Seventy-five per cent of mental illness begins before 25 years of age, with one in five young people (children and adolescents) diagnosed with a mental health problem.1 Yet, Australian data indicate that only 29% of those affected contact a professional service of any type.2 Given the poor prognosis for adolescents and adults with untreated psychiatric symptoms, these low rates of access and treatment are particularly disturbing.3,4
The Internet is increasingly becoming a support of choice for young people, with research demonstrating that young people actively seek health information and referrals through the Internet and online discussion groups,5 including accessing sensitive information on AIDS, birth control and mental health issues.6
In Australia, a recent convenience survey of over 8000 young people aged 15–24 years found that, after family and friends, young people turn to the Internet for support; it is preferred to telephone helplines, individuals in the community (eg, doctors, ministers), community agencies, and teachers or school counsellors.7
The Internet represents great potential for delivering mental health support and services to large populations. Recent research suggests that the Internet supports social networks and existing social connections, both online and offline,8 and it can support increased community participation9 and increase the likelihood of help seeking.8 One advantage of being online is that young people are more confident talking about sensitive or embarrassing issues.10
Reach Out! (http://www.reachout.com.au) is a web-based service for young people aged 16–25 years. Its aim is to improve the mental health and wellbeing of young Australians by enhancing mental health literacy, increasing resilience, and facilitating help-seeking. Young people have been directly involved in the development and delivery of the service.11 It consists of five components (Box).
Over 70% of 15–24-year-olds seeking health information online want to know that it has come from a credible source.6 Reach Out! has a database of over 290 fact sheets developed by professionals using evidence-based content, and reworded by young people to ensure that the “voice” resonates with young people. The information most commonly sought is about depression.
Young people require a “space” that is safe and supportive, where they can interact and share their experiences with others.12 Reach Out! staff, with advice from clinicians, supervise a peer-moderated online forum. Thematic analysis and longitudinal tracking of forum users, measuring mental health literacy and help-seeking, will determine if participation results in attitude change and an increase in access to service providers.
Among teens, 72% of males, and 48% of females play video games either online or on consoles.13 Reach Out! Central (ROC), based on the principles of cognitive behaviour therapy, uses gaming technology to engage young people. It appeals through its interactivity, colourful aesthetic, use of popular music, ease of use, and overall gaming fun. Young people who have used the ROC prototype rate it as helpful (92% males and 97% females; n = 224). A planned randomised controlled trial, funded by beyondblue: the National Depression Initiative, will determine the effectiveness and impact of games on mental health.
Young people look to the Internet to express themselves creatively and to document and share personal experiences.14 Twenty per cent keep a blog and nearly 40% read a blog,15 while 61% of young people aged 13–17 years have a profile on a social networking site.16 Reach Out! builds on these trends through social networking and digital storytelling.
Young people are increasingly looking for ways to access and transport digital content. Two popular trends, podcasting and short message service (SMS),17,18 have been included on Reach Out!.
It has made me realise that I’m definitely not the only person that goes through the same things as me . . . no matter how “weird”, or whatever, it may seem. It was also the reason that I decided to finally go and get counselling . . . if it wasn’t for RO, there is no way on earth I would even think of doing such a thing (male, age 22).
As a clinical psychologist working with young people, I find the Reach Out! forums a very useful resource. In my experience, the forums can provide a very useful adjunct to counselling and therapy and also offer further assistance options for those who may otherwise have limited access (eg, due to geographical isolation) (Louise Rémond, Clinical Psychologist, Health Psychology Unit, University of Technology, Sydney).
Practical tips for making young people aware of Reach Out!
Print fact sheets and stories for young people or direct them to http://www.reachout.com.au
Promote http://www.reachout.com.au as a resource for young people through postcards, stickers and posters available from the Inspire Foundation
Register your interest at infoATreachoutpro.com.au to become involved in a network of professionals working with young people
Reach Out! executes integrated marketing campaigns, including online, print, radio, television, and outdoor advertising using pro-bono partnerships. Advertising is aimed directly at young people, using language, imagery, and concepts that they respond to. A network of young volunteers reviews concepts before they are implemented.11 A community sample of 300 young people indicated that 30% of young Australians are aware of Reach Out!.
The Internet is a medium that forms part of young people’s everyday lives, and mental health professionals should recognise the explosive growth of social networking websites, such as MySpace and Facebook, and the role they play in young people’s lives. It can service unlimited numbers simultaneously and offers the added benefits of anonymity and continuous availability. Reach Out! costs less than $1 per visit. This compares with about $150 per hour for face-to-face counselling sessions, and between $19.87 and $58.89 to deliver telecounselling to one person.19
Reach Out! has gained credibility with young people as a result of its meaningful youth participation program.11 It embraces youth culture, having a presence in environments that young people associate with fun and aspirations. Youth brand and media partners, such as Triple J, MySpace, Jay Jays, General Pants, Coca-Cola and Schoolies, and inspirational website content make Reach Out! a space where young people feel comfortable, increasing their likelihood of turning to it when they need help. It is closely aligned with the needs, interests and language of today’s young people and delivers evidence-based content in a non-threatening and non-patronising way.
To reduce depression in young people, we must develop new ways of promoting access to help. Reach Out! is a valuable community resource and fits well with our national moves to reduce the burden of mental health problems among young Australians (Professor Ian Hickie, Executive Director, Brain and Mind Research Institute, Sydney).
Reach Out! Pro (http://www.reachoutpro.com.au) is a new website which provides GPs, psychologists, psychiatrists, allied health professionals and educators with information and tools. Community consultation is currently underway, but it is expected that this information will include how young people use Reach Out!, and will also provide suggestions for how professionals can incorporate Reach Out! into their work with young people to achieve better and more sustained mental health outcomes.
- Jane Burns1
- Carolyn Morey2
- Alexandra Lagelée3
- Anna Mackenzie4
- Jonathan Nicholas5
- The Inspire Foundation, Sydney, NSW.
We acknowledge the young people and mental health professionals who have worked with the Inspire team and given freely of their time to help create the Reach Out! website. Reach Out! is a program of the Inspire Foundation (http://www.inspire.org.au), a national charity that uses the Internet and related technologies to improve the mental health of young people.
None identified.
- 1. Kendall PC, Kessler RC. The impact of childhood psychopathology interventions on subsequent substance abuse: policy implications, comments, and recommendations. J Consult Clin Psychol 2002; 70: 1303-1306.
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- 6. Rideout V. Generation Rx.com: how young people use the internet for health information. Menlo Park, Calif: Henry J. Kaiser Family Foundation, 2001. http://www.kff.org/entmedia/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13719 (accessed Oct 2006).
- 7. Mission Australia. National survey of young Australians: key emerging issues. Melbourne: Mission Australia, 2006. http://www.missionaustralia.com.au/cm/resources/documents/National%20Youth%20Survey%202006.pdf (accessed Oct 2006).
- 8. Boase J, Horrigan JB, Wellman B, Rainie L. The strength of Internet ties: the Internet and email aids users in maintaining their social networks and provide pathways to help when people face big decisions. Washington, DC: Pew Internet and American Life Project, 2006. http://www.pewinternet.org/pdfs/PIP_Internet_ties.pdf (accessed Jul 2006).
- 9. Kraut R, Patterson M, Lundmark V, et al. Internet paradox: a social technology that reduces social involvement and psychological well being. Am Psychol 1998; 53 : 1017-1031.
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- 13. Magazine Publishers of America. Engagement: understanding consumers’ relationships with media. A resource for advertisers, agencies, marketing and media professionals. New York: Magazine Publishers of America, 2006. http://www.magazine.org/advertising_and_pib/engagementguide.pdf (accessed Aug 2007).
- 14. Lenhart A, Fox S. Bloggers: a portrait of the internet’s new storytellers. Washington, DC: Pew Internet and American Life Project, 2006. http://www.pewinternet.org/pdfs/PIP%20Bloggers%20Report% 20July%2019% 202006.pdf (accessed Oct 2006).
- 15. Lenhart A, Madden M. Teen content creators and consumers. Washington, DC: Pew Internet and American Life Project, 2005. http://www.pewinternet.org/pdfs/PIP_Teens_Content_Creation.pdf (accessed October 2006).
- 16. National Center for Missing and Exploited Children. New research reveals risky internet behavior among teens, but there are encouraging signs of improvement with increased involvement of parents and guardians [press release]. Atlanta, Ga: NCMEC, 2006. http://www.missingkids.com/missingkids/servlet/NewsEventServlet?LanguageCountry=en_US&PageId=3166 (accessed Jul 2007).
- 17. Madden M. Podcast downloading. Washington, DC: Pew Internet and American Life Project, 2005. http://www.pewinternet.org/pdfs/PIP_podcasting.pdf (accessed Oct 2006).
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Abstract
With 75% of mental illness beginning before 25 years of age, it is essential that we improve young people’s capacity to manage adversity and increase their opportunities for accessing professional help.
With its unique ability to connect people to information and to other people, the Internet offers opportunities to engage the 70% of young people with mental health problems who currently are not seeking professional help.
Reach Out! is a national Internet-based mental health service for young people. It has been accessed by over 6 million users since its launch in 1998.
Reach Out! plays a role in the prevention of mental health problems by:
facilitating help-seeking and connecting young people with services, such as general practitioners, and allied and mental health professionals in their local communities; and
providing opportunities for all young people to develop the skills and capacity to better understand mental health difficulties and manage adversity, thereby complementing traditional support.