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One in five Americans suffers from mental illness, yet only 44 percent receive treatment. Why? People with behavioral health problems face a growing number of obstacles that prevent them from receiving the care they need – from provider shortages to finances the mere unwillingness to seek treatment due to stigma. With telehealth, primary care physicians – nearly half of which treat mental health conditions – now have another viable option: online cognitive behavioral therapy, or iCBT. In fact, 75 percent of healthcare executives believe telemedicine has the potential to transform the standard of care for behavioral health and psychiatry.

iCBT is the use of cognitive and behavioral techniques that are typically used in face-to-face therapy for treating mental health issues. The online version is composed of education, skills training, activities and exercises to promote the application of new knowledge and coping skills. It does this through structured modules of content that are delivered using text, pictures, animations, audio files and videos – all of which can be done anytime, from the comfort and privacy of the patient’s own home.

Here’s why iCBT is fundamentally changing how we treat mental health:

• Combats Provider Shortage

The U.S. is facing a growing shortage of clinicians – particularly in rural areas, where the majority of American’s live. Some states, such as Alabama, have a 1 to 260 clinician-to-patient ratio. Lengthy wait times – even in major cities – also pose as a significant challenge. Patients in Boston, for example, have to wait up to 66 days on average to see a doctor for a traditional in-clinic visit. To adequately address demand, at least 5.9K more mental health professionals are needed in the U.S.

For patients – especially those in need of immediate treatment, iCBT eliminates wait times for a face-to face appointment, granting immediate access to care. Further, numerous clinical studies have shown online therapy solutions to be equally effective as face-to-face interventions.

• Breaks Down Barriers To Access

Patients who cannot access standard healthcare services – whether they suffer from other heath conditions and are prohibited from travel or don’t have access to transportation – can access iCBT anytime, from any location. From a provider’s perspective, the ability to enroll patients’ immediately and identify a need rather than having them call or schedule an appointment, also promotes continuity of care and increases clinical workflow. Additionally, studies have shown that individuals leveraging web-based therapy are more likely to remain engaged in face-to-face therapies when online treatments are used as a supplement.

• Takes Stigma Out Of The Equation

For many individuals, sharing intimate feelings with a stranger makes them incredibly uncomfortable. While younger generations are typically more open to face-to-face therapeutic interventions, for many, including those in the Baby Boomer generation, there is a stigma attached to mental health and a desire to keep problems private.

It was nearly 20 years ago when the U.S. Surgeon General labeled stigma as “perhaps the biggest barrier to mental healthcare.” Further, according to a survey of nearly 600 adults over the age of 60 in rural North Carolina who were asked why they didn’t seek mental health treatment for their conditions – the majority responded, “I should not need help.”

Privacy issues are also a concern for people wanting or needing to seek treatment for mental health. In rural communities, for example, residents may actually know the behavioral healthcare specialist personally – if the community is even lucky enough to have one. In larger communities, patients might be hesitant to share personal information that makes them vulnerable to a stranger or question whether the practitioner abides by HIPAA standards.

While as a society we still have a long way to go in terms of eliminating the stigma associated with mental illness, iCBT can be a more appealing option for those individuals too embarrassed to seek treatment.

• Less Expensive For Patients, Providers And Payers 

In the treatment of mild to moderate mental health conditions, iCBT platforms demonstrate the ability to offer services to six times as many patients than other care models, while generating the same outcomes. This has allowed healthcare providers to offer iCBT programs across their entire population, while minimizing valuable resources and better enabling hospitals to triage patients.

For patients, online therapy also offers a less expensive option than in-person therapy. Typically, iCBT is a low-intensity intervention where patients can move through the online content at a self-administered pace, reducing the amount of clinical support time required. In addition to the cost of a face-to-face therapy session, iCBT eliminates the need for patients to take time off from work during business hours, as well as the drive time to and from a specialists’ office.

Eventually, online therapy can help ease the strain put on emergency services for the treatment of behavioral health, which all too often serves as the first line of care for patients without insurance.

• Scalable Solutions Easily Integrate Into Existing Healthcare Systems

iCBT allows providers and payers to offer scalable solutions that have a high degree of efficacy. There are numerous online therapy solutions that can be customized to meet the individual needs of health systems and their populations, with the ability to easily integrate with existing technologies. These solutions can be used throughout the care pathway and enhance the patient-doctor experience and results. Developers of iCBT solutions have made the integration simple and user experience intuitive to help promote adoption and effective results.

Widespread adoption of web enabled devices web and cellular coverage, internet-based programs transcend geography, reaching any web-enabled device, anywhere. Whether someone lives in a skyscraper or on a farm, where doctors are plentiful or scarce, help for mental illness is readily accessible. iCBT offers clinically validated, easy to integrate, scalable solutions to health systems to address the waiting lists and access issues at the core of behavioral health delivery across the U.S.

About The Author

Derek Richards, Ph.D., is the Chief Science Officer at SilverCloud Health, which provides evidence-based online mental health and behavioral healthcare solutions.

While telehealth isn’t a new concept, it’s increasingly becoming a more popular option for delivering behavioral healthcare services.

In fact, 75 percent of healthcare executives believe telemedicine has the potential to transform the standard of care for behavioral health and psychiatry.

The advancement of this accessible technology could not have come at a better time. People with behavioral health problems face a growing number of daunting obstacles that prevent them from receiving the effective care they need – from finances to clinician shortages to the mere unwillingness to seek treatment due to stigma. With telehealth, primary care physicians – nearly half of which treat mental health conditions – now have another viable option: online cognitive behavioral therapy, or iCBT.

iCBT is the use of cognitive and behavioral techniques that are typically used in face-to-face therapy for treating mental health issues. The online version is composed of education, skills training, activities and exercises to promote the application of new knowledge and coping skills. It does this through structured modules of content that are delivered using text, pictures, animations, audio files and videos – all of which can be done anytime, from the comfort and privacy of the patient’s own home.

Here’s five reasons why online cognitive behavioral therapies are the future of mental health:

1. Ease of access
Patients who cannot access standard healthcare services – whether they suffer from other heath conditions and are prohibited from travel or don’t have access to transportation – can access iCBT anytime, from any location. From a provider’s perspective, the ability to enroll patients’ immediately and identify a need rather than having them call or schedule an appointment, also promotes continuity of care and increases clinical workflow. Additionally, studies have shown that individuals leveraging web-based therapy are more likely to remain engaged in face-to-face therapies when online treatments are used as a supplement.

2. Alleviates stigma and privacy concerns
For many individuals, sharing intimate feelings with a stranger makes them incredibly uncomfortable. While younger generations are typically more open to face-to-face therapeutic interventions, for many, including those in the Baby Boomer generation, there is a stigma attached to mental health and a desire to keep problems private.

It was nearly 20 years ago when the U.S. Surgeon Generallabeled stigma as “perhaps the biggest barrier to mental health care.” Further, according to a surveyof nearly 600 adults over the age of 60 in rural North Carolina who were asked why they didn’t seek mental health treatment for their conditions – the majority responded, “I should not need help.”

Privacy issues are also a concern for people wanting or needing to seek treatment for mental health. In rural communities, for example, residents may actually know the behavioral healthcare specialist personally – if the community is even lucky enough to have one. In larger communities, patients might be hesitant to share personal information that makes them vulnerable to a stranger or question whether the practitioner abides by HIPAA standards.

While as a society we still have a long way to go in terms of eliminating the stigma associated with mental illness, iCBT can be a more appealing option for those individuals too embarrassed to seek treatment.

3. Lower cost of care for providers, payers and patients
In the treatment of mild to moderate mental health conditions, iCBT platforms demonstrate the ability to offer services to six times as many patients than other care models, while generating the same outcomes. This has allowed healthcare providers to offer iCBT programs across their entire population, while minimizing valuable resources and better enabling hospitals to triage patients.

For patients, online therapy also offers a less expensive option than in-person therapy. Typically, iCBT is a low-intensity intervention where patients can move through the online content at a self-administered pace, reducing the amount of clinical support time required. In addition to the cost of a face-to-face therapy session, iCBT eliminates the need for patients to take time off from work during business hours, as well as the drive time to and from a specialists’ office.

Eventually, online therapy can help ease the strain put on emergency services for the treatment of behavioral health, which all too often serves as the first line of care for patients without insurance.

4. Addressing the clinician shortage
Fifty six percent of American adults with a mental illness do not receive treatment and a nationwide clinician shortage is a key part of the problem – particularly in rural areas, where the majority of American’s live. Some states, such as Alabama, have a 1 to 260 clinician-to-patient ratio. Lengthy wait times – even in major cities – also pose as a significant challenge. Patients in Boston, for example, have to wait up to 66 days on average to see a doctor for a traditional in-clinic visit. To adequately address demand, at least 5.9Kmore mental health professionals are needed in the U.S.

For patients – especially those in need of immediate treatment, iCBT eliminates wait times for a face-to face appointment, granting immediate access to care. Further, numerous clinical studies have shown online therapy solutions to be equally effective as face-to-face interventions.

5. New care models are scalable and easily integrate into existing healthcare systems
iCBT allows providers and payers to offer scalable solutions that have a high degree of efficacy. There are numerous online therapy solutions that can be customized to meet the individual needs of health systems and their populations, with the ability to easily integrate with existing technologies. These solutions can be used throughout the care pathway and enhance the patient-doctor experience and results. Developers of iCBT solutions have made the integration simple and user experience intuitive to help promote adoption and effective results.

In an age of widespread web and cellular coverage, internet-based programs transcend geography, reaching any web-enabled device, anywhere. Whether someone lives in a skyscraper or on a farm, where doctors are plentiful or scarce, help for mental illness is readily accessible. iCBT offers clinically validated, easy to integrate, scalable solutions to health systems to address the waiting lists and access issues at the core of behavioral health delivery across the U.S.

Nearly two out of three 18- to 24-year-olds worry each month about paying their bills and, of those, more than 80 percent said it negatively impacted their mental health. Recently, global online health firm SilverCloud studied nearly 2,000 participants and found that money worries about debt and their financial future caused anxiety and hopelessness. Among factors driving these anxieties are college students who are food and housing insecure and those who have accumulated student loan debt. It is no wonder that, with more than 44 million Americans owning more than $1.5 trillion, so many are experiencing poor mental health outcomes. Ameritech Financial, a document preparation company, assists those overwhelmed by student loan debt in finding, applying for and maintaining enrollment in federal programs, such as income-driven repayment plans (IDRs) that can possibly reduce monthly payments, hopefully reducing anxiety and better-allowing clients to focus on their lives, not just their finances.

“Our young people are facing financial challenges right now and it makes sense that their mental health suffers,” said Tom Knickerbocker, executive vice president of Ameritech Financial. “We can help those struggling with student loan debt find the right federal program, such as an IDR, based on income and family size, that might lower their monthly payment enough to improve their financial and mental health.”

Nearly 84 percent of those with money worries said their debt and financial problems had caused them anxiety about their future. Many of these also said they experienced low moods or feelings of hopelessness. The average college student now spends more time at work than in the classroom. These financial pressures reduce leisure time and recreational opportunities as students pick up more hours to try to stay afloat in college. Under these types of stresses, mental health declines are both alarming and predictable.

Of those interviewed, 71 percent believed that people who are suffering from poor mental health are less able to manage their financial challenges. Unfortunately, this means that those who are under financial stress have poorer mental health outcomes. These individuals then have a more difficult time managing their financial challenges. This self-perpetuating spiral of despair can be debilitating. Fortunately, there are more mental health options available, especially online behavioral health companies. There are also options available to those overburdened by student loan debt. Ameritech Financial expertly guides clients through what some feel is an overly complex process of securing the right IDR that might even end in forgiveness after 20 or 25 years of enrollment.

“Unfortunately, we can’t directly help those with mental health issues,” said Knickerbocker. “But we may be able to help with one of the underlying financial conditions that may drive mental health issues — student loan debt.”

In a YouGov survey, 61 per cent of respondents claimed debt had negatively affected their mental health and 59 per cent predicted the number of people struggling with debt will rise over the next decade.

The survey was commissioned by health tech company SilverCloud Health to mark the 10-year anniversary of the global financial crisis and found an expectation that financial institutions address the relationship between debt and mental health.

Of the 1,962 participants interviewed, 42 per cent believed financial institutions should be responsible for supporting the mental wellbeing of customers in financial difficulty with an emphasis on providing online mental health resources to those in debt.

The survey found 71 per cent of respondents believe people suffering from poor mental health are less able to effectively manage financial difficulties.

In recent years the Financial Conduct Authority has demonstrated an increased interest in how firms are treating vulnerable clients, including those struggling with poor mental health, and is expected to implement further assessment early next year.

Ken Cahill, chief executive of SilverCloud, said he hopes more financial institutions will work to provide services which are mindful or supporting customer mental health.

He said: “The results of this British survey clearly demonstrates that British mental health has greatly suffered over the past decade as a result of financial difficulty stemming from the global crisis.”

Dr Thomas Richardson, psychologist and co-designer of SilverCloud’s mental health programme ‘Space From Money Worries’, said financial difficulties and mental health problems are often incorrectly treated separately.

He said: “Financial difficulties and mental health problems are often part of the same problem, but most support options treat them individually, offering debt advice separately from mental health help.

“So, for example, you might be offered a debt advice appointment but if you are so anxious you cannot face it then it will not help.”

Dr Richardson said the root psychological mechanisms which lead to a cycle of financial difficulties and poor mental health must be addressed.

He added: “The negative thinking patterns which prevent you tackling your debt, the worry and avoidance which stops you seeking financial help and the impulse spending which digs you deeper into a debt hole.”

Anna Sofat, founder at Addidi Wealth, said she feels there is definitely a link between mental and financial wellbeing so the survey findings should not be a surprise to anyone in the financial industry.

She said: “What is surprising is that the link and the appalling statistics, that 25 per cent of people in the UK have no savings at all and 1 in 10 spend more than they earn, reported by Skipton Building Society in March, are not used by the regulator or government to determine societal benefit or economic output.

“I am hoping that as impact investing becomes more mainstream, the impact of debt products on communities will be used to make investment judgement about individual companies.”

Over half of Irish people reported a decline in their mental health as a result of the economic crash 10 years ago, a new survey suggests.

Out of those who felt their mental health was impacted by the downturn, 17 per cent said it deteriorated “significantly” and 14 per cent said they had thought about suicide as a result.

Forty two per cent of those whose health was affected by the crash reported sleep problems and 28 per cent said they received professional psychological help.

One third said their mental health issues affected their ability to handle their financial problems effectively.

The national survey of 1,000 people was carried out by Amarach Researchand mental health technology company SilverCloud. It was released to mark the tenth anniversary of the 2008 bank bailout.

Dr Derek Richards, who led the research, said “ability turns to inability” when mental health issues are combined with financial problems.

He said it’s a “vicious cycle” where financial issues cause stress and anxiety which in turn prevents the sufferer from addressing their money problems.

“The type of behaviour they should be engaging in, like opening bills and talking to the bank, now becomes overwhelming.”

David Hall of the Irish Mortgage Holders Organisation, which assists distressed home-owners, said his organisation ran a similar study a few years ago. It found a significant number of people had tried to kill themselves over mortgage problems.

“Our single biggest daily challenge is people’s mental health,” he said. “We’ve had a number of clients who have taken their own lives.”

He said the issues don’t just affect the person holding the debt. “It impacts on their family’s mental health and their actual physical health and their relationships.”

Mr Hall said the Government, the health service and the banks have not considered the mental health consequences of the crash and its aftermath, although he says a number of bankers and TDs admit it is a major issue.

“I’ve got two people at the moment who have attempted to take their own lives. One is out of hospital, one is still in hospital.”

He said he has to “battle” with the bank to ensure it doesn’t call this person demanding repayment of their debt while they are in hospital following the suicide attempt.

According to the SilverCloud research, 57 per cent of people surveyed also said the financial crisis has made their generation more pessimistic.

Financial institutions should have “emotional support structures” to help vulnerable or distressed clients with financial problems, 66 per cent of respondents said.

Offering mental health supports to customers would benefit not just the customer but also the banks themselves, Dr Richards said. He pointed to research showing that businesses who support their employees health enjoy greater success.

“What we need is for financial institutions to consider the whole person and consider specifically those who get into difficultly.”

He said financial institutions must understand it’s not just their customer’s problem; it’s also their problem if the customer is unable to address their debt due to mental health issues.

A major study into workplace wellbeing by mental health charity Mind has revealed that poor mental health at work is widespread, with half (48 per cent) of all people surveyed saying they have experienced a mental health problem in their current job.

The survey of more than 44,000 employees, as part of Mind’s Workplace Wellbeing Index, also revealed that only half of those who had experienced poor mental health had talked to their employer about it, suggesting that as many as one in four UK workers is struggling in silence.

In-depth analysis has revealed that offering managers proper support can make a huge difference. Managers who felt their employer supported their mental health at work, or actively built their skills in supporting team members with mental health problems, were far more likely to feel confident in promoting staff wellbeing.

Manager confidence, in turn, is closely linked with whether employees feel able to disclose. Those staff who felt their manager supported their mental health or could spot the signs that someone might be struggling were far more likely to say they would be able to talk about their mental health at work.

To support better mental health at work, it’s then clear that line managers must feel comfortable and confident supporting their employee’s mental health. Training line managers is an essential part of this.

Trystan works for Welsh Water Dwr Cymru. Last year he took time off work to help manage his depression. With mental health awareness training from Mind Cymru, his line manager Karen, was better able to support Trystan back into work.

Karen Rogers, Health and Safety Manager at Welsh Water Dwr Cymru said:

“I found the Mind training really useful and I know it has been for other managers as well. It enables us to look out for those behavioural changes in our colleagues and then have those conversations with them and support them if they are struggling with their mental health.”

Mind’s mental health training will help your managers get mental health support right at a team and individual level. They deliver in-house training as a cost-effective way to promote the mental wellbeing of your staff. Specifically designed for employers and is ideal for line managers and HR teams, Mind offer training on the following topics:

• Managing mental health at work
• Mental health awareness
• Customer support and mental health
• Emotional intelligence and resilience

Mind Cymru will be running their next public access course in Wales, at their Cardiff office on Wednesday 21 November 2018. The one day course, Managing Mental Health at Work, is suitable for anyone who manages staff, or finds themselves doing so informally. You’ll learn how to recognise when a staff member is struggling and how you can support them professionally.

You can also access Silvercloud Mental Health Awareness at Work, which offers employees at any level in your organisation with an introduction to mental health and well-being in the workplace – they’ll explore the difference between good and poor mental health, common mental health problems, stigma around mental health and access tips on how to look after their own mental health and support colleagues.

We all have mental health – sometimes it will be good and sometimes we will struggle. Where we are on this scale and how we are feeling may impact how we work. With better support and more understanding, many of us may feel better able to manage our mental health at work, leading to happier and more productive work environments.

A welcome conversation surrounding mental health has arisen but as more people make the decision to reach out, too few find a supportive hand.
Not a week passes without a report on Ireland’s mental health system, where lengthy waiting lists, staff shortages and inadequate facilities are the rule rather than the exception. Minister of State with special responsibility for mental health Jim Daly recently announced plans to pilot mental health “web therapy”; signalling a growing recognition of the need for novel approaches.

The capabilities of technology in the mental health sphere continue to flourish and developing therapeutic applications based upon systems driven by artificial intelligence (AI), particularly chatbots, is one arena that’s rapidly expanding. Yet, if you needed to open up, would you reach out to a robot?

Bot benefits
While not specifically focused on AI, a study from the Applied Research for Connected Health (Arch) centre at UCD shows 94 per cent of Irish adults surveyed would be willing to engage with connected mental health technology.
Study co-author Dr Louise Rooney, a postdoctoral research fellow at Arch, says AI-based systems with a research and a patient-centred focus could be beneficial.

“I don’t think AI is the answer to everything or that it could fully replace therapy intervention but I think there’s a place for it at every juncture through the process of treatment; from checking in, to remote monitoring, even down to people getting information,” she says.
The latest Mental Health Commission report shows waiting times for child and adolescent mental health services can reach 15 months. Rooney believes AI-based therapy could be particularly useful for young people who “respond very well to connected mental health technology”. The anonymity of such platforms could also break down barriers for men, who are less likely to seek help than women.
Prof Paul Walsh from Cork Institute of Technology’s department of computer science feels that AI-driven tools can “improve the accessibility to mental health services” but won’t fully replace human therapy.

“For those who are vulnerable and need help late at night, there’s evidence to show [therapy chatbots using AI and NLP] can be an effective way of calming people,” says Walsh, who is currently researching how to build software and machine learning systems for people with cognitive disorders. “If someone’s worried or stressed and needs immediate feedback, it’s possible to give real-time response and support without visiting a therapist.”
Professor of psychiatry at Trinity College Dr Brendan Kelly says AI-based platforms such as chatbots can help people to take control of their wellbeing in a positive manner.

“They can help people to take the first step into an arena that may be scary for them but I feel there will come a point that this is combined with, or replaced by, a real therapist,” adds the consultant psychiatrist based at Tallaght Hospital.
Privacy concerns Using AI-driven mental health therapy doesn’t come without concerns, one being privacy.

“Clearly it’s a very important issue and people shouldn’t use something that compromises their privacy but it’s not a deal-breaker,” says Kelly. “There are ways to ensure privacy which must be done but [fears and challenges] shouldn’t sink the boat.”
Being completely transparent with users about data collection and storage is key, Rooney adds.

Whether AI can determine someone’s ability to consent to therapy is another potential caveat raised by Rooney. However, she feels that forming “watertight legislation” for this technology and ensuring it’s backed by research can help to overcome this and other potential pitfalls.

While most current tools in this field focus on mental wellbeing and not severe problems, Walsh raises the potential of false negatives should AI decide somebody has a chronic illness. To avoid this, it’s important to keep a human in the loop.

“Many machine-learning systems are really hard to analyse to see how they make these judgements,” he adds. “We’re working on ways to try to make it more amenable to inspection.”

As potentially anybody can engineer a system, Walsh recommends avoiding anything without a “vast paper trail” of evidence.
“These will have to go through rigorous clinical trials,” he says. “We need policing and enforcement for anything making medical claims.”
Humans could become attached to a therapy chatbot, as was the case with Eliza, a chatbot developed at Massachusetts Institute of Technology in the 1960s. However, Walsh doubts they will ever be as addictive or as great a threat as things like online gambling.

While the sentiment that AI-based therapy will assist rather than replace human therapy is quite universal, so is the view it can have a great impact.
“Achieving optimum mental health involves being open to all different ingredients, mixing it up and making a cake. AI can be part of that,” says Rooney.
If well regulated, Walsh says AI can augment humans in terms of treating people.

“I’m hopeful that benefits would be accentuated and the negatives or risks could be managed,” says Kelly. “The fact that it’s difficult and complex doesn’t mean we should shy away, just that we must think how best to capture the benefits of this technology.”

Brains behind the bots
Stanford psychologist and UCD PhD graduate Dr Alison Darcy is the brains behind Woebot: a chatbot combining artificial intelligence and cognitive behavioural therapy for mental health management.

“The goal is to make mental health radically accessible. Accessibility goes beyond the regular logistical things like trying to get an appointment,” explains the Dublin native, who conducted a randomised control trial of Woebot before launching. “It also includes things like whether it can be meaningfully integrated into everyday life.”

Darcy is clear that Woebot isn’t a replacement for human therapy, nor will he attempt to diagnose. In the interest of privacy, all data collected is treated as if users are in a clinical study.

Not intended for severe mental illness, Woebot is clear about what he can do. If he detects someone in crisis, Woebot declares the situation is beyond his reach and provides helplines and a link to a clinically-proven suicide-prevention app.

Originally from Wexford, Máirín Reid has also harnessed the capabilities of AI in the mental health sphere through Cogniant. Founded in Singapore with business partner Neeraj Kothari, it links existing clinicians and patients to allow for non-intrusive patient monitoring between sessions.
It’s currently being utilised by public health providers in Singapore with the aim of preventing relapses and aiding efficiency for human therapists. As Cogniant is recommended to users by human therapists, decisions on consent capabilities are formed by humans.

“Our on-boarding process is very clinically-driven,” says Reid. “We’re not there to replace, but to complement.”

While not intended for high-risk patients, Cogniant has an escalation process that connects any highly-distressed users to their therapist and provides supports. There’s also a great emphasis on privacy and being transparent from the offset.
“Clinicians are saying it drives efficiency and they can treat patients more effectively. Patients find it’s non-intrusive and not judgmental in any form.”

Regular physical activity lasting 45 minutes three to five times a week can reduce poor mental health – but doing more than that is not always beneficial, a large US study suggests.

A total of 1.2 million people reported their activity levels for a month and rated their mental wellbeing.

People who exercised had 1.5 fewer “bad days” a month than non-exercisers, the study found.

Team sports, cycling and aerobics had the greatest positive impact.

All types of activity were found to improve mental health no matter people’s age or gender, including doing the housework and looking after the children.

The study, published in The Lancet Psychiatry Journal, is the largest of its kind to date but it cannot confirm that physical activity is the cause of improved mental health.

Previous research into the effects of exercise on mental health have thrown up mixed results, and some studies suggest that lack of activity could lead to poor mental health as well as being a symptom of it.

Exercise is already known to reduce the risk of heart disease, stroke and diabetes.

Adults taking part in the study said they experienced on average 3.4 days of poor mental health each month. For those who were physically active, this reduced to only two days.

Among people who had been diagnosed previously with depression, exercise appeared to have a larger effect, resulting in seven days of poor mental health a month compared with nearly 11 days for those who did no exercise.

How often and for how long people were active was also important.

Being active for 30 to 60 minutes every second day came out as the optimal routine.

But there could be such a thing as doing too much exercise, the study concluded.

Dr Adam Chekroud, study author and assistant professor of psychiatry at Yale University, said: “Previously, people have believed that the more exercise you do, the better your mental health, but our study suggests that this is not the case.

“Doing exercise more than 23 times a month, or exercising for longer than 90-minute sessions is associated with worse mental health.”

He said the positive impact of team sports suggested that social sports activities could reduce isolation and be good for resilience, while also reducing depression.

Over 130,000 people in Wales will have access to a digital mental health service through a new programme with digital health company, SilverCloud Health.

SilverCloud Health will work with the Powys Teaching Health Board (PTHB) to provide programmes for mental health issues such as stress, anxiety and depression. More so, the company will offer a range of programme specifically designed for younger people suffering from mental health issues.

The partnership comes after PTHB secured funding from the Welsh Government through the Efficiency Through Technology Fund (ETTF) for a national online CBT therapies programme. The project will initially only focus on the population in Powys but it’s hoped that the other health board in Wales will follow suit.

SilverCloud is used by over 60% of NHS Mental Health providers across England and offers the broadest a range of evidence-based programmes for conditions including stress, depression and anxiety as well as specific programmes for long-term chronic conditions.

A launch event in Wales for the partnership was attended by Welsh Government officials and representatives from the six other Welsh national health boards to discuss progression towards a national roll-out of these services.

Health secretary Vaughan Gething said: “I am committed to improving access to mental health services throughout Wales so that patients can get the treatment they need more quickly and easily. This innovative project will allow patients to access CBT-based therapies online in their own homes. It is an excellent example of how we can use technology to meet the increasing demand on the modern NHS in Wales. I look forward to seeing how the project develops.”

Speaking at the launch in Powys, Rhiannon Jones – director of Community Care, Mental Health and Therapies, PTHB said: “We are delighted to partner with SilverCloud Health, enabled through a Welsh Government Technology Grant, to implement online Cognitive Behavioural Therapy across Powys. The large geography of the County, coupled with rurality and isolation can present a challenge for timely and accessible mental health services. Online CBT will address some of these challenges, whilst also focusing on prevention, early help and support and self-management across all ages, using evidence-based technology.”

SilverCloud’s CEO Ken Cahill said: “We are delighted to have PTHB on board as a partner and look forward to working with them and seeing the same kind of results that our programmes have achieved elsewhere across the UK, namely a user satisfaction of 98% and programme completion at 80%. Being able to offer as much choice as possible to people in terms of access to mental health support is vital to ensuring we curb the rising epidemic of anxiety and depression. We look forward to offering the same services to the other Welsh health boards as part of a national roll-out.”

Digital Health Age sits down with Dr Derek Richards, director of Clinical Research & Innovation at the online mental health service, SilverCloud Health. Users of SilverCloud Health work through an eight-week course which they can complete at their own pace. Designed to help manage stress, anxiety and depression, SilverCloud Health uses cognitive behavioural therapy (CBT) to help users change the way they think and feel about certain things with a dedicated supporter selecting topics for users and checking in with them every two weeks. The service caters to over 200 health systems across the world and has been adopted onto the NHS’ apps library. More so, a partnership in the US with insurance group, Gallagher Student Health & Special Risk, has seen 26 universities sign on to use the online platform. Here, Dr Richards discusses how online therapies can help people with mental health problems and what the NHS can do to drive mental health services.

 

Q1. Do you think people are more willing to tackle their mental health problems through digital/online interfaces rather than through face-to-face therapies?

A1. The way people choose to manage their mental health problems is very personal and can vary from person to person. For some people, face-to-face therapies are the most helpful solution – however, for a growing number, a busy lifestyle can mean that regular face-to-face therapy may not be feasible and for some an online approach is preferred. There is also the issue of funding – the need for investment in mental health services is well documented and this can affect how people access services. I think the idea of digital platforms has also become far more accepted, by patients and healthcare professionals alike. Online solutions, like SilverCloud Health, allow access to more patients and enables them to access a safe and secure environment, which can be personalised, so it feels like their own space. Because it is accessible online, it’s available whenever that person needs it most, but has the unique benefit of a supporter for the human touch. People are increasingly turning to the internet in search of mental health support, especially those among younger age groups. As we conduct many aspects of our lives online – banking, movies, social – it is also appropriate to have an expectation that we can access care online too.

 

Q2. What was it like getting SilverCloud adopted onto the NHS apps library and what can the NHS do more of to drive digital health?

A2. We’re really pleased that SilverCloud Health platforms are included in the NHS app library and we’re delighted to be working with almost 60% of IAPT (Improving Access to Psychological Therapies) programmes across the UK already. The app library helps to distinguish online solutions, like SilverCloud Health, which are built on strong evidence and demonstrate the effectiveness of the intervention. This means that the interventions can be trusted to deliver with the fidelity and care required. Increasingly, as the NHS IAPT services seek to reach higher targets for access, quality and outcomes, digital will see a significant growth, such as evidence based digital solutions – like SilverCloud Health.

 

Q3. Where do you think mental health is currently tackled the least? (Universities/ workplace, particular industries etc.)

A3. Definitely in the workplace. The majority of the population work in some capacity and are therefore spending much of their lives at work Relationships are sought and made with colleagues (or not in some cases), which can provide a source of support or add to the stresses of work, if relationships are for example strained, or are lacking.  All employees will, to some extent, transition through life’s ups and downs during their working life and life events can of course have a massive impact on our physical and mental health. For example, key life events that can really test us include; starting work for the first time, bereavement, family pressures, economic demands, divorce, separation, etc. All of these types of events impact us to a greater or lesser extent at an individual level and will therefore impact us in the workplace. So it makes complete sense to have interventions for mental health available at work, where people spend so much of their time. Employers have a unique opportunity to provide employees with programmes and interventions that not only help them to build resilience in the workplace, but support workers going through tough life events outside of work too.

 

Q4. Can services like SilverCloud help increase access to mental health treatment across the NHS?

A4. There are so many obstacles to accessing mental health care, from lengthy waiting lists and funding issues, to distance from service locations for people living in rural areas or new mums with limited transport or childcare. There are also those who are living with a disability or long-term condition, which can also make it difficult to get out for appointments. Then there are the ‘social’ barriers to overcome – the continued stigma of mental health and negative perception of treatments. A lot of work has been done to overcome these barriers and offering low-intensity online-internet delivered interventions, particularly through a self-referral pathway, has opened up therapy to far more people.

A growing body of evidence indicates significant cost savings, waiting time reductions and a potential for scalability with online therapy, that cannot be achieved with more traditional and time-intensive interventions. The National Institute for Health and Care Excellence (NICE) guidance suggests a Psychological Wellbeing Practitioner (PWP) working face-to-face, or over the telephone for 30 minutes, can see a maximum of 250 clients per year; with SilverCloud 10-15 minute digital reviews, a PWP has the potential to see more than double the number of patients in a year.

 

Q5. How can digital interventions help treat mental health problems such as depression and anxiety?

A5. There are numerous research studies reporting positive outcomes for online-delivered treatments for depression and anxiety. CCBT (Computerised Cognitive Behavioural Therapy) is a form of CBT (Cognitive Behavioural) Therapy that is delivered via computer rather than face-to-face with a therapist. It can be delivered in a series of weekly sessions and should be supported by a trained supporter.

CBT is based on the concepts that your thoughts, feelings, physical sensations and behaviours are all connected, and that unhelpful thoughts and behaviours can trap you in a cycle leading to emotional challenges. CBT offers coping skills and strategies to help you change any unhelpful thought patterns to improve the way you feel in the present and has been shown to be an effective treatment for a number of different mental health conditions. The SilverCloud Health programmes’ evidence-based content is based on CBT principles.

 

Q6. Do you think there is still stigma surrounding mental health or do you see awareness around the topic increasing?

A6. I believe that a great deal has been done to fight the stigma around mental health. During last month’s Mental Health Awareness Week, I was overwhelmed by the volume of conversations around mental health conditions, including anxiety and depression, as well as a focus on stress reduction and building resilience. Recently, numerous celebrities have publicly talked about their own struggles with mental health, and the work of campaigns like the ‘Time To Change’ campaign and ‘#mendthegap’ are doing a great deal to encourage people to get support if they need it. That said, there is still a taboo around mental health, with some people still fearful to seek the help they need, particularly at university or in the workplace. I think it is vital to maintain the momentum of mental health awareness throughout the year.

 

Q7. What would you like the NHS to do more of to increase and improve mental health services?

A7. Many people with long-term conditions are also living with mental health issues. There is a growing body of evidence to suggest that managing their mental health can also positively impact how they manage their long-term condition, giving better outcomes across the board. NICE has recommended that patients with chronic physical and co-morbid mental health problems can benefit from treatment such as evidence-based computerised CBT programmes to improve their condition. This type of joined-up approach could greatly help reduce the impact on the NHS.

 

Q8. Are there any limits with digital interventions for mental health compared to face-to-face therapy?

A8. Historically, online delivered interventions have been troubled with a lack of engagement from clients and consequently poor clinical outcomes. However, in recent years, with the development of human-computer interaction (HCI) approaches to engagement, and the recognition that supported delivery of CBT online, yields greatest clinical success, e-therapy interventions have greatly improved. In recent years, attitudes have also changed and more positive attitudes exist towards accessing mental health care online – indeed, this has come with the growth and acceptance of digital in our lives more generally. Like any psychosocial or psychological recovery pathway, any singular intervention is not a panacea, internet delivered solutions are simply to be understood as one step in a journey of care that can change based on the needs of the individual patient.

 

Q9. Are there any technologies you would recommend for helping people take better care of their mental health?

A9. These days there are a host of mental health tools and apps online, to help support people with their mental wellbeing, from meditation apps to more advanced platforms for diagnosed conditions. Digital interventions are becoming more and more sophisticated and the future of this sector, looking at how AI can be used to recognise and respond to mental health conditions, for example, is really exciting.

For anyone experiencing mental health issues, I’d recommend speaking to your healthcare provider or counsellor to talk about the best options for you.