• How does a Rural Private Practice Clinical Psychologist use e-MH?





    1. How do you use e-MH resources in your work as a Clinical Psychologist in a rural private practice setting ?

    In several ways:
    • Firstly, clients may be directed towards doing an online program (like MoodGym) in between sessions if deemed necessary. This might help reinforce things that we cover in session.

    • Secondly, I will suggest certain apps to some clients to reinforce some of the strategies we might discuss in session.

    • Thirdly, if we have a waiting list, it can be useful to direct people towards online programs if there are no other face-to-face options locally available.

    • Finally, I will recommend certain suicide-prevention websites with online counselling (such as Kids Helpline) to those at a higher risk or who have indicated that they feel they might need to talk to someone at short notice (I also tell such people to present to the local hospital emergency department if necessary).



    2. What types of e-MH tools and resources do you use with your clients?

    Evidence-based tools are very important to use where possible. So, I often recommend websites like MoodGym and Mental Health Online for adults and Bite Back for teenagers as online CBT and positive psychology interventions.

    Other information websites such as Beyond Blue for adults, and Reachout and Kids Helpline for young people. Counselling and crisis support can be provided by appropriately staffed online services such as Lifeline and Kids Helpline.

    I am more wary of apps because of the general lack of evidence, but I most recommend Smiling Mind for mindfulness meditation. I also recommend the Reachout suite of apps, and other apps that are “relaxing” by nature, and this might include certain game-type apps for children whose focus is not so much mental health, but which might offer ways of helping an individual to calm down and relax (like Relax Melodies). I am excited about a number of apps currently in development and being researched around Australia, including several through the Black Dog Institute that will hopefully be available in the not-too-distant future.


    3. How do you use them with your clients?

    I tend to be more interested in using e-mental health resources in a “coaching” manner, or as a “symptom-focused treatment” to reinforce strategies discussed in sessions. In this respect, I see the potential of mobile apps, but remain frustrated by the lack of research. This is what has driven me towards the topic of my own PhD. I don’t see these digital resources as replacing face-to-face, but rather complimenting face-to-face therapy. I consider these resources being part of the “homework” that clients do in between sessions. But in a rural area where I am, the potential for e-mental health will allow people to access information and treatment that they might otherwise not be able to access face-to-face due to availability and/or cost.


    4. What benefits does using e-MH bring to your practice?

    The first thing that comes to mind in answering this question is the potential to engage young people more effectively.

    But I’ve found it can also give clients a greater sense of control over their own recovery. It can also encourage clients to do more “homework” activities in between sessions.

    Given that we often have waiting lists to access our service, it is also good to be able to offer e-mental health options to those on the waiting list when there are no other local face-to-face services available.


    5. Have there been any challenges to using e-MH with clients and if so how did you overcome them?

    I have found one of the biggest challenges of using e-Mental Health tools is trying to keep on top of what is available, and then working out if it might be suitable for clients, especially if there is no scientific evidence for its effectiveness.

    It can be difficult to find the time to teach myself how to use these resources. It is one thing to learn about what is available out there, but it is another thing to then take the time to download an app or look at a website and work out how to use these resources most effectively for my practice and my clients. I think there is a definite need for more specific training in using particular e-MH resources.

    As far as cost is concerned, many of the good e-MH resources are free or are modestly priced. However, some are more expensive than others, and this then becomes a barrier for some clients. Finally, access to the Internet is still an issue for many in rural areas, and slow download speeds can really affect an individual’s engagement with a website or app.


    6. How long have you been practicing as Clinical Psychologist?

    I have been a Clinical Psychologist in private practice since 2013. Before then, I worked in a non-government agency while completing my Masters.


    7. What are the key features you look for when choosing an e-MH resource for use with your clients

    I wish there were more e-MH resources that were “preventative” in their approach rather than being “treatment” focused. I have found that many apps take the approach: “If you’re feeling down or anxious, then just pull out the app and get some strategies for dealing with it.” I’m more interested in apps like Smiling Mind that are more preventative in their approach, where the focus is more: “If you use this app every day, it will help you to maintain wellbeing and good mental health.”

    I think more research is needed into developing apps that are effective when used regularly (even every day) for a period of time, so that this can be incorporated into an individual’s daily schedule, rather than taking an ad-hoc approach to treating symptoms when they arise. This also fits in better with the idea of clients doing regular “homework” in between sessions to get the most out of those sessions.

    Finally, good evidence is also obviously important, and such e-MH resources with good evidence really stand out from the crowd.


    8. What tips can you give to colleagues who are thinking about using e-MH resources?

    There are many online resources that have good evidence. It is good to become familiar with at least a handful that you can offer to clients as alternatives.

    The apps situation is different – very few mental health apps have good evidence. At the very least, look for apps that are based on well-established scientific principles (such as CBT, ACT etc). It is best to get to know these apps better before recommending them to your clients, and to always tell them that the evidence is not there … yet. It doesn’t mean that some apps may not be potentially effective, it just means that they haven’t been scientifically evaluated, so a little more caution is required before health professionals recommend their use. But well researched mental health apps seem to be just around the corner – a number of apps are currently being developed and evaluated in Australia by reputable institutions such as The Black Dog Institute, Monash University and others, and these will hopefully become available in the next year or two.


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