>In what ways is the story being shared congruent with your organizational brand and the experience of people who are members of your organization? If a person sharing their story about living with mental illness was part of your organization, how would their mental health be supported? What barriers might they encounter? </p>
<p>How does your organization plan to address systemic gaps for people with mental illness as you also work to increase mental health awareness?</p>
<p>Being gifted with the story of someone’s lived experience is a privilege.</p>
<p>This Bell Let’s Talk Day, let’s commit to honouring that gift. It’s priceless.</p><img src="https://counter.theconversation.com/content/130260/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melanie-Anne Atkins works for Western University. Her PhD research was supported by Western University Faculty of Education's Alberta O'Neill Ontario Graduate Scholarship in 2016.</span></em></p>Here’s what you need to know before you share your mental health story, or ask others to share.Melanie-Anne Atkins, Educational Developer, Centre for Teaching and Learning, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1113572019-03-04T18:58:36Z2019-03-04T18:58:36ZOnline therapies can improve mental health, and there are no barriers to accessing them<figure><img src="https://images.theconversation.com/files/261582/original/file-20190301-22864-alqk3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Digital approaches mean people can access therapies from their own home.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>In recent weeks, the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSReviewTaskforce">Medicare Benefits Schedule Review Tasforce’s</a> Mental Health Reference Group published its <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/58EFEA022C2B7C49CA2583960083C4EA/$File/v2-MHRG%20Final%20Report.pdf">report and recommendations</a>, part of a wide-ranging review of services subsidised by Medicare.</p>
<p>They recommended a massive expansion of the $1.5 billion <a href="http://www.health.gov.au/mentalhealth-betteraccess">Better Access</a> program, which enables Medicare-subsidised visits to psychologists and other health professionals.</p>
<p>But simply striving to get more people into face-to-face care with health professionals is a limited and expensive strategy. </p>
<p>If we’re serious about improving access to mental health care, we need to look to online therapies. The evidence says they <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2604310">can be effective</a> instead of, or as well as, seeing someone face-to-face.</p>
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Read more:
<a href="https://theconversation.com/for-people-at-risk-of-mental-illness-having-access-to-treatment-early-can-help-111429">For people at risk of mental illness, having access to treatment early can help</a>
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<h2>Digital approaches to mental health care</h2>
<p>Some studies have found online therapy to be <a href="https://www.ncbi.nlm.nih.gov/pubmed/25273302">as effective</a> in reducing symptoms as therapy delivered face-to-face by a clinician. This evidence is strongest in relation to <a href="https://www.ncbi.nlm.nih.gov/books/NBK76016/">depression, stress and anxiety</a>. </p>
<p>One meta-analysis of data from <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2604310">3,876 adults</a> found those who underwent internet-based cognitive behavioural therapy to treat symptoms of depression had better outcomes than those who didn’t use online therapies. They were also more likely to stick to their treatment.</p>
<p>So self-guided internet-based cognitive behavioural therapy is a viable alternative to current first-step treatment approaches for symptoms of depression and anxiety. </p>
<p>Online approaches vary, but they commonly present a course of psychological therapy structured so the participant can track their progress over time and seek further assistance if their situation deteriorates.</p>
<p>As an example, <a href="https://mindspot.org.au/">Mindspot</a> offers a three step online process of therapy, beginning with information, followed by assessment, and finally, treatment.</p>
<p>Treatment consists of online courses across several areas, depending on the user’s needs. These courses might cover mood issues, obsessive compulsive disorder, and post-traumatic stress disorder. </p>
<p>People can elect to do a course independently, or could be referred by a health care professional, such as their GP. When health practitioners refer their patients into Mindspot they receive patient progress reports.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/261855/original/file-20190304-110134-145iznu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/261855/original/file-20190304-110134-145iznu.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=203&fit=crop&dpr=1 600w, https://images.theconversation.com/files/261855/original/file-20190304-110134-145iznu.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=203&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/261855/original/file-20190304-110134-145iznu.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=203&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/261855/original/file-20190304-110134-145iznu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=255&fit=crop&dpr=1 754w, https://images.theconversation.com/files/261855/original/file-20190304-110134-145iznu.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=255&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/261855/original/file-20190304-110134-145iznu.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=255&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">Mindspot takes users through a three step process which starts with learning about mental health.</span>
<span class="attribution"><span class="source">Screenshot</span>, <span class="license">Author provided</span></span>
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<p>These online therapies can be critical for reaching traditionally under-serviced groups, such as <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0119895">young people</a> and people living in <a href="https://ruralhealth.org.au/sites/default/files/publications/nrha-factsheet-mental-health_0.pdf">rural areas</a>.</p>
<p>Other key advantages of these stand-alone digital approaches include 24/7 availability of care, and the absence of the fees that would otherwise be paid out-of-pocket for a face-to-face consultation.</p>
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Read more:
<a href="https://theconversation.com/is-online-therapy-as-good-as-talking-face-to-face-with-a-clinician-51492">Is online therapy as good as talking face-to-face with a clinician?</a>
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<p>The range of online mental health tools available has expanded enormously over recent years. This has spawned <a href="https://beacon.anu.edu.au/">review sites</a> that help users navigate to online mental health therapies that best meet their needs.</p>
<p>And new research is looking at how digital technologies can be used for the prevention of mental illness as well as its treatment. The Black Dog Institute’s <a href="https://www.blackdoginstitute.org.au/news/news-detail/2019/01/02/big-things-ahead-for-mental-health-research-in-2019">Future Proofing Study</a> will engage 20,000 year 8 students to see how they can use their smartphones to prevent anxiety and depression.</p>
<h2>We can facilitate team-based care online</h2>
<p>Perhaps the greatest opportunity for enhanced mental health service delivery is to start to use digital technologies to drive new models of care specifically designed to meet the needs of each individual.</p>
<p>For people with more complex, disabling and persisting conditions, the <a href="https://www.ncbi.nlm.nih.gov/books/NBK19830/">international evidence</a> clearly indicates bringing together a team of professionals is best practice.</p>
<p>For example, a person with an eating disorder is likely to benefit from integrated, multidisciplinary care provided by a GP, a nurse, a dietitian, a psychologist, a peer worker, and so on. </p>
<p>There are already some efforts to foster this online. An example of this can be found in the <a href="https://www.innowell.org/project-synergy">InnoWell platform</a>, which service providers can use to bring together different professionals and resources tailored to suit each patient’s needs. </p>
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<img alt="" src="https://images.theconversation.com/files/261818/original/file-20190304-110119-1gekiks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/261818/original/file-20190304-110119-1gekiks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/261818/original/file-20190304-110119-1gekiks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/261818/original/file-20190304-110119-1gekiks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/261818/original/file-20190304-110119-1gekiks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/261818/original/file-20190304-110119-1gekiks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/261818/original/file-20190304-110119-1gekiks.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">As well as online therapies, there are a variety of mobile apps that target mental health and well-being.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>Using online assessment tools at the point of service request, those with milder needs are connected to a range of evidence-based apps and e-tools matched to their needs. Meanwhile, those with more complex needs are connected to care which will benefit them, including face-to-face services.</p>
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Read more:
<a href="https://theconversation.com/does-more-mental-health-treatment-and-less-stigma-produce-better-mental-health-72141">Does more mental health treatment and less stigma produce better mental health?</a>
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<p>As a proportion of the total, new clients into Better Access were <a href="https://www.aph.gov.au/%7E/media/Committees/clac_ctte/estimates/add_1011/doha/243.pdf">68% in 2008, 57% in 2009</a>, and just <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2019/health/mental-health-management">32.6%</a> in 2016-17. This increase in repeat customers suggests two things. First, perhaps people did not get the help they needed or had problems too complex to be managed within the program. And second, there may be limits on the extent to which the program can continue to meet its stated goal of increasing access to mental health services.</p>
<p>While the Medicare review relegated online therapies to “longer-term” reform, new digital and team-based approaches are key to driving improved models of increased access, at relatively low individual cost, to high quality mental health care.</p>
<p>Australia’s <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-e-emstrat">e-Mental health strategy</a> needs action. The Medicare review into mental health represents a significant opportunity to get future investments right. </p>
<p>This means shifting from a focus just on access to instead considering how best to provide high quality, individualised services at scale – particularly to those who are disadvantaged economically, socially or geographically.</p><img src="https://counter.theconversation.com/content/111357/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Hickie is the chief scientific advisor and a 5% equity shareholder at InnoWell Pty Ltd. InnoWell has been formed by the University of Sydney to administer the $30 million Australian government-funded Project Synergy.</span></em></p><p class="fine-print"><em><span>Sebastian Rosenberg 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>Online therapies for mental health can be as effective as talking therapies. If we want to expand access to mental health care, it’s important we embrace digital approaches.Sebastian Rosenberg, Fellow, Centre for Mental Health Research, Australian National UniversityIan Hickie, Professor of Psychiatry, University of SydneyLicensed as Creative Commons – attribution, no derivatives.