Digital mental health tools for Aotearoa’s digital generation

Love it or hate it, digital tools are here to stay. “Screenagers” (young people) are discerning users with little tolerance for outdated or glitchy products. Even when a digital tool is backed by good science, this does not guarantee young people will use it.

Mental health continues to be an important public health issue. The latest survey conducted by the Adolescent Health Research Group found that, in 2019, 23 per cent of young people reported depressive symptoms, compared with 13 per cent in 2012 (youth19.ac.nz). Higher rates were reported by females and young people from marginalised and/or socially disadvantaged communities. The impacts of the global pandemic are also likely to have a lasting effect on mental health.

A comprehensive and culturally responsive public mental health response is one that can reach the entire population and equip young people and their whānau with the skills and strategies to be resilient. This includes face-to-face services (primary and tertiary, NGOs, school counsellors) and a variety of digital tools.

Digital mental health tools can reach large audiences in a familiar, engaging and convenient format that is available 24/7. They provide help to young people who are unable, unwilling or not yet ready to access services, or for whom services may not be appropriate.

Support can come in the form of easy-to-access health information (in written, audio and video formats), practical strategies for dealing with everyday problems (multimedia, interactive exercises), right through to evidence-based therapies such as cognitive behavioural therapy (CBT).

Formats can vary from website interventions, smartphone apps, to virtual or augmented-reality interventions. Digital tools can also cater for self-management, clinician-supported interventions (eg, oversight by email to enourage patient adherence), and a blended therapist-and-digital approach.

There are more than 200,000 health and wellbeing apps available for download, many commercially driven (often with no scientific evidence to prove they work), designed outside of Aotearoa (lacking cultural relevance), or requiring some type of cost (a fee for registration, yearly subscription, or additional fee for premium features).

We acknowledge that digital tools available in Aotearoa must demonstrate a commitment to the four principles in Te Tiriti o Waitangi so that rangatahi and whānau Māori have equitable access to help.

The following digital tools have been developed or adapted in Aotearoa, are evidence informed and have culturally relevant content. Many of these digital tools are supported by the Ministry of Health. Additional information can be found in Digital Tools for Mental Health and Wellbeing: Stocktake (tinyurl.com/DigToolsStocktake) and on the Health Navigator website (healthnavigator.org.nz/apps).

The following digital tools have been designed for adult audiences but may also be suitable for some young people. Many may be helpful for whānau members supporting the young person with mental health concerns.

Auntie Dee (auntydee.co.nz) is a web-based tool that guides the user through a simple step-by-step process of structured problem solving – from naming the problem, through generating and evaluating possible solutions, all the way to choosing an appropriate action. It is interactive, simple to use and takes a couple of minutes to complete.

Small Steps (smallsteps.org.nz) is a website that outlines 12 strategies to help “manage stress, lift mood and calm the mind”. Content is conveyed through short texts, simple illustrations, brief video demonstrations and interactive exercises and quizzes. Some of the written content can be toggled between English and te reo Māori.

Just a Thought (www.justathought.co.nz) is a New Zealand adaptation of an Australian web-based tool for the treatment of anxiety and depression. There are eight courses, some of which include audio and New Zealand sign language. Content is modular and delivered through illustrated stories with interactive exercises and quizzes. While the programme is designed as a self-help tool, clinicians can register to monitor their patients through an online dashboard.

Groov by Mentemia (groovnow.com) is an app that allows users to explore different activities to boost their mental health. Content is organised into small activities, such as relaxation tools, daily mood checks and motivators, and short videos and articles on different topics.

Manaaki Ora is an app specifically for Māori individuals and whānau who want to know what to do if they are concerned about their own or others’ mental health. Based around Te Whare Tapa Whā, this app provides a way for Māori to learn and actively engage in building their own wellbeing and supporting other whānau members.

Your encouragement and support can be the difference between the young person engaging with the tool or not

How can you support patients to get the most out of digital tools such as these?

Take the first step yourself. Download a few of the tools to find out how they work, and think about how young people in your care might respond to them.

Ask young people or their whānau if they have heard of, or used any, digital tools. Young people will be happy to give you their frank feedback – if it’s good, you can use it as a testimonial with other patients.

Seeing is believing – show them the tool and how it works on your phone or tablet.

Only recommend tools from reputable sources (eg, developed by a university/research centre), backed by evidence and, ideally, made in Aotearoa.

Encourage young people to download or register on the spot (it is usually very quick) to eliminate hesitation later on. Consider having Wi-Fi freely available in your clinic to make it easier for patients.

Act like their coach. There is ample evidence that digital tools are effective – when they are completed! Your encouragement and support can be the difference between the young person engaging with the tool or not. Check on their progress, ask about their experience and troubleshoot if needed.

You can also suggest that the whānau work through the digital tool together. Younger teens may be particularly keen to share their experience with parents or siblings.

Remember, different things will appeal to different people, so offering choices and trying more than one tool is key.

Digital tools are part of the solution for improving the mental health of young people in Aotearoa. Their development needs an integrated team of people with mental health, computer science, marketing and indigenous health knowledge, with young people and their whānau as co-designers.

Digital tools have their own challenges, such as the expense associated with development, ongoing maintenance and marketing. However, their potential to reach young people when and where they need them is the key reason we need to continue to innovate and test new tools that are developed. n

Karolina Stasiak is a senior lecturer in the department of psychological medicine, University of Auckland. Tania Cargo (Ngāti Maru, Ngāti Manu, Ngāpuhi) is a clinical psychologist and senior lecturer at the University of Auckland. Sarah Hopkins is a research fellow at the University of Auckland. Sarah Hetrick is a clinical psychologist and associate professor in youth mental health at the University of Auckland

The authors have been involved in the development and rollout of SPARX (KS) and Headstrong (KS, TC, SH, SH)