Current and Future Trends in Internet-Supported Mental Health Interventions

Despite growing research in the past two decades involving Internet-supported or online mental health interventions, there has been only a few attempts to provide a synthesis of the research findings and future trends. The Internet has grown exponentially during this time, providing greater access to a wider population than ever before. Consequently, online mental health interventions have the potential to be cost-effective, convenient, and reach a more diverse population than traditional, face-to-face interventions. This paper reviews and summarizes the current research for online mental health interventions and discusses future trends. These interventions range from psychoeducational static webpages and complex, personalized, interactive cognitive-behavioral-based self-help programs, to videoconferencing, self-help support groups, blogging, and professional-led online therapy. Future trends in online interventions include the greater prevalence of online therapy and the use of video chat and videoconferencing technologies to enhance and extend the therapeutic relationship. The use of texting or short message service (SMS), mobile communications, smart phone applications, gaming, and virtual worlds extends the intervention paradigm into new environments not always previously considered as intervention opportunities. We find that there is strong evidence to support the effective use and future development of a variety of online mental health applications.     

Interactive Health Communication Technologies in the Public Health Sector: Positive Perceptions Still Outpace Actual Utilization

ABSTRACT

Effective population-based and patient-centered public health care is highly dependent on timely and reliable health-related information. The continuous growth and availability of health-related information brought about by the emergence of a new digital communications environment offers a range of opportunities that facilitate access to useful health information for the public health sector–for providers as well as patients. Such advancements, however, can only be realized if public health professionals are knowledgeable about existing sources of online health information, have the ability to successfully judge the reliability of online health information, and are able to acquire the information in a timely and efficient manner. This research follows on the heels of a survey of public health professionals in New York State that concluded that limited access and knowledge negatively impacted utilization of interactive health communication technologies. In this study, a survey was administered to providers at a large county health department located in central Michigan. Results indicate that perceptions regarding the advantages of online health information still far outweigh actual utilization. Barriers to actual utilization include lack of easy access to computers with high-speed connections, trusted and timely online information, training and staff development issues, and organizational policies concerning computer access and usage.     

Mental Health Professionals' Exposure to Clients with Problematic Internet Experiences

ABSTRACT

This paper examines clients' exposure to problematic Internet experiences among a national sample of 2,098 social workers, psychologists, marriage and family therapists, and other mental health professionals. This analysis finds that mental health professionals are working with clients experiencing a range of problems related to Internet use. However, these professionals have generally not been exposed to training or information in the professional literature on the topic of working with clients with problematic Internet experiences. We identify several areas in which additional training is needed and review practical implications for mental health professionals.     

Youth Sexual Exploitation on the Internet: DSM-IV Diagnoses and Gender Differences in Co-occurring Mental Health Issues

This paper explores conventional (non-Internet-related) mental health issues and DSM-IV diagnoses seen among a sample of 512 youth receiving mental health services for an Internet-related problem, with particular attention to victims of online sexual exploitation. Youth victims of online sexual exploitation were more likely to have a post-traumatic stress disorder than youth with other Internet-related problems. Specific attention was given to differences among subgroups of female and male youth victims of online sexual exploitation as compared with same-gender youth with other Internet-related problems. Findings suggest the importance of including Internet use and victimization as part of a standard clinical assessment.     

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.     

Information Systems and Mental Health Services

Summary

This paper examines issues related to applying information technology in behalf of mental health service delivery systems. Each of these issues has an impact on how well information technology has been able to serve the mental health system. These are not primarily information technology issues. They are concerns that have to do with the structure of the mental health system; the way management might use an information system; and the role of money and power in the mental health system. How these issues are resolved will have a major impact on how well the promise inherent in information technology is realized in the coming decade.     

Chapter 4. Older Latinos and Mental Health Services

SUMMARY

This article discusses the biopsychosocial and spiritual aspects related to older Latinos' use of mental health care. It also addresses the environment that older Latinos have to navigate to access mental health services. Structural barriers to mental health services are emphasized as critical to a holistic assessment of the client's situation.     

The Family Experience of the Crisis of Involuntary Treatment in Mental Health

While policy and practice standards emphasise the importance of engaging and supporting families of people with mental health problems, many families have reported feeling unsupported and distanced from treatment and care planning in acute inpatient units. There has been little systematic interest in the changing role and experiences of families throughout the emergence of illness, crisis, seeking of treatment, and subsequent recovery. Nineteen in-depth interviews were conducted with the next of kin of 17 people who had been admitted under an Involuntary Treatment Order in a large metropolitan hospital in the Brisbane region. A general inductive approach was used to analyse the data. While hospital admission was described as a time where, ideally, families were able to let go of being responsible for their relative's behaviour and let the health care professionals take over, for many this did not occur. We suggest four critical elements for providing recovery-oriented support to families. These include: (a) ensuring that families feel that their relative is safe and receiving the care needed; (b) keeping the family informed about their relative's progress; (c) ensuring families have access to information about the mental health system, and (d) working in partnership with the families.

IMPLICATIONS

• Family wellbeing is improved when they feel part of a supportive team.

• Instituting an open policy where families can contact ward staff easily and access information about the person they care for may alleviate families’ anxieties and minimise stress.

• Family work is enhanced when health professionals acknowledge families’ relationships, expertise, and understanding of their family member.

     

What is the role of e-technology in mental health services and psychiatric research?

In this article, the role of e-technology is explored, with an emphasis on the advantages and disadvantages of its use for health care and mental health research. E-technology is broadly understood to include the Internet and related information technologies, and in recent years, its use has grown rapidly. The Internet is a major source of health information, and there is potential to deliver enhanced services through this medium. In addition, e-technology's role in future mental health service delivery and research will continue to expand as increased numbers of consumers, caregivers, health professionals, and the general population go online, particularly as the technology is refined and made even more user friendly.     

Adolescents Seeking Mental Health Services

Summary

Inner-city adolescents receiving mental health services often get inadequate medical care. However, when those who seek counseling are asked about their health concerns, they say they want to discuss them with their therapists. Based on responses to a clinical self-assessment questionnaire (Adquest), adolescent mental health clients reported sleep difficulties, weight and eating concerns, and frequent headaches and stomachaches. Age and gender differences in patterns of vulnerability and willingness to talk were explored.     

Barriers and Facilitators of Responding to Problem Gambling: Perspectives from Australian Mental Health Services

Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.     

Asian Americans and Mental Health Services

Abstract

Research in the 1970s and 1980s revealed that Asian Americans, compared with other ethnic groups, tended to under-utilize mental health services. This article is aimed at adding new information to the literature by examining data from the 1990s. The raw data comprised 97,212 total admissions representing 45,774 total individuals utilizing mental health services during a four-year period in San Diego County, California. By comparing our findings with previous research cases on utilization patterns of mental health services, new evidence is found about Asian Americans in terms of their (1) underrepresentation in mental health services, (2) presentation of more severe symptoms than those of other racial/ethnic groups when first seen at clinics, (3) lower dropout rates and higher average lengths of stay than other racial/ethnic groups, and (4) higher percentages of using day treatment and outpatient programs but lower percentage of using inpatient programs.     

Mental Health and Online,Land-Based and Mixed Gamblers

Although high rates of problem gambling have been identified among Internet gamblers, most studies have failed to identify the relative contribution of multiple forms of gambling as opposed to the exclusive participation in online forms. The aim of this study was to investigate differences in mental health status in exclusive online, exclusive land-based, and mixed Internet and land-based samples of gamblers drawn from the general population. A sample of 4594 respondents completing an online survey were categorised as exclusive online, land-based and mixed form gamblers. Participants completed a questionnaire eliciting demographic details, participation on all forms of gambling, use of alcohol, tobacco and drugs, help-seeking, and personal problems experienced due to gambling, as well as measures of problem gambling and psychological distress. Findings indicated that mixed gamblers exhibited higher problem gambling scores, level of gambling involvement, and consumption of alcohol during gambling than exclusive online gamblers. Land-based gamblers experienced higher levels of psychological distress, self-acknowledged need for treatment, and help-seeking behaviour. These findings suggest that exclusive online gamblers represent a different subpopulation at lower risk of harm compared to gamblers engaging in multiple forms. Understanding the characteristics of different problem gambling subpopulations may inform the development of more effective targeted interventions.     

Global Mental Health in Action: Reducing Disparities One Community at a Time

There are great disparities in mental health care around the world. Traditional approaches to mental health care have not been found to be transferrable to many parts of the world and are inadequate to address these disparities. Unconventional approaches are needed that match the traditions of care‐seeking and care‐giving within the communities where they are delivered. The authors review the global mental health literature and discuss how marriage and family therapists are in a particularly good position to have worldwide impact on mental health disparities. Five principles of global mental health are presented along with an example of how these principles are applied through the Reducing Mental Health Disparities One Community at a Time (RD1CT) model.     

The Evolution of Mental Health Care Policy and the Implications for Social Work

Abstract

The focus of this article is on the evolution of mental health care policy in the United States from the eighteenth century to the present. To the extent that social work practice enacts policy, this article focuses particularly on the ways 20th century social workers have reflected, interpreted, and forged mental health care initiatives and reforms. The article includes a discussion of how the cycles of mental health reform (moral treatment, mental hygiene, and community mental health) have influenced not only the roles but also the actual practices of social workers. The article concludes with a consideration of the impact of managed care on mental health policy and the implications for social work.     

Divorce Disclosures and Adolescents' Physical and Mental Health and Parental Relationship Quality

Two studies were constructed to examine the associations between custodial parents' negative disclosures about the other parent after a divorce and parent–adolescent relational quality (closeness and satisfaction) and adolescents' physical and mental health. In general, the results suggested that even though negative disclosures about the other parent might be associated with more cohesive relationships between custodial parents and adolescents, it does not mean that adolescents are immune to the physical and psychological effects of such disclosures. In Study 2, negative disclosures about the other parent were associated with adolescents' increased reports of physical and mental health symptoms. The results revealed a similar effect for general divorce information and adolescents' mental health. However, there was no association for catharsis and adolescents' physical and mental health. The results from both studies also revealed that adolescents perceived that their custodial parents disclosed more negative information about the other parent than the parents perceived that they disclosed.     

Homelessness and Children's Use of Mental Health Services: A Population-Based Study

This study examined whether children who become homeless differ from other low-income children in their mental health service use before and after their first homeless episode, and to what extent homelessness is associated with an increased likelihood of mental health service use. Differences between children with and without new onset of sheltered homelessness in the use of mental health services emerged following homelessness and widened over time. Sheltered homelessness and foster care placement history were associated with increased odds of receiving inpatient and ambulatory mental health services. Findings underscore the importance of collaborations between homeless assistance, foster care, and mental healthcare in efforts to mitigate family homelessness and collateral needs among homeless children.     

Digital Na(t)ives? Variation in Internet Skills and Uses among Members of the “Net Generation”*

People who have grown up with digital media are often assumed to be universally savvy with information and communication technologies. Such assumptions are rarely grounded in empirical evidence, however. This article draws on unique data with information about a diverse group of young adults’ Internet uses and skills to suggest that even when controlling for Internet access and experiences, people differ in their online abilities and activities. Additionally, findings suggest that Internet know‐how is not randomly distributed among the population, rather, higher levels of parental education, being a male, and being white or Asian American are associated with higher levels of Web‐use skill. These user characteristics are also related to the extent to which young adults engage in diverse types of online activities. Moreover, skill itself is positively associated with types of uses. Overall, these findings suggest that even when controlling for basic Internet access, among a group of young adults, socioeconomic status is an important predictor of how people are incorporating the Web into their everyday lives with those from more privileged backgrounds using it in more informed ways for a larger number of activities.     

Scientifically supported mental health intervention in schools: meeting accountability demands with an online resource

Legislation has been passed that holds schools increasingly accountable for the proficiency of all students, including those with mental health problems. A critical obstacle impeding the ability of schools to effectively support students is the lack of access to quick, pre-screened, and organized information about scientifically-supported interventions that effectively address youth mental health problems. A new mental health best practices database was developed and made available online that provides access to free and user-friendly information about evidence-based interventions for use in schools. School staff will be better able to meet accountability demands of legislation and to effectively respond to student mental health problems.