HTN continues its exploration of digital mental health by talking to SilverCloud’s Co-Founder and Clinical Director, Professor John Sharry, about his interest in children and young people’s mental health (CYP) and what the future could have in store for the entire sector, as it continues to expand.
A psychotherapist and an adjunct professor at the School of Psychology in University College Dublin, Professor Sharry explains his career background, how digital can complement face-to-face therapy, and what to consider if you want to add more online tools to your offering.
Hi John, tell us about yourself and your role
By training, I’m a social worker and psychotherapist – I’ve worked in child and adolescent mental health for 30 years now. I have always been interested in supporting children, young people and their families.
I was one of the founders of SilverCloud, about 12 years ago, which started out as a research project on how to enhance therapeutic services using digital tools. The idea was to reach larger numbers of families, young people, and adults through digital means. It was a new way to access them.
How do you expect digital tools to help with NHS backlogs in mental health support for young people?
Youth mental health has always been a big issue. It’s even more so with COVID because young people have been disproportionately impacted, in terms of the lockdown. They’re at the time of life when they’re meant to be out, meeting friends and socialising.
Going out is not just an optional extra, it’s a central part of the whole developmental process. When they were locked down that was all cut off and it was almost like you’d cut out a developmental stage for them and there were big increases in problems such as social anxiety – people have lost their confidence about meeting others. They can have difficulties making friends – they’ve missed a lot of school and when they do go to school they’re masked up and can’t talk to anyone. It’s a massive setback for young people, I think.
Digital can help with the whole therapeutic process in several ways. It’s not meant to replace human contact, but to enhance it. SilverCloud isn’t designed as just a self-help programme that people do online. Very central to it is a set of relationships – there’s a qualified supporter at the heart of it. The personal support is the key thing. It facilitates the young person or the family’s contact with the professional service. There’s no therapy or help without people.
The digital world helps in three ways: one is that it increases access, as some people aren’t up to making a journey into an office to talk to somebody but they can do a baby step of interacting with a programme like SilverCloud, where they can get help and interaction with a coach; number two is that it’s a good adjunct if you’re seeing a young person in a clinic and it’s difficult to get a conversation going, it is a good way to break the ice, by saying ‘let’s look at this programme online’; the third way is when dealing with post-treatment, as a [type of] maintenance – when people see the therapist less often they can log in online and make a programme to build on all the success they’ve had.
It’s also a good way of managing a large waiting list, as well. You can see more people, at the same time, online. We’re finding with SilverCloud that, rather than doing a one-to-one hour with somebody, you can give support asynchronously to three or four people at the same time. You can access and support a bigger group of people online.
Tell us about SilverCloud’s ‘Space from…’ programmes
We’re trying to develop a suite of programmes to cover and fit into how professional services work. It’s not a replacement for professional services, it’s to support and enhance existing mental health services and make them more effective and accessible for young people.
The suite of programmes we have are addressing the most common of mental health problems for young people, which are primarily anxiety and depression. We’ve got a ‘Space from…’ programme for each and a programme that looks at both depression and anxiety – [as] about 40 per cent of young people would have a mixture of both symptoms. Professional services can encourage people to take part in those programmes.
We also have programmes for parents to support a young person who is anxious or depressed, or to [help] build a young person’s self-esteem, because often the person who is most motivated to help is the parent. In the research, when you look at outcomes probably the most effective way is to support both the parent and the young person. That’s where you maximise outcomes.
One of the big advantages of parents accessing support is that they if they’re anxious that helps them, too. It also helps them feel more confident in supporting their child. Parents are a very important part of the helping process. Supporting families holistically is something I’m very interested in. Sometimes services aren’t organised around that, they just see the patient and have no way of working with the families. If you have an adult going to mental health services and they’re depressed, they don’t often consider that they are also parent. But sometimes the cause of their depression is parenting, so supporting their parenting would make a difference.
You can provide more effective support by looking holistically at families, as opposed to individuals. We’re trying to persuade services to adopt that approach and be more family-central, as opposed to just patient-central. It’s not either/or, it’s both.
People using the SilverCloud programme like the fact that they can do the programmes at their own pace. They can do 20 minutes on the bus or during a tea break – the accessibility is really valuable to people, as is the support and feedback from their online supporter.
What are your hopes for the future of the SilverCloud programmes?
From my point of view, there’s always a new programme to be developed. We have the programmes that focus on depression and anxiety, which fit into traditional mental health services. But I am also interested in the wellbeing space and positive psychology – which is often the better way to present similar information, or a different route for people who are struggling with mental health. For some people it helps to accept a depression or anxiety label, for others a well-being approach is more helpful. It’s more [about] preventative, positive mental health and how to get the most out of your life, how to manage stress and make good friendships or succeed in college.
We do have positive mental health mini-modules that are accessible from the depression programme, which cover topics such as friendships, getting on with parents, managing stress, positive self esteem etc.
What else would you tell mental health services to consider when adopting digital tools?
The goal is to enhance mental health services, so you’d have to look at individual services and what their goals and target groups are, and what would help them do that better. It’s very bespoke to the individual service.
You might get a service with the challenge that they have too big of a waiting list and can’t cope with the amount of people. They could offer a much shorter, more streamlined digital service to the waiting list and reach a larger number of people with an effective programme.
It is similar, in a way, to when a young person logs into a programme through SilverCloud – we are trying to discover their goals, their pathways – it must fit with what they want, as opposed to what we think they need, which doesn’t work so well.
How do you see the adoption of digital mental health services evolving in the future?
It’s already there; young people are ahead of the curve. If a young person – or indeed any adult – is worried about something, the first thing they do is ‘doctor Google’ and search online for some help.
They may go to a reputable health site like the NHS, or they might go to something less reputable, a peer group or a social media group. But certainly, that is the first port of call.
The problem is that formal mental health services are usually stuffy and behind the curve, and they’re not ‘in the online space’. The important thing is that they do get ‘in the space’ and be a reputable source of information and support. Unfortunately, there is lots of harmful mental health information online – for there are many ‘pro-anorexia’ sites that makes things worse for people suffering from eating disorders.
Mental health services must move into being there, where young people are. The first principle of mental health is to join the patient or client where they are, not where you think they should be.
It has already happened, it’s just [about] how well mental health services adapt into the online digital world.