The Opportunities and Challenges of the First Three Years of Open Up, an Online Text-Based Counselling Service for Youth and Young Adults.

We present the opportunities and challenges of Open Up, a free, 24/7 online text-based counselling service to support youth in Hong Kong. The number of youths served more than doubled within the first three years since its inception in 2018 in response to increasing youth suicidality and mental health needs. Good practice models are being developed in order to sustain and further scale up the service. We discuss the structure of the operation, usage pattern and its effectiveness, the use of AI to improve users experience, and the role of volunteer in the operation. We also present the challenges in further enhancing the operation, calling for more research, especially on the identification of the optimal number of users that can be concurrently served by a counsellor, the effective approach to respond to a small percentage of repeated users who has taken up a disproportional volume of service, and the way to optimize the use of big data analytics and AI technology to enhance the service. These advancements will benefit not only Open Up but also similar services across the globe.

Who seeks help online? Comparing online and offline help-seeking preferences amongst youths with suicidal ideation.

BACKGROUND: Research consistently report an inverse relationship between suicide risk and help-seeking. The increasingly available internet-based support potentially offers an attractive alternative to traditional forms of assistance. The study compared the characteristics of suicidal youths in Hong Kong and their online and offline help-seeking behaviours. METHODS: Participants (N = 1214, age-range = 15-24 years) responded to the anonymous 2018 Hong Kong Online Survey on Youth Mental Health and Internet Usage. Respondents with suicidal thoughts were classified into those who sought help online and offline, or online only ("online-help"); those who sought help offline only ("offline-help"); and those who never sought help ("no-help"). They responded to questions concerning mental health, perception towards online support, internet use, help sources, and demographic information. RESULTS: The online-help group differed significantly from other groups, with greater suicidal ideation, distress, risk behaviours, and spent more time online for non-work-related purposes. Their perceived benefits of online support include anonymity, avoiding embarrassment, and social support. They are more likely to seek help from a combination of informal and formal sources. LIMITATIONS: No data on whether participants sought help online or offline first, and their current treatment status is available. Our study adopted conveniences sampling, and few respondents have sought help online exclusively. CONCLUSION: Online support offers an alternate way of engaging at-risk youths. Future clinical practice should consider online platforms as a complement, rather than a replacement, of offline platforms.

Spinal somatostatin-positive interneurons transmit chemical itch.

Recent studies have made significant progress in identifying distinct populations of peripheral neurons involved in itch transmission, whereas the cellular identity of spinal interneurons that contribute to itch processing is still a debate. Combining genetic and pharmacological ablation of spinal excitatory neuronal subtypes and behavioral assays, we demonstrate that spinal somatostatin-positive (SOM) excitatory interneurons transmit pruritic sensation. We found that the ablation of spinal SOM/Lbx1 (SOM) neurons caused significant attenuation of scratching responses evoked by various chemical pruritogens (chemical itch). In an attempt to identify substrates of spinal itch neural circuit, we observed that spinal SOM neurons partially overlapped with neurons expressing natriuretic peptide receptor A (Npra), the receptor of peripheral itch transmitter B-type natriuretic peptide. Spinal SOM neurons, however, did not show any overlap with itch transmission neurons expressing gastrin-releasing peptide receptor in the dorsal spinal cord, and the gastrin-releasing peptide-triggered scratching responses were intact after ablating spinal SOM neurons. Dual ablation of SOM and Npra neurons in the spinal cord reduced chemical itch responses to a greater extent than ablation of SOM or Npra neurons alone, suggesting the existence of parallel spinal pathways transmitting chemical itch. Furthermore, we showed that SOM peptide modulated itch processing through disinhibition of somatostatin receptor 2A-positive inhibitory interneuron. Together, our findings reveal a novel spinal mechanism for sensory encoding of itch perception.