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Tips for integrating digital mental health into clinical practice

In late 2020, I was lucky enough to start in a new role at The Clinical Research Unit for Anxiety & Depression (CRUfAD) at St Vincent’s Hospital Sydney. This was the year in which there were many challenges and barriers to accessing mental health care, as we all faced the extreme uncertainty of the COVID-19 pandemic.

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Working as a Clinical Psychologist, I was often hearing from clients, colleagues, and noted from my own personal experience, how the already difficult-to-access mental health system was becoming increasingly over-burdened, unaffordable, and felt out of reach for many.

 

Starting in my role at CRUfAD, I was introduced to their digital mental health platform known at THIS WAY UP. I had experience using mental health apps and psychoeducational online resources with clients previously, however THIS WAY UP’s Cognitive Behaviour Therapy programs, and their flexible use in practice with clients, was a game-changer. Digital mental health has become particularly helpful in providing people with access to evidence-based treatment during times of financial hardship, and when face-to-face treatment has been a challenge, if not impossible, due to the COVID-19 pandemic.

 

One very important message to keep in mind, is that digital mental health interventions are not aiming to replace face-to-face treatment, but are an equally effective treatment option available. Like all interventions and treatment modalities, treatment approach is determined by the individual needs of the client. However, it is also important to consider how access to evidence-based digital mental health interventions have been able to meet the needs of many by providing more affordable, accessible therapy that can meaningfully improve quality of life and mental wellness. 

 

In working at the Anxiety Disorders Clinic within CRUfAD, as well as in private practice, I have seen digital mental health programs benefit many clients. The key to this, as with any intervention, is recommending a digital mental health intervention when this is appropriate for the individual, and when they are motivated and eager to engage with it. Many of these factors are also influenced by the clinician’s familiarity with and confidence in the online intervention, as well as how they introduce it to their client. 

 

In my experience, there have been some common challenges in using digital mental health interventions, as well as many benefits. These are highlighted in more detail below, including some tips that have helped me to integrate digital mental health as a new tool in my own clinical practice:

 

Common challenges

  • Lack of uptake

Sometimes after having recommended a digital mental health intervention to a client, they haven’t then engaged with it. Digital mental health simply isn’t for everyone, for a number of reasons. Among these reasons may be that the person is seeking a face-to-face therapeutic relationship, that they require a higher level of support, that they aren’t interested, or perhaps don’t feel comfortable with online mental health programs. At other times, they may have simply forgotten about the online program, such as other home-based practice tasks that we often set during sessions. It can be worth gently checking in to remind your client “How did you go with the online course?” or “Did you have any questions about it, or trouble getting started?” If you can help them with these barriers, that’s fantastic. At the same time, accepting that perhaps it isn’t the best treatment fit is also a good learning experience.

 

  • Responding to scepticism

A common challenge when introducing an online program to clients can be managing an initially sceptical response, which is very understandable. As with any concern or uncertainty raised by a client, it is best to lean in to their questions with a genuine curiosity. Thank your client for sharing their concerns and scepticism, and together unpack what these concerns are. Common concerns may be issues regarding privacy when using an online program, worries that the program will be ineffective, and fear of the unknown. As their clinician, you are best placed to validate initial reactions that can arise, and provide your client with accurate information about the online program you are recommending, so that they can make an informed decision. It helps to know ahead of time how to answer questions regarding privacy, treatment efficacy of the program, and have a good understanding of what your client can expect if they get started with a digital mental health intervention.

Useful tips

  • Familiarity with the intervention

As with any other treatment skill, intervention, or therapeutic modality, it’s essential as a clinician to understand what the intervention entails, and match this to the individual client’s clinical needs. Ensuring you are recommending only evidence-based digital mental health interventions is key. Try out the resource yourself first – this helps to familiarise yourself with the platform, find out what’s helpful about it, and to assist you in being able to discuss and introduce the intervention to your client(s). The more clients you support through an online program, the more confident you become at knowing how to help them use digital mental health programs and apply the skills to their day to day life.

 

  • Formulation and treatment fit

Be clear about the person’s individual clinical formulation and needs. If the person is presenting with complex, severe mental health symptoms, regular face-to-face sessions in a multidisciplinary team environment is likely to be most helpful. If the person is presenting with depression, anxiety, or sleep issues, which aspects need to be targeted in treatment following your formulation? And how might a CBT-based digital mental health intervention help them to overcome these challenges? If they are motivated to learn practical skills to help reduce their symptoms, a digital mental health intervention could be a good treatment-fit., either as a stand-alone treatment or in conjunction with face to face sessions to reinforce the concepts and skills being taught.

 

  • Providing flexible options

Digital mental health tools can be used at different phases of treatment. For example, providing access to online CBT courses whilst a client is on a waitlist for face-to-face therapy can really help them to understand their difficulties, and start to experience symptom reduction rather than symptom increase during the waitlist period.

 

I have found that digital mental health interventions have significantly strengthened treatment outcomes, as a built-in ‘practice’ for clients to complete between sessions. For example, if  the client is learning practical skills (e.g., thought challenging, relaxation techniques, graded exposure tips) outside of face-to-face or telehealth sessions, this can  create space during individual sessions to focus on interpersonal challenges, identity issues, and other complex stressors that may benefit more directly from space within the therapeutic relationship.

 

For individuals who are struggling to access mental health support, digital mental health interventions can make the world of difference. Particularly for clients who live in rural and remote areas who may not have access to a mental health service within their area. Providing them with the option to engage in affordable, evidence-based treatment online is both necessary, and a powerful step forward.

 

These are just a few of the tips I have found helpful in understanding digital mental health, and learning how to effectively integrate this into my own ‘therapy toolkit’.

 

If you have found these tips useful, and would like to learn more about THIS WAY UP, please don’t hesitate to contact our team to learn more, or reach out to me in my role whereby I can offer clinician-to-clinician support.

 

Contact details: [email protected]

THIS WAY UP website: www.thiswayup.org.au

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Katie Dobinson

Katie Dobinson has recently joined the team at THIS WAY UP as a Clinical Psychologist. A major focus of Katie’s role is to support clinicians interested in using digital mental health treatments to augment care in the community.

Katie is here to provide clinician-to-clinician support for your THIS WAY UP clinic questions. Whether you’re wondering how THIS WAY UP might be beneficial to your clinical practice, have any questions about course suitability for your client/patient(s), or would like to talk through CBT course content.

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