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.
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.
It is great that the articles are not condescending (they don’t talk down to young people with the “I’m an adult I know best” tone). Its asset as a site is that it covers a wide range of issues (male, age 18).
I have a 15-year-old son who is currently quite depressed, and, although [he is] on medication and seeing a psychiatrist, I was looking for other resources, especially plain and simple facts and useful information to encourage him to participate more in his recovery. He is resisting help, and I wanted something that I could encourage him to use at home in a less threatening environment (his view not mine). I have printed out several fact sheets and signed up for the newsletter. I wish I had discovered this site a LONG time ago (female, age 44).
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.
I know personally that for me it is much easier to open up [on the online discussion forums], because it is at my own pace and at a level I’m comfortable with. I’ve always had difficulty talking, and this is sorta a place which is helping me to “open up” (male, age 17).
I think the forums have had a very positive effect on my mental health. As I’ve said, I’ve had nothing but good experiences on the forum, which is certainly uplifting. It’s also nice to just get other perspectives on things. Sometimes you wonder just how big of a wacko you are until you to start to realise that there are other people on the same page as you with regards to certain issues (male, age 25).
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.
I think [ROC] is a good idea and it is more appealing than plain text. It is also a good idea, as some people may be afraid of seeking help (male, age 19).
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.
In unsolicited online feedback, young people say that Reach Out! helps them understand their difficulties. This includes accepting that they might need professional help, understanding how mental health services work, and finding the courage to seek help face-to-face or over the telephone.
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).
Thank you so much for your help. I have signed up with the counsellor at our school and she is really helping me deal with it. It’s good to know that a lot of other people are in similar situations as myself and I am not alone (female, age 16).
I’ve been hurt a lot, done a lot of stupid things, etc, but RO has really helped. I didn’t realise it at the time, but every time I read a fact sheet or a story I was recognising my illness. RO led me to call KHL [Kids Help Line] and get help. Thanks guys (female, age 17).
My psychiatrist told me about it. I’m a 17-year-old gal with bipolar disorder. When things get hard, it’s nice to have a little “escape” place. I can just look at the stories, read articles, and realise there are people who care out there. Then I shoot my anger away in the rocket, send a dream and get on with life. Often, coming here has just tipped me over the ledge onto the grassy side and prevented me from taking my life. Thank you (female, age 17).
Online profiling of 1432 young people conducted in 2006 shows that, of those surveyed, 37% visit Reach Out! once a week or more, and one in three stays on the site for 20 minutes or longer. Seventy-five per cent said they would return to the site if going through “tough times”, and 80% said they would refer it to a friend. When repeat visitors were asked if they had sought help after visiting Reach Out!, 38% said they had spoken to a mental health professional.
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!.
MySpace is one of the most successful and fastest-growing websites for young people worldwide, with 113 million global users and 1.5 million members in Australia within 3 months of its launch. Using viral marketing techniques (marketing techniques that use pre-existing social networks), it is possible to reach young people who may be at risk of mental health difficulties. Reach Out! maintains an interactive MySpace page that young people become “friends” with. The Reach Out! profile on MySpace was created in August 2006 and has more than 5000 “friends”.
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.
Reach Out! is in a unique position to reduce the stigma associated with mental health problems, to increase help-seeking behaviour, and to raise awareness of available support. Leveraging its marketing campaigns and partnerships with youth brands, Reach Out! aims to connect more young people with local service providers. It offers an opportunity, firstly, for young people to take their first steps towards accessing professional mental health support and, secondly, for community services, such as general practitioners, health centres and clinicians, to more effectively engage with young people.
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.
The major challenge for successful mental health reform will be for key organisations, service providers and professionals to collaborate to create a culture that reduces stigma and facilitates early help-seeking by young people. Services will not only need to attract young people, but also engage them over a period of time to ensure continuity of treatment. To do so, they will need to be relevant and responsive to young people’s needs and preferences.
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