Here’s a thought: if you’re over 30, you belong to the last generation to know a world without computers. It’s not surprising that efforts to harness technology for youth health are using young people as the teachers and experts, as was outlined in an event at the National Press Club last week.
Below is an edited version of an address given by Associate Professor Jane Burns, Chief Executive Officer of the new Cooperative Research Centre for Young People, Technology and Wellbeing (YAW-CRC), with the title, The Happiness Highway: Leveraging technologies to improve wellbeing for young Australians.
By Jane Burns
Every young Australian deserves to be happy, healthy, safe and resilient – but what does this mean? Take Bronte as an example. Bronte’s childhood was a happy one. She’s from a well-off suburban family, she did exceptionally well at school, she was athletic, vice-captain of her primary school and had many friends. Bronte was a ‘normal’ run-of-the-mill kid. In fact, her normality was partly the reason why it was so hard for people to understand what was going on – mental illness simply does not happen to people like her.
Bronte barely survived adolescence. For 5 hard years her life spiraled out of control and was filled with suicide attempts, drug addiction, severe depression and intense anger. She was finally referred by her school to the Brain & Mind Research Institute (BMRI), a state-of-the-art clinical service in Sydney and diagnosed with bipolar disorder. As Bronte said afterwards: ‘It was pure luck that I stumbled across the BMRI. I was very lucky to walk through those doors and enter into quality care.’
Bronte’s story is not uncommon. However, receiving quality mental health care and getting it at the right time, is uncommon.
Today Bronte is studying at University but her life could have followed a very different path, one with dire consequences.
Suicide is a leading cause of death for young people aged 15-24, equal to motor vehicle accidents. Mental health difficulties affect one in four young Australians – over one million young people struggle each day with depression, anxiety, eating disorders and substance use problems.
The burden associated with mental illness disrupts relationships with family and friends, education and work and significantly impacts a young person’s quality of life. Conservative estimates from studies around the world show that one suicide affects 28 people: family, friends and community members. Mums. Dads, Brothers. Sisters. Schoolmates. Teachers. Sporting Coaches. Employers. Mental Health Professionals. Too often these suicides are a consequence of untreated mental illness.
Research shows us that 75% of mental illness begins before the age of 25 and despite reforms in the mental health sector and community awareness campaigns, a shocking 70% of young people experiencing a mental illness still do not seek help.
Every year mental illness costs Australia $48.6 billion: over a third of this can be attributed to loss of life to suicide and suicide attempts; untreated mental illness amongst young people and the impact this has on productivity, medical, carer and welfare costs accounts for more than $10 billion, and the balance, an alarming $20.5 billion, relates to the care and support associated with the reduced wellbeing of young people due to mental illness.
In the last budget $2.2 billion over 5 years was allocated to mental health. It’s a small pot and not nearly enough to close the funding gap. Five billion over five years is more on the money.
A study by John Beddington and others was published in Nature in 2008. It argued that countries must learn to make better use of their citizens’ cognitive resources if they are to prosper economically and socially. That is, we need to grow our mental wealth.
Beddington argued that a positive approach to life is associated with greater curiosity, more flexible thinking and a greater openness to learning – which translates to economic competitiveness, prosperity, social cohesion and inclusion.
This compels us to shift from thinking about investment in mental health as a moral issue (even though it is), to arguing that we must invest big because the economic future of our country rests on our young people being not only well educated but mentally healthy, fit and strong.
We simply cannot continue to do the ‘same old same old.’ If we are to address the significant burden placed on Australia due to poor mental health or low ‘mental wealth’ we need to look to new solutions and think in innovative ways.
Consider for a moment that my generation (anyone over thirty) is the last generation that knows what it’s like to live in a world without the Internet or social media. When I was ‘growing up’ I learnt to type on a typewriter with a clunky return arm, not a keyboard with a soft-touch ‘enter’ button. If I had something to say to a friend I wrote notes that I passed under the desk at school or spent hours on the landline after school until Dad came in and yelled at me to get off the phone.
We are the last generation to know a world without computers.
Today over 95% of young Australians use the Internet daily. Smart phones and social networking (used on a regular basis by 83% of young people) have completely changed the way young people engage with the world around them. Unlike adults, young people just do not make a distinction between their online and offline worlds. To use the words of Jack Heath, Inspire Foundation’s Founder: ‘technology for young people is like the air they breathe’.
The flip side of the technology revolution is the rise of serious challenges for young people related to technology use: cyberbullying, sexting, cyberaddiction and inappropriate facebook content. 71% of parents are worried about their child’s safety online. Policy makers, schools, service providers, corporate media outlets and parents are under increasing pressure to respond to an exponentially expanding technology-universe filled with risk and uncertainty.
So what terrifies parents? Take Tony as an example. Tony’s terrified about what his two teenage boys are doing online. He doesn’t understand why they love games; he’s not sure how often they access the internet, what they look at online and what they do with photos they might create with their mobile phones. He’s heard about a thing called sexting and he knows a little bit about cyberbullying but in Tony’s day bullying involved the big boys at school putting the little kids in the rubbish bins.
Tony is your classic but digitally disconnected parent – legitimately concerned but not sure of the answers. A virtual chasm exists between young people (anyone under the age of 30) and old people (the rest of us). If this digital disconnect persists, it will lead ultimately to ineffectual social policy and programs that fail to address either young people’s or adults’ needs. To reduce the digital disconnect we need to get everyone on the same screen.
Can we attend to parents’ fears, without either over-emphasising or trivialising the risks? Can we keep the good, get rid of the bad and leverage the opportunities that technology affords to promote the wellbeing of young Australians? At the Cooperative Research Centre for Young People, Technology and Wellbeing (YAW-CRC), we believe the answer is yes, but only through cooperation.
Last year, in December 2010, the Australian Government through its Cooperative Research Centres Program announced a $27.5 million investment towards a new CRC. It was our CRC, for Young People, Technology and Wellbeing.
Led by the Inspire Foundation, YAW-CRC brings together 70 partners in an enviable mix of large and small not-for-profit organisations; world class youth researchers across 17 universities; innovative thinkers from Industry and business; and mental health advocates. Never before have the Australian youth and mental health sectors united so cohesively around a single research issue: the use of technology and how it impacts on the wellbeing and mental health of young people.
We’re putting our money where our mouth is, and already we have set up A National Brains Trust of young people aged 15 to 25. The Brains Trust will provide strategic direction to YAW-CRC. Their voices will be valued, and their ideas and concerns will help build the powerhouse of ideas to drive our CRC, along with the views of world-class scientists and seasoned mental health reformers.
And we do have a powerhouse to draw upon. The $27.5 million Australian government’s investment is matched by over $80 million in cash and in-kind contributions from our 70 partners. Technology partners like Google, Yahoo7 and Telstra Foundation bring industry knowledge and unprecedented reach to connect with young people.
We have industry, but we also have the commitment and dedication of the large not-for-profits working alongside grass roots organisations and small innovative enterprises.
We have made a major commitment to young and early career academics, with an education and training program that starts in high school, continues with work placement and culminates in 25 PhDs and travelling fellowships to Johns Hopkins in the US. For 24-year-old Kris Gesling:
“YAW-CRC is very important to young people like me. Not only will it research and develop new tools to improve mental health and wellbeing, it will also provide invaluable experience and opportunities for the next generation of social researchers.”
YAW-CRC is at the beginning of its journey, and we draw inspiration from the success stories of other CRCs: soft contact lenses, the hybrid cochlear implant, improved coal productivity, the quality of beef and better mine safety. Like those other CRCs, ours will also conduct innovative research to help solve problems.
Our big question is: what does the ‘hybrid cochlear ear’ or the ‘soft contact lens’ of the mental health and wellbeing world look like? Is technology the 21st century vaccine that potentially could help to prevent suicide, depression, eating disorders and substance use problems?
Here are some examples.
First, cyberbullying – a major concern for 71% of Australian parents. In Australia spectacular work is being done to support schools in an effort to become ‘e-smart’. Led by the Alannah and Madeline Foundation it is the equivalent of the slip-slop-slap Sunsmart campaign. There has also been a significant investment in education resources by the Australian Communications and Media Authority, the Australian Federal Police and the National Association for the Prevention of Child Abuse and Neglect.
Earlier this year YAW-CRC researchers from Murdoch and the University of Western Sydney conducted research into social networking and safety online. Working directly with young people and adults they created virtual living labs – role reversals where young people became the teachers, and the ‘adults’ became the recipients of that education.
The researchers concluded that involving young people in developing and delivering solutions to ‘youth problems’ like cyberbullying leads to the creation of information that is more relevant, more engaging and ultimately more impactful.
What could this research mean in practice? Imagine combining this e-smart framework with content developed by an army of young people – digital content like short stories, videos and podcasts created by young people about being safe online. Simple messaging delivered via word of mouth on social networking services like facebook, twitter and habbo. It would be a combination of tips and advice, devised for young people and written by young people, full of suggestions about how to cope with difficult situations and where to go for further information from YAW-CRC partner organizations who specialise in cybersafety.
If schools are covered and young people are covered, all that remains is to back it up is a virtual knowledge Hub of information about cybersafety available 24/7 as downloadable podcasts of thought leader interviews for parents and professionals.
Second, to providing technology solutions to young people who are vulnerable. Young people with a disability or a chronic illness, young carers, indigenous Australians, homeless young people, same-sex attracted and young people from non-English speaking backgrounds are vulnerable. They are vulnerable because they experience stigma, are socially isolated or are without resources.
Young people who are same-sex attracted are six times more likely to attempt suicide than their heterosexual peers. This increased risk is due to the stigma and confusion they experience, either in suppressing their sexuality or coping with the stresses of coming out. Through YAW-CRC, these young people will work with researchers and our small grassroots not-for-profits the Freedom Centre, the National LGBTI (lesbian, gay, bisexual, trans/transgender and intersex) health alliance and twenty10 to explore technology solutions. These could include the creation of an online campaign to stamp out homophobia in schools. Until we ask young people we won’t know.
Young people with a disability face significant communication and social skills challenges. Making friends, keeping friends, simply being included is hard work and many young people with a disability are simply shut out of schools, workplaces and the community. Victoria University brings to YAW-CRC researchers with interests in IT, disability and mental health promotion. Working at a local community level in Footscray in Melbourne, the University will explore how the use of virtual worlds and games can be used to teach life skills like communication and cue recognition for young people with Autism Spectrum Disorders. The joy of practising life skills in a virtual world or through the safety of a game is that young people can make mistakes without consequences. They can learn from those mistakes in a virtual environment and then translate that knowledge to the face-to-face interactions they might have in the community, with family and peers at school.
Third, to reforming our broken mental health care system. The introduction of the National Broadband Network could dramatically change and fast-track the way we deliver services to those experiencing mental health difficulties.
Our partners who provide mental health services to young people – reachout.com, headspace, butterfly, beyondblue, lifeline, kidshelpline and many others – all recognise that investing in e-mental health services for young people is wise. For a generation that has grown up with the internet and web-enabled devices, accessing support online feels comfortable, safe and easy. Its anonymity and 24-hour availability are added advantages for a young person that is not yet ready to ‘speak’ to someone face-to-face or by phone.
Online services offer a critical pathway to appropriate care and play a crucial role in reaching the 70 per cent of young people experiencing mental health difficulties who aren’t currently being helped. The advantage of e-mental health services is that they don’t require training a new workforce, constructing new buildings or rolling out centres one community at a time. They are available 24 hours a day and are able to absorb huge demand at little cost, making them an ideal complement to other reforms in mental health.
Going back to Bronte, or any distressed young person anywhere in Australia. They might be a 16-year-old living in Kalgoorlie with their mum and dad, they could be a 21-year-old university student sharing a house in the suburb of Parramatta in Sydney or a 24-year-old guy taking over the reins on the family farm in a remote area of Western Australia. These distressed young people are not just having a bad day. They can’t get out of bed, their drinking could be out of control, they are not sleeping at night and they’ve lost their appetite. They just don’t enjoy life anymore. They’ve shut out their friends and their family. Or worse, they’re showing up to life every day putting on a happy face and no one knows how dark their thoughts have become.
At the moment they have two tools that could save their lives by providing immediate access to the support they need: a mobile phone and a laptop computer. The NBN is fast so access isn’t a problem (remember this is five years into the future) – and if they don’t have a computer at home they can access one at school or their local community centre.
Let’s look at the journey of ‘Jack’. He’s a 21-year-old and it is five years in the future, and this is his story:
I’m studying at uni but my grades are starting to drop off. I can’t sleep at night but can barely get out of bed in the morning. My Friday night usually involves a few beers at the pub listening to a local band, but these nights have started to turn messy and my drinking is out of control. A few times I’ve ended up in a brawl with my mates. My girlfriend has had enough and has bailed out of our relationship. My life sucks and I’m worried about my drinking.
After a bad ‘bingey’ Friday night, Jack does what everyone does when they are looking for an answer to a tough question – goes to Google and types in ‘sick of life’. Straight away he will be linked in with the work of world-class research scientists and mental health professionals and service providers. Jack is immediately directed to an online Question and Answer service, YAW-LINK. His question is ranked as being really important and he’s asked a few other questions about life and what’s making it tough. He fills in a 5 minute survey and gets a simple report that tells him his level of drinking is dangerous. He feels sick at the thought that something could be wrong with him. In a comfortable and private environment he checks out some options.
The Q&A directly links him to stories from other young people on the reachout.com and headspace sites. He’s invited to download a mental fitness toolbox for guys that has tips and hints on how to manage anger, how to keep on top of the game and how to keep on track with his diet and exercise. He’s taken on a virtual tour of his local Headspace, all from the privacy of his own home. Eventually Jack feels comfortable enough to talk to an online counsellor in the e-health clinic who suggests a face-to-face meeting with a Headspace psychologist.
The psychologist introduces him to moodgymmobile, a cognitive behaviour therapy program developed by the Australian National University and modified for use on Jack’s mobile phone. This psychologist is a YAW-SMART psychologist, technologically savvy and able to help him download some free mobile phone apps. These can directly monitor his moods, link to his sleep patterns and help him track his diet and exercise. Best of all, he’s in control, having created his own modified wellbeing centre by picking and choosing what works for him. Jack now has the full support of his psychologist, backed up by a virtual clinic with online group therapy if he wants it.
The opportunities technology affords are limitless and only constrained by our capacity to move quickly and in step with technology as it evolves. We can only achieve the vision of a ‘mentally wealthy’ Australia by working in partnership with young people. Join us in realising the vision of the CRC for young people, technology and wellbeing. In the words of VicHealth, a major partner, together we can do better.
In the same way that dietary salts, mosquito nets and condoms can be the highest-return investments in developing countries, investment in the mental wealth of young people through the use of technology may well be the highest-return investment available in the developed world. We must view young people as part of the solution – they are not simply a problem that must be fixed, externally and at arm’s length.
• Jane holds a VicHealth Principal Research Fellowship at Orygen Youth Health Research Centre, Centre for Youth Mental Health at the University of Melbourne and an Honorary Fellowship at the Brain & Mind Research Institute, University of Sydney. She was a Commonwealth Fund Harkness Fellow in 2004–2005 at the University of California, San Francisco. She joined beyondblue: the national depression initiative in its start up phase and established and managed the youth agenda. Jane completed her PhD in Medicine (Psychiatry and Epidemiology) at the University of Adelaide (1994-1996).
