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Presentation delivered by A/Prof Frances Kay Lambkin at #digfestival 16 October 2014. Follow-up directly for more information.
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Associate Professor Frances Kay-Lambkin PhDNational Health and Medical Research Council Research Fellow
It’s worth a try…Integrating technology into the treatment of mental health and addictive disorders
Global eHealth Research & Innovation Cluster, UoN
The mental health of
Australians
NSMHWB (2007)
Comorbidity is the rule◉ 25-50% of people experience comorbidity– >1 mental disorder
– One mental disorder and 1+ physical conditions
◉ Every year, approx. 340,000 Australians experience the combination of a mental health and alcohol/other drug problem– Excluding tobacco alone
– Increasing by approx. 10% annuallyAIHW (2012) Comorbidity of mental disorders & physical conditions
Sacks et al. (2013) J Substance Ab Treat, 44: 48-493Rush (2007) Am J Psychiatry, 164(2): 201-204
Treatment access is poor◉ In Australia, the proportion of adults with
current mental health problems using traditional services has not increased:– 38% in 1997 vs. 35% in 2007.
– Physical disorders = 80%.
◉ Despite government initiatives– Estimated annual investment $3.2 billion.
– Australia – BOiMHC – 10 sessions with psychologist.
Australian Bureau of Statistics (2008). ABS Cat No. 4326.0
Christensen & Hickie (2010). Medical J Aust 192(11): S53-S56.
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)
How do we overcome these barriers?
The potential of e-health to respond...◉ E-health = rapidly expanding field of health
information and communication technology.
◉ Widespread recognition within health sector that better use of e-health initiatives should play a critical role in improving the healthcare system.
◉ Increasing acceptance for individuals to take a more active role in protecting their health and participating in their own health care.
Access to technology…bridging the digital divide Gen
PopMild Dep
Mod-Sev Dep
Risky Drink
Harmful Drink
Psychosis PTSD + AOD
Mobile 44% 34% 37% 46% 41% 34% 34%
Mobile with Internet 22% 23% 30% 21% 41% 30% 48%
Internet 84% 84% 79% 87% 100% 65% 66%
Gen Pop=General Population (N=894) – no MH/AOD Mild Dep=PHQ-9 score 5-9 (N=188) Mod-Sev Dep=PHQ-9 score ≥ 10 (N=67) Risky Drink=AUDIT score 8-15 (N=135) Harmful Drink=AUDIT score ≥ 16 (N=22) Psychosis=Current diagnosis (N=115) PTSD+AOD=Current AOD treatment (N=29)
Previous use of the Internet for…
Gen Pop
Mild Dep
Mod-Sev Dep
Risky Drink
Harmful Drink
Psychosis PTSD + AOD
Mental Health
9% 19% 39% 12% 27% 18% 17%
AOD 2% 6% 5% 2% 32% 7% 31%
Gen Pop=General Population (N=894) – no MH/AOD Mild Dep=PHQ-9 score 5-9 (N=188 Mod-Sev Dep=PHQ-9 score ≥ 10 (N=67 Risky Drink=AUDIT score 8-15 (N=135) Harmful Drink=AUDIT score ≥ 16 (N=22) Psychosis=Current diagnosis (N=115) PTSD+AOD=Current AOD treatment (N=29)
Potential of eHealth in comorbidity
Individual determinants Structural determinants
•Mental health literacy •Support systems
•Attitudes to services •Referral pathways
•Attitudes to conditions •Payment systems
•Perceived stigma •Geographical isolation
•Time commitments •Lack of relevant services
•Reliance on self
(Barker, et al., 2005; Rickwood, et al., 2007)
Does eHealth deliver for comorbidity?
• Self-Help for Alcohol/other drugs and DEpression
• 10 modules of CBT/MI and mindfulness– Behavioural activation– Managing thoughts– Problem solving– Drink/drug refusal– Coping with cravings– Relapse prevention
SHADE (www.shadetreatment.com)
iTreAD (www.itread.com.au)
• Online monthly monitoring• 4 sessions of CBT for
depression and binge drinking– Challenging thoughts– Behavioural activation– Coping with cravings
• Online social networking
• Serious game for depression and alcohol misuse– See links between mood
and drinking
• Pilot testing underway– Engagement of young
people– Effective in translating key
CBT messages to real life
SHADoW
Will eHealth overcome attitudinal barriers?◉ Will populations with addictive disorders,
who are typically low-treatment seeking access eHealth to support their concerns?– ?pride, ?fear of stigma, ?manage on their own
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)
SHADE study◉ No differences in therapeutic alliance or treatment
satisfaction for therapist-delivered versus SHADE treatment.
◉ No relationship between treatment preference and retention, alliance or perceptions.
◉ If no preference, significantly greater benefit for alcohol use from SHADE.
◉ Content and modality of SHADE delivery acceptable
• “Helped me take more control in my life”
Kay-Lambkin et al. (2012), J Dual Diagnosis 8(4):262-276
The vital piece in the puzzle….us!What concerns people about eHealth?
◉ Sample with psychosis
– Trust, credibility, accuracy of information
– Privacy concerns
– Impersonal
◉ Sample of General Population excl. psychosis
– Reliability and accuracy of information
– Confidentiality and anonymity
– ImpersonalCarroll & Rounsaville (2010) Current Psychiatry Reports 12: 426-
432Kay-Lambkin et al. (2011) BMC Public Health 11:277
How might we address this*?◉ Website/Promotion/Champion
– Provide evidence for efficacy– Expertise of developers– Transparency of sponsorship of site, ownership and
authorship of content– Last updated information– Quality seal of approval– Recommended by peers/family/professionals/other sites
◉ Internet treatment a useful step within a larger therapeutic process
◉ Appropriate marketing in non-Internet environments*Kay-Lambkin et al. (2011) BMC Public Health 11:277)
Klein et al. (2010) JMIR12 (5): e51p1-e51p12
Acknowledgements◉ Amanda Baker◉ Maree Teesson◉ David Kavanagh◉ Brian Kelly◉ Terry Lewin◉ Vaughan Carr
Funding◉ AERF◉ NHMRC◉ DoHA
Institutions