Digital tools for mental health

Dr Terry Fleming develops and studies digital tools designed to support mental health and wellbeing.

Dr Terry Fleming stands before a poster that includes the text 'Faculty of Health, Te Wāhanga Tātai Hauora' and a graphic of a crowd of people.

New Zealand faces increasing demand for mental health and wellbeing services. This reflects both an increase in expressed demand (more people asking for help) and an apparent increase in anxiety, depression, and distress. New Zealand mental health services are funded to address the needs of around 3 percent of the population, yet more than 10 percent of teenagers have significant signs of depression and more than 15 percent reported serious thoughts of suicide in the past year. This is an urgent issue that is attracting enormous public interest and government attention.

There is no one answer to improving mental health. Some people will benefit from talking therapies or medications, others from improvements in sleep, exercise, or life balance. Prevention is important, with action needed to reduce inequality, housing unaffordability, job insecurity, and rates of violence and abuse. Alongside these efforts, digital mental health tools form part of the solution.

Digital mental health tools are online or computerised programs, platforms, and apps designed to support mental health or wellbeing. They range from commercial products (such as Calm, an app offering meditation and ‘sleep stories for grown ups’), to the use of virtual reality for phobias and visual-processing games to reduce intrusive hallucinations. Some such tools are accessed by tens of thousands of people each month. Some have been tested in rigorous trials; others have no, or limited, research support.

I worked for many years as a clinical social worker, developing and delivering youth health and mental health services, mainly in South Auckland. Engaging young people with high needs in support services came with major challenges. Around the same time, in my role as a parent of teenage boys, one phrase was on high rotation: ‘Time to get off the computer.’ I thought there must be something we could use in this online thing.

With colleagues in Auckland, I co-created SPARX, a computerised therapy for adolescents with depression. It uses a virtual guide and a game-like format where users can learn and practise skills in a non-threatening, yet responsive, environment. In one of the larger trials of digital treatment for teenagers in the world, we found SPARX to be equivalent to treatment as usual. The SPARX therapy is publicly available, funded though the Ministry of Health, and now has a life of its own, with a Nunavut development in Canada, a gender diverse version, an augmented reality version proposed in Japan, and trials around the world.

Early in 2018, I joined the University as a senior lecturer in the new School of Health. My research is in scalable approaches to improving mental health and wellbeing, including via digital approaches. I’m working with national and international groups on digital mental health projects, including a Digital Futures project with staff and the input of students from Engineering, Health, and Psychology.

As a clinician and as a bioware (human), I would never propose that digital tools should replace human support. However, they can be available at 3 am, provide an inroad to getting help (for example, by demystifying therapy) and offer alternative approaches for those who prefer them.