Anthony Venning

Participatory Research as One Piece of the Puzzle: A Systematic Review of Consumer Involvement in Design of Technology-Based Youth Mental Health and Well-Being Interventions

Background Despite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth. Objective To investigate consumer involvement processes and associated outcomes from studies using participatory methods in development of technology-based mental health and well-being interventions for youth. Methods Fifteen electronic databases, using both resource-specific subject headings and text words, were searched describing 2 broad concepts-participatory research and mental health/illness. Grey literature was accessed via Google Advanced search, and relevant conference Web sites and reference lists were also searched. A first screening of titles/abstracts eliminated irrelevant citations and documents. The remaining citations were screened by a second reviewer. Full text articles were double screened. All projects employing participatory research processes in development and/or design of (ICT/digital) technology-based youth mental health and well-being interventions were included. No date restrictions were applied; English language only. Data on consumer involvement, research and design process, and outcomes were extracted via framework analysis. Results A total of 6210 studies were reviewed, 38 full articles retrieved, and 17 included in this study. It was found that consumer participation was predominantly consultative and consumerist in nature and involved design specification and intervention development, and usability/pilot testing. Sustainable participation was difficult to achieve. Projects reported clear dichotomies around designer/researcher and consumer assumptions of effective and acceptable interventions. It was not possible to determine the impact of participatory research on intervention effectiveness due to lack of outcome data. Planning for or having pre-existing implementation sites assisted implementation. The review also revealed a lack of theory-based design and process evaluation. Conclusions Consumer consultations helped shape intervention design. However, with little evidence of outcomes and a lack of implementation following piloting, the value of participatory research remains unclear.

The effectiveness of cognitive-behavioural therapy with hopeful elements to prevent the development of depression in young people: a systematic review

Background  The onset of depression during adolescence can adversely impact future functioning. Cognitive-Behavioural Therapy (CBT) has been suggested to prevent depression in adolescence by providing an individual with the ability to interpret and the tools to deal with the impact of negative life events. Objective  Examine the best available evidence to determine the effectiveness of CBT to prevent the onset of depression in young people, and assess whether the incorporation of hopeful elements makes CBT more effective. Search strategy  A comprehensive three-step search strategy was developed to find both published and unpublished studies in English from 1987 to March 2007. Papers selected for retrieval were then assessed for methodological validity by two independent reviewers. Selection criteria  Papers that used a randomised controlled design and investigated the efficacy of CBT to prevent the onset of depression in young people between the age of 10 years and 16 years were included. Papers were included if the CBT involved between four and 15 sessions, a follow-up period of between 3 and 24 months and included typical strategies, such as the identification of negative and irrational beliefs, the establishment of links between thoughts, feelings and behaviours, and provided tools so participants could self-monitor these. Data analysis  Data were extracted using the standard tool from the Joanna Briggs Institute, pooled in a meta-analysis, and then grouped and analysed according to the amount of hopeful elements the CBT was judged to contain. Results and conclusion  Limited evidence was found to indicate that CBT, regardless of its content (i.e. with or without hopeful elements), is effective at preventing the onset of clinical levels of depression in young people on a sustained basis. Nonetheless, given the devastating impact that depression can have on young peoples future functioning, further research is needed to develop effective interventions to equip young people with the cognitive skills to buffer its onset on a more sustained basis and to enable them to reach and sustain mental health.

Is Hope or Mental Illness a Stronger Predictor of Mental Health

Health promotion strategies often focus on the prevention or alleviation of mental illness in an attempt to indirectly promote mental health. But, while the absence of mental illness may be a consequence of mental health, it does not necessarily signal or lead to mental health (Keyes & Lopez, 2002), suggesting that a focus on mental illness may not be the optimal way to promote mental health. The current study adopted a positive psychological approach and tested whether hope was a stronger predictor of mental health in young people than was mental illness. Confirmatory factor analysis was used to test the proposed model, and data were drawn from a sample of young South Australians (N = 3913; 1317 years). The results indicated that hope was a significantly stronger predictor of mental health than was mental illness. These results have implications for the content of strategies to promote mental health in young people.

Mental Health Technologies: Designing With Consumers

Despite growing interest in the promise of e-mental and well-being interventions, little supporting literature exists to guide their design and the evaluation of their effectiveness. Both participatory design (PD) and design thinking (DT) have emerged as approaches that hold significant potential for supporting design in this space. Each approach is difficult to definitively circumscribe, and as such has been enacted as a process, a mind-set, specific practices/techniques, or a combination thereof. At its core, however, PD is a design research tradition that emphasizes egalitarian partnerships with end users. In contrast, DT is in the process of becoming a management concept tied to innovation with strong roots in business and education. From a health researcher viewpoint, while PD can be reduced to a number of replicable stages that involve particular methods, techniques, and outputs, projects often take vastly different forms and effective PD projects and practice have traditionally required technology-specific (eg, computer science) and domain-specific (eg, an application domain, such as patient support services) knowledge. In contrast, DT offers a practical off-the-shelf toolkit of approaches that at face value have more potential to have a quick impact and be successfully applied by novice practitioners (and those looking to include a more human-centered focus in their work). Via 2 case studies we explore the continuum of similarities and differences between PD and DT in order to provide an initial recommendation for what health researchers might reasonably expect from each in terms of process and outcome in the design of e-mental health interventions. We suggest that the sensibilities that DT shares with PD (ie, deep engagement and collaboration with end users and an inclusive and multidisciplinary practice) are precisely the aspects of DT that must be emphasized in any application to mental health provision and that any technology development process must prioritize empathy and understanding over innovation for the successful uptake of technology in this space.

The promise and the reality: a mental health workforce perspective on technology-enhanced youth mental health service delivery

BackgroundDigital technologies show promise for reversing poor engagement of youth (16–24 years) with mental health services. In particular, mobile and internet based applications with communication capabilities can augment face-to-face mental health service provision. The literature in this field, however, fails to adequately capture the perspectives of the youth mental health workforce regarding utility and acceptability of technology for this purpose.MethodsThis paper describes results of in-depth qualitative data drawn from various stakeholders involved in provision of youth mental health services in one Australian rural region. Data were obtained using focus groups and semi-structured interviews with regional youth mental health clinicians, youth workers and support/management staff (n = 4 focus groups; n = 8 interviews) and analysed via inductive thematic analysis.ResultsResults question the acceptability of technology to engage clients within youth mental health services. Six main themes were identified: young people in a digital age, personal connection, power and vulnerability, professional identity, individual factors and organisational legitimacy.ConclusionsThese findings deepen the understanding of risks and challenges faced when adopting new technologies in mental healthcare. Recommendations for technology design and implementation in mental health services are made.

Complete mental health in South Australian youth: prevalence, measurement, and promotion

From a positive psychological perspective, a focus on developing an individual’s strengths rather than exclusively focusing on the symptoms of mental illness is a better way to promote a sustainable mental health. With this in mind, the Complete State Model of Mental Health (Keyes CLM, Lopez SJ, Towards a science of mental health. In: Snyder CR, Lopez JL (eds) Handbook of positive psychology. Oxford University Press, New York, pp 45–59, 2002) was adopted to examine both mental health and mental illness within Australian adolescents (13–17 years; N = 3,913). Normative scores for the Adult Hope Scale (Snyder et al, J Pers Soc Psychol, 60:570–585, 1991) were established, and results suggest that the prevalence of mental health has been overestimated, and that the presence of hopeful thinking is a better predictor of mental health than the absence of mental illness. This research helps to redirect the focus of mental health policy and practice in Australia by highlighting the importance of a positive focus in developing strategies to promote a sustainable mental health and reduce the burden of mental illness, both in adolescence and beyond.

Exploring psychological wellbeing in a sample of Australian actors

Objective The objective of the current study was to explore what factors might impact the psychological wellbeing of adult, Australian professional actors. Method Twenty South Australian actors were recruited using purposive and snowball sampling. Ten were male and 10 female, ranging in age from 22 to 66 years old, with self‐reported professional experience ranging from 1 to 50 years. The participants were interviewed in‐depth about their experiences of being an actor, with a particular focus on wellbeing, and the data were analysed using thematic analysis, with numerous checks in place for methodological rigour. Results Two broad categories of themes were established; environmental and personal factors. Environmental factors included power, lifestyle, fringe‐dwelling, engagement, the tribe, and taking care of yourself. Personal factors included pursuit, strengths, the calling, precariousness and looking within. Conclusions Themes were considered in terms of contemporary wellbeing theory, along with clinical implications relating to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM5). Findings included: actors experience a range of threats to wellbeing, such as problems with autonomy, lack of environmental mastery, complex interpersonal relationships and high self‐criticism. Factors facilitating wellbeing include ongoing personal growth and a sense of purpose. The findings also suggest that actors are vulnerable to depression, generalised anxiety symptoms, vicarious trauma, and perfectionism.

People, processes, and systems: An observational study of the role of technology in rural youth mental health services

The merits of technology-based mental health service reform have been widely debated among academics, practitioners, and policy makers. The design of new technologies must first be predicated on a detailed appreciation of how the mental health system works before it can be improved or changed through the introduction of new products and services. Further work is required to better understand the nature of face-to-face mental health work and to translate this knowledge to computer scientists and system designers responsible for creating technology-based solutions. Intensive observation of day-to-day work within two rural youth mental health services in South Australia, Australia, was undertaken to understand how technology could be designed and implemented to enhance young peoples engagement with services and improve their experience of help seeking. Data were analysed through a lens of complexity theory. Results highlight the variety of professional roles and services that can comprise the mental health system. The level of interconnectedness evident in the system contrasted with high levels of service self-organization and disjointed information flow. A mental health professionals work was guided by two main constructs: risk and engagement. Most clients presented with a profile of disability, disadvantage, and isolation, so complex client presentations and decision-making were core practices. Clients (and frequently, their families) engaged with services in a crisis-dependent manner, characterized by multiple disengagements and re-engagements over time. While significant opportunities exist to integrate technology into existing youth mental health services, technologies for this space must be usable for a broad range of medical, psychological and cognitive disability, social disadvantage, and accommodate repeat cycles of engagement/disengagement over time.

Half Full or Half Empty: The Measurement of Mental Health and Mental Illness in Emerging Australian Adults

Narrow approaches to the conceptualisation and measurement of ‘mental health’ are regularly but inconsistently adopted in research and practice. For example, an exclusive focus on the identification of mental illness or mental wellbeing runs the risk of failing to detect individuals with low or high levels of the other, and does nothing to represent an individual’s level of complete mental health (i.e., taking both mental wellbeing and illness into account). The current study compared three approaches to the measurement of mental health regularly applied in the literature - an exclusive mental wellbeing / an exclusive mental illness / and a complete mental health approach – to determine if they produce similar outcomes. South Australian emerging adults were recruited (N=117; M=24.4 years, SD=0.75) and categorised into four mental health groups according to the Complete State Model (CSM; Keyes & Lopez, 2002) of mental health: flourishing (complete mental health), languishing or struggling (incomplete mental health or illness), or floundering (complete mental illness) and categories were compared. Results showed that the ‘mental health’ of the sample differed depending on the measurement approach used, and lend support to a complete mental health approach to better inform, develop, and target health promotion strategies.

Designing for practice: understanding technology use in rural community-based youth mental health contexts

Abstract Social and mobile technologies appear to have remarkable scope to improve the access and quality of remote frontline mental health services. However, their potential has not yet been realised, due in part to an insufficient appreciation of remote mental health care settings as contexts for design. This study reports on a participatory design (PD) process involving mental health practitioners and clients, focusing on three participatory future workshops. Visioning, Scenario building and Mock-up phases encouraged participants to explore: (1.) What is needed and possible? (2.) Where would it fit? Who would use it and why? and (3.) How would it look, feel & function? These activities generated a contextualised understanding of frontline mental health service provision, and the possible roles of technology within it. PD methods were effective in a number of respects: defining domain criteria associated with mental health care; supporting community-based youth mental health professionals to articulate the roles of technology in their work; and identifying new opportunities for technologies in this space. Mental health applications can do more than provide a means of self-tracking or serve as a treatment surrogate; rather they can support clients’ autonomy with respect to self-discovery and direction-setting in treatment and recovery.