Integration eHealth tools into the treatment of mental health and alcohol/other drug use problemsAn overview of work at the CBMHR

Frances Kay-Lambkin PhDNational Health and Medical Research Council Senior Research Fellow

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The mental health of Australians

NSMHWB (2007)

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In Australia, the proportion of adults with current mental disorders (incl. substance use disorder) using traditional services has not increased:

o 38% in 1997 vs. 35% in 2007.o Physical disorders = 80%.

Despite government initiativeso Estimated annual investment $3.2 billion.o Australia – BOiMHC – 10 sessions with psychologist.

Treatment access is poor

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Treatment for alcohol disorders?

0.00

0.25

0.50

0.75

1.00

0 20 40 60Years Since Onset

Abuse Dependence

Cumulative Probability of Treatment Contact

14 years

23 years

• On average, Australians seek treatment 18 years after onset

• Lifetime treatment rate is 34.6%• Current treatment coverage is 11%

Alcohol Dependence

Alcohol Abuse

Chapman et al. (in submission)Andrews et al. (2004) British Journal of Psychiatry 184: 526-533

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Why don’t people seek treatment?

Individual determinants

Structural determinants

•Mental health literacy •Support systems

•Attitudes to services •Referral pathways

•Attitudes to conditions •Payment systems

•Perceived stigma •Geographical isolation

•Time commitments •Lack of relevant services

•Reliance on self (Barker, et al., 2005; Rickwood, et al., 2007)

Australian Institute of Health and Welfare (2008)

“Increased health care service demands, costs and complexities are already

testing the limits of the financial, physical and human resources of the Australian

Health System...These challenges will not be solved by doing more of the same,

particularly given the limits of available human and financial resources...”

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How do we overcome these barriers?

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E-health = rapidly expanding field of health information and communication technology.Widespread recognition within health sector that better use of e-health initiatives should play a critical role in improving the healthcare system.Increasing acceptance for individuals to take a more active role in protecting their health and participating in their own health care.

The potential of e-health to respond...

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Access to technology

Gen Pop Mild Dep Mod-Sev Dep Risky Drink Harmful Drink Psychosis PTSD + AOD0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mobile Mobile with InternetInternet

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Does eHealth deliver for mental health and alochol/other drug use problems?

Self-Help for Alcohol/other drugs and DEpression10 modules of CBT/MI and mindfulness

o Behavioural activationo Managing thoughtso Problem solvingo Drink/drug refusalo Coping with cravingso Relapse prevention

SHADE (www.shadetreatment.com)

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Serious game for depression and alcohol misuse

o See links between mood and drinking

Pilot testing underwayo Engagement of young peopleo Effective in translating key

CBT messages to real life

SHADoW

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Funded by the Commonwealth Department of Health and Ageing (AUSTRALIA)Adapt face-to-face ATS interventionsRandomised controlled trial

Breaking the Ice…

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Will populations with addictive disorders, who are typically low-treatment seeking access eHealth to support their concerns?

o ?pride, ?fear of stigma, ?manage on their own

Will eHealth overcome attitudinal barriers?

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What do the end users think?• One client who presented with ongoing depression and alcohol

dependence has logged on 663 times in 28 days (23 times a day).

• Even clients who don’t post very often are logging in and “lurking” • “I just wanted to thank you having been around. I know your research

project is coming to an end for me, and I haven't been specially active on this platform (if at all!) - but I went through some very dark times last year and it's been good knowing you were around, receiving sporadic emails from iTreAD and knowing I could reach out to you if needed.”

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Consider using the Internet…Gen Pop

Mild Dep Mod-Sev Dep

Risky Drink

Harmful Drink

Psychosis PTSD + AOD

M Health Treatment

17% 28% 39% 21% 45% 33% 55%

AOD Treatment 7% 10% 7% 11% 36% 20% 62%

Gen Pop=General Population (N=894) – no MH/AOD Mild Dep=PHQ-9 score 5-9 (N=188 Mod-Sev Dep=PHQ-9 score ≥ 10 (N=67 Risky Drink=AUDIT score 8-15 (N=135) Harmful Drink=AUDIT score ≥ 16 (N=22) Psychosis=Current diagnosis (N=115) PTSD+AOD=Current AOD treatment (N=29)

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SHADE study◉ No differences in therapeutic alliance or treatment

satisfaction for therapist-delivered versus SHADE treatment.

◉ No relationship between treatment preference and retention, alliance or perceptions.

◉ If no preference, significantly greater benefit for alcohol use from SHADE.

◉ If high on perfectionism, better outcomes for depression and alcohol use from SHADE.

Kay-Lambkin et al. (2012), J Dual Diagnosis 8(4):262-276

Kavanagh, D (2014) Six reasons to integrate e-health into psychological practice. InPscyh. June, 2014

“There is a quiet revolution going on. E-health is rapidly changing

psychology practice, just as it is affecting every other area of our

lives. It is a revolution that is here to stay. It presents challenges for

psychological training and practice, but we need not be afraid. If we fully embrace e-health’s opportunities, we

can offer the community a level of service and everyday support that has

never before been possible”

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Acknowledgements

CollaboratorsAmanda BakerMaree TeessonDavid KavanaghBrian KellyTerry LewinVaughan Carr

Global eHealth Research &

Innovation Cluster, UoN

f.kaylambkin@unsw.edu.au @FranKayLamb

FundingAERFNHMRCHMRIDoHA