Thursday 23 November 2017

The internet has its place in managing mental health - but be cautious

picture posed by model
picture posed by model

Patricia Casey

The internet has revolutionised how we learn about and view illness. For better or worse, the information about all aspects of health and disease is enormous, and available at the touch of a button, whether we are on the bus, sitting in our car in traffic, or at home in front of our fire. In the UK, almost half of all adults search for health information online, almost treble the figure in 2007.

The information available online takes several forms: there are scientific articles; articles written by non-professionals; and personal narratives. There are also non-traditional approaches, such as videos of various operations and procedures. There is also access to various online therapies - particularly in the area of mental health.

Cognitive and behavioural treatment manuals can be easily downloaded. Some may be used with the assistance of a therapist online (manualised assisted therapy) while others are self-help in style, where the user follows the steps in the manual but without any back-up assistance.

There are quality concerns about all of these approaches and users might find it impossible to differentiate what is professional and evidence-based and what is not.

Some of my patients have expressed concern that particular websites might be harmful. For example, a pro-anorexia (pro-ana) website which encourages young people to limit their diet and promote the anorectic look. Others, such as self-harm chat rooms, may promote self-harm by normalising the behaviour. Some have been implicated in high-profile suicides.

Because of the diversity and approach of these websites, the public - seeking authoritative and helpful information - might be misinformed, and even harmed.

A further aspect is the personal support that some chat rooms might provide. Those who suffer with illness sometimes feel that their doctors do not fully understand their personal experiences. Others just want to hear about the experiences of others with the same illness, and their coping strategies. This too is a mixed bag of positive and negative advice, but there is evidence that peer support does help in reducing mental distress symptoms.

One of the most reliable and informative mental health/illness websites is that which is provided by the London-based Royal College of Psychiatrists (rcpsych.ac.uk). However, this site just provides written information and, as yet, does not have a user chat room.

An initiative that has been in operation since the late 1990s is healthtalk.org. This was started by two doctors, Ann McPherson and Andrew Herxheimer in Oxford, after both had been given medical diagnoses.

They decided that they wanted to hear about the lived experiences of those who had similar diagnoses, and so, set up this peer support site. It quickly changed into recorded interviews with other patients rather than written accounts, and it also combined research information, delivered in plain language, for the readers.

Recently, the site has added a mental health section and there is now a collection of 12 mental health interviews.

Most are on depression, including the experience of taking medication, on changing medication, the effect on young people and so on.

There is also a section on self-harm from a parental perspective, minority experience of mental health issues, the experience of those with psychosis, and a section on eating disorders.

The edited recordings were made in several English-speaking countries. The interviews on the experience of psychosis were used by the National Institute for Health and Care Excellence (NICE) when compiling its guidelines on the experience of people using adult mental health services in the NHS. According to a recent article, published in the Psychiatric Bulletin (Kidd and Ziebland October 2015), around five million people visited the website in 2015.

The website deals also with physical conditions such as stroke, various cancers, asthma, but half of the visitors were seeking mental health information.

The site is very user-friendly and resting alongside rcpsych.ac.uk, the two should be a huge asset to those with mental health problems.

Hopefully healthtalk.org will expand the conditions and treatments covered in the coming months and years. These sites are not an alternative to professional treatment. Providing education and peer support is an advantage for those who wish to avail of these facilities whether or not they are in treatment.

Information, provided it is accurate, is empowering and - having viewed both websites - I cannot recommend them highly enough.

We have nothing comparable to healthtalk.org in this country, but that should not defer us from using the best that is produced by our nearest neighbour.

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