The Helpfulness of Web-Based Mental Health and Well-being Forums for Providing Peer Support for Young People: Cross-sectional Exploration.

BACKGROUND: Young people are increasingly seeking out web-based support for their mental health and well-being. Peer support forums are popular with this age group, with young individuals valuing the fact that the forums are available 24/7, providing a safe and anonymous space for exploration. Currently, little systematic evaluation of the helpfulness of such forums in providing support has been conducted. OBJECTIVE: This study examined the helpfulness of the support offered within web-based mental health and well-being peer support forums for young people. It specifically investigated the self-reported user ratings of helpfulness reported through the completion of a developing experience measure. The ratings will be used to consider further development of the measure and reflect upon the overall helpfulness of the forums as indicated by the reported scores. METHODS: The study used routinely collected practice-based outcome data from web-based mental health forums for young people. These forums are hosted by the UK-based web-based therapy and support service, Kooth. A cross-sectional design was used to explore-using a range of inferential statistical measures-the outcomes reported by those accessing the forums using a Peer Online Community Experience Measure (POCEM). To consider the helpfulness in general, 23,443 POCEMs completed in 2020 were used. A second data set of 17,137 completed POCEMs from the same year was used to consider whether various engagement indicators had an impact upon the helpfulness rating. RESULTS: Female users aged between 11 and 16 years predominantly completed the POCEM. This is in keeping with the majority of those using the service. In total, 74.6% (8240/11,045) of the scores on the POCEM indicated that the individuals found the posts helpful. An ANOVA indicated that male users were more likely to report obtaining intrapersonal support, whereas female users obtained interpersonal support. Furthermore, the POCEM scores reflected the internal consistency of the measure and provided an insight into the way that young people made use of the peer support resource; for instance, posts that were rated more helpful were correlated with spending longer time reading them, and the topics discussed varied throughout the day with more mental health issues being discussed later at night. CONCLUSIONS: The results seem to demonstrate that, overall, the young people involved in this study found web-based peer support helpful. They indicate that peer support can provide an important strand of care within a supportive mental health ecosystem, particularly during time periods when in-person support is typically closed. However, limitations were noted, suggesting that caution is needed when interpreting the results of this study. Although such services are incredibly well used, they have received little research attention to date. As such, further investigation into what constitutes helpful and unhelpful peer support is needed.

The Therapeutic Goals Set by University Students in an Anonymous Web-Based Therapy and Support Setting.

The interest in student mental health and wellbeing has increased in recent years. Additionally, there is a rising volume of students seeking support. Numerous online resources have been developed to meet this need, including anonymous web-based therapy. To date, there has been little focus upon how students may utilise such a service, and this study examines routine evaluation data (solicited from a Goal-based Outcome Measure) from a United Kingdom based service provider. Over the course of one academic year (2018-2019), 211 students articulated therapeutic goals within Kooth Student, a web-based therapy and support service for individuals in higher education. These goals were examined for key trends. The students identified a total of 625 goals to work on in therapy, with individuals setting an average of three goals each. The most common goals focused upon obtaining additional support within the service and exploring their emotions. The results suggested that female students were more likely to move towards achieving their goals, with goals that did move shifting an average of 7.74 on a 10-point scale. Practical goals that focused upon getting more help, both inside and outside the service, were most likely to be achieved. In contrast, self-help/self-care goals were less likely to be achieved. These results provide a helpful insight into how students made use of therapy and highlight the importance of the interaction that web-based services have with other provision (web-based and in-person). They also demonstrate the challenge of capturing meaningful outcome data in anonymous services.

The design and development of an experience measure for a peer community moderated forum in a digital mental health service.

Online digital mental health communities can contribute to users' mental health positively and negatively. Yet the measurement of experience, outcomes and impact mechanisms relating to digital mental health communities is difficult to capture. In this paper we demonstrate the development of an online experience measure for a specific children and young people's community forum inside a digital mental health service. The development of the Peer Online Community Experience Measure (POCEM) is informed by a multi-phased design: (i) item reduction through Estimate-Talk-Estimate modified Delphi methods, (ii) user testing with think-aloud protocols and (iii) a pilot study within the digital service community to explore observational data within the platform. Experts in the field were consulted to help reduce the items in the pool and to check their theoretical coherence. User testing workshops helped to inform the usability appearance, wording, and purpose of the measure. Finally, the pilot results highlight completion rates, differences in scores for age and roles and "relate to others", as the most frequent domain mechanism of support for this community. Outcomes frequently selected show the importance of certain aspects of the community, such as safety, connection, and non-judgment previously highlighted in the literature. Experience measures like this one could be used as indicators of active therapeutic engagement within the forum community and its content but further research is required to ascertain its acceptability and validity. Multi-phased approaches involving stakeholders and user-centred design activities enhances the development of digitally enabled measurement tools.

The Session Wants and Need Outcome Measure: The Development of a Brief Outcome Measure for Single-Sessions of Web-Based Support.

Single-session, brief interventions in therapy for young people make up a large proportion of service provision, including in digital mental health settings. Current nomothetic mental health measures are not specifically designed to capture the benefit or 'change' directly related to these brief interventions. As a consequence, we set out to design an outcome measure to concretely demonstrate the value of single-session interventions. The Session Wants and Needs Outcome Measure (SWAN-OM) aims to capture in-session goals and focuses on being user-centric, elements critical to the success of single-session and brief interventions which typically are asset-based and solution-focused. We describe the 4-stage process that was followed to develop this measure: (I) classical item generation and development, (II) content and (III) face validity pilot testing, and (IV) a user-experience approach with young people using framework analysis. This final stage was critical to ensure the integration of this outcome tool into a web-based digital therapy setting, a context which adds another layer of design complexity to item and measure development. This iterative methodology was used to overcome the challenges encountered and to place the needs of the young people and service practitioners at the centre of the design process, thus ensuring measure usability. To end, we highlight the main lessons learnt from engaging in this design process. Specifically, the needs of a measure for single-session interventions are considered, before outlining the learning associated with integrating the measure into a digital mental health platform. Both of these areas are emerging fields and, as such, this study contributes to our understanding of how an idiographic patient outcome theory driven measure can be created for use in a web-based digital mental health therapy service.

A Theory of Change for Web-Based Therapy and Support Services for Children and Young People: Collaborative Qualitative Exploration.

BACKGROUND: Web-based counseling and support has become increasingly commonplace for children and young people (CYP). Currently, there is limited research that focuses on the mechanisms of change within complex telepsychology platforms, a factor that makes designing and implementing outcome measures challenging. OBJECTIVE: This project aims to articulate a theory of change (ToC) for Kooth, a web-based therapy and support platform for CYP. METHODS: A collaborative qualitative research design involving professional staff, academic partners, and young people was used to develop the ToC. The following three major reflective phases were engaged: a scoping workshop involving professional staff and academic partners, a series of explorative projects were completed to inform the development of the ToC, and the draft ToC was reviewed for coherence by key stakeholders (young people, online professionals, and service managers). RESULTS: A collaboratively developed ToC was presented. This was divided into the conditions that lead to individuals wanting to access web-based therapy and support (eg, individuals wanting support there and then or quickly), the mode of service delivery (eg, skilled and experienced professionals able to build empathetic relationships with CYP), and the observed and reported changes that occur as a consequence of using the service (eg, individuals being better able to manage current and future situations). CONCLUSIONS: Developing the ToC helps to shed light on how web-based therapy and support services aid the mental health and well-being of CYP. Furthermore, it helps to understand the development of positive virtual ecosystems and can be used to devise evaluative tools for CYP telepsychology providers.

'Like a human being, I was an equal, I wasn't just a patient': Service users' perspectives on their experiences of relationships with staff in mental health services.

OBJECTIVES: The quality of therapeutic relationships in psychiatric services has a significant impact upon the therapeutic outcomes for people diagnosed with a severe mental illness. As previous work has not explicitly explored service users' in-depth views about the emotional impact of these relationships, the objective of this work was to bring this perspective to the fore and to gain a greater understanding about which relational components can lead to psychological change. DESIGN: The project was conducted alongside a service user organization. An interview design was used to qualitatively explore service users' experiences and perceptions of their relationships with mental health practitioners. METHODS: Eight individuals who had experience of the mental health system in the United Kingdom were interviewed. Interpretative phenomenological analysis was used to analyse the data. FINDINGS: Three superordinate themes emerged from the analysis. These were (1) Trying to survive: am I a person or just an object in the system?; (2) Traumatic experiences within relationships; and (3) Helpful and transformative relationships. Further, the key transformative components of these relationships were power, safety, and identity. CONCLUSIONS: Mental health services should be more focused upon care, rather than control. The Power Safety Identity (PSI) model, a reflexive model based upon key relational components highlighted by participants, is proposed for services and professionals to consider their work. The components of this model are managed by mental health practitioners and can determine whether these relationships maintain, increase, or alleviate psychological distress. PRACTITIONER POINTS: Awareness of the relational components of power, safety, and identity has the potential to help practitioners reflect upon the tensions they experience in their relationships with service users. Mental health services and professionals that are sensitive to issues related to power, safety, and identity when responding to the needs of the service users can improve how individuals perceive the quality of care provided by them. Relationships between service users and mental health practitioners can encourage recovery if they are consistent, safe, trusting, provide protective power, and mirror a positive sense of self.

Supporting emotional well-being in schools in the context of austerity: An ecologically informed humanistic perspective.

BACKGROUND: Schools are commonly asked to take on roles that support the emotional well-being of students. These practices are in line with humanistic education theory and can be difficult to fulfil by schools. Broader ecological pressures, such as periods of austerity, are likely to add to the difficulty in meeting students' needs. AIMS: To explore whether professionals in schools believe that their work supporting pupils' emotional well-being has changed as a consequence of the current period of austerity. SAMPLE: This project reports the views of staff from three secondary schools in the North West of England. A purposive sample of 29 individuals, including members of the senior leadership team and newly qualified teachers, were involved. METHODS: All participants were interviewed about their perceptions of the impact of a sustained period of austerity upon their work. The transcripts of these interviews were analysed using thematic analysis. FINDINGS: Educational professionals associated wider socio-political factors with a perceived increase in the need for emotional support of pupils. They reported taking on new roles and responsibilities to accommodate this and noted they are doing so with fewer resources and limited governmental support. CONCLUSIONS: This paper concludes that considering humanistic education theory alongside ecological theory helps to conceptualize how socio-political factors can impact upon the emotional well-being in schools. An ecologically informed humanistic framework is depicted based upon the findings of this project as a means of understanding how these two theories complement one another and interact.

A systematic review exploring how young people use online forums for support around mental health issues.

Background: Young people increasingly look towards the Internet for support. Online forums have been developed to provide mental health support, but they have received little attention in the research to date. Aims: To summarise the existing literature examining how individuals use online forums to obtain support for mental health difficulties. Methods: A systematic review of electronic databases was conducted to identify empirical literature in this area. The papers that met the inclusion criteria and satisfied quality assessment review were analysed for key themes. Results: Twenty-one papers were found. Three common themes in the papers were associated with opportunities of the technology: (1) Providing stand alone or complementary informal support, (2) Providing informational, emotional and infomotional support, and (3) Making use of the specific practical opportunities afforded by forum technology. A further three themes were associated with challenges: (1) Managing the expectations of forum users, (2) Ensuring service user safety, and (3) Navigating the technical challenges associated with forums. Conclusions: The paper highlights the potential for individuals to access dynamic and responsive support within online forums. Additionally, it reflects upon the major areas that mental health professionals need to be aware of when entering into this arena.

Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support.

BACKGROUND: The Internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals which they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support, and most importantly help them feel less alone and normalize their experiences in the world. OBJECTIVE: The aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what young people discuss and how they seek support on the forum (objective 1). Furthermore, it looked at how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support (objective 2). METHODS: Kooth is an online counseling service for young people aged 11-25 years and experiencing emotional and mental health problems. It is based in the United Kingdom and provides support that is anonymous, confidential, and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a 2-year period, which resulted in a dataset of 622 initial posts and 3657 initial posts with responses. Thematic analysis was employed to elicit key themes from the dataset. RESULTS: The findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large dataset also reveal that this informational or emotional support can be viewed as directive or nondirective. The nondirective approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way, but the sharing process is hoped to be of use to the poster. The directive approach, in contrast, involves individuals making an explicit suggestion of what they believe the poster should do. CONCLUSIONS: This study adds to the research exploring what young people discuss within online forums and provides insights into how these communications take place. Furthermore, it highlights the challenge that organizations may encounter in mediating support that is multidimensional in nature (informational-emotional, directive-nondirective).

Adapting cognitive behavioral therapy to meet the needs of Chinese clients: Opportunities and challenges.

With the growing influence of China (Chinese people/culture) on the world's politics, economy, and culture, the psychological wellbeing of Chinese people is becoming increasingly important for both researchers and practitioners. Despite this, the cultural responsiveness of many conventional psychotherapeutic models has often been brought into question. In contrast, cognitive behavioral therapy (CBT) is rapidly becoming one of the most popular approaches in the mental health service industry and has been successfully adapted into many different cultural contexts. The current article is a theoretical discussion of the opportunities and challenges that CBT faces with respect to how it might meet the cultural needs and preferences of Chinese clients. Suggestions for successful cultural adaptation are offered based on existing research and practices. It is concluded that many features of CBT appear to match well with the Chinese cultural perspective. However, despite this promising start further work is needed to focus specifically on its practical effectiveness for Chinese clients.