Prepared for the U.S. Surgeon General’s Report on Mental Health

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As director of Mental Health Net, one of the top three World Wide Web sites devoted to mental health issues, an online psychologist, and a pioneer in the field of online mental health, it is an honor to write about how the Internet has vastly helped people learn and find support on issues relating to mental health. I am indebted to Sylvia Caras, of the Madness group and a long-time advocate of consumer issues in mental health, for bringing this report to my attention and encouraging me to contribute to it.

The Internet has had an increasingly valuable role in the promotion and care of individuals battling mental health problems. This role has taken on a number of facets ranging from virtual self-help support groups, and informational Web sites, to using online resources to announce research trials, organize advocacy and educational efforts, and reduce the stigma long associated with mental disorders. A mid-1998 Internet search (on the AltaVista search engine) for keywords relating to mental health discovered the following results: “mental health” returned 303,514 results, “mental illness” returned 58,367 results, and “madness” returned an astounding 401,480 results (Caras, 1998).

Virtual Self-Help Support Groups

Virtual self-help support groups are one of the oldest and perhaps strongest uses of the Internet in mental health. Fulfilling needs similar to real-world, mutual self-help support groups, online support groups are varied in their depth of community, technologies used, and purpose. Technologies used range from newsgroups to mailing lists (listservs), but the goal remains the same. Online support groups allow individuals to share their experiences, hopes, dreams, troubles, and difficulties in coping with a mental disorder with others who have been there, or are there now. Mutual self-help support groups are not run by any type of professional, and yet are the more popular mental health forums available online today. The Internet allows people from all different cultures to come together and share in support and hope to help face the same terrifying experiences of mental illness. Such groups for rare medical disorders or for people who live in rural locations are also valuable. A real-life group would be nearly impossible to run for many rare medical problems, even in larger communities. A person with a traumatic brain injury might be the only individual in a 500-mile radius who has that problem in rural Montana. The research literature has long supported the benefits of mutual self-help support groups (see, for example, Humphreys & Noke, 1997; Kyrouz & Humphreys, 1997). Their online brethren are likely to be similarly effective and beneficial. Researchers such as King (1996) and Finn (1996) have also begun to look at the effectiveness and research issues involved in studying online support groups.

Information and Education

The second important effort has been in the dissemination of basic mental health information, most often via World Wide Web sites. This information ranges in nature from site to site, but often includes things such as the symptoms associated with a particular disorder, effect and empirically researched treatments, psychopharmacology reference information, and even personal stories about grappling with the disorder posted on thousands of people’s Web sites throughout the world (Grohol, 1997). Objective information helps a person learn more about a disorder before ever having to consult with a mental health professional. Knowing some basic information about one’s concerns can also help a person ask more informed questions of the mental health professional. Mental Health Net (1998), an index of mental health resources online which I oversee, currently lists over 8,000 such online resources. These resources continue to grow daily at an astounding rate.

Subjective information sharing can help a person free their own inner demons through writing, sharing, and publishing on the World Wide Web as well. Through sharing one’s experiences with a mental disorder, treatments, and personal tribulations, this information becomes a unique and helpful learning base for others. Those who read these published experiences suddenly realize that they are not alone in grappling with this problem. Personal stories, poetry, artwork, and other endeavors released by one’s imagination are published daily on thousands of Web sites around the world. The Internet allows these interactions to occur in ways never before possible. Anyone can become a self-publisher to a potential audience of millions.

With the additional online tools of anonymity and pseudonymity, people feel much more comfortable discussing these types of issues (Grohol, 1998). A stigma is still attached to mental health problems in society. The online world, however, makes all people equal. It doesn’t matter that a person is depressed online; others see him or her for the human being that they are.

Advocacy

Internet technologies also allow for increased advocacy efforts in a manner which isn’t easily equaled in the real world. Grassroots advocacy online costs little in terms of money or effort, and the reach is nearly limitless. Reaching millions instead of hundreds, consumer efforts such as MadNation (1998), The Madness Group (1998), and the Support Coalition (1998) have helped spread the word of their educative and lobbying efforts in the mental health field to far more quarters than would have been possible without the Internet.

Direct Services

Some people also use Internet technologies for direct care, via Internet-based mental health services and interventions by trained professionals. Currently there are over 120 mental health service providers online (Metanoia, 1998). While these services are still largely in their infancy, they are a fast-growing field and foretell a trend toward direct patient care online. Stuart Klein (1997) has hypothesized that the lack of visual cues in telephone therapy only intensifies the need and ability to listen. This can be transposed onto the online mental health services as well, except that “listening” is done through reading of an individual’s words, what is written and what is not. Klein points out this theory is supported by information processing research. And he notes Lester’s (1995) research, which reported the lack of nonverbal cues is nothing new in counseling roles in society. Psychoanalysis, where the analyst sits out of view of the patient, and Catholic confessions are used as illustrative examples. Lester (1995) also details how phone counseling is advantageous for physically disabled clients who may not be able to travel easily, and is very empowering for them. These same benefits are likely true of online counseling as well.

Summary

As online use steadily increases, it is not surprising that more and more people are getting their mental health information, education, and support from the Internet. Online communities of support have existed for years and continue to grow and flourish. The depth of experience and information found online is difficult to equal in the real world. I hope the importance of the Internet as not only an educational and reference tool, but also as a warm, caring place to share support and help, is understood as an integral part of any public education effort.

References

Caras, S. (1998). Personal communication. Ferguson, T. (1996). Health online. Addison-Wesley: New York.

Finn, J. (1996). Computer-based self-help groups: On-line recovery for addictions. Computers in Human Services, 13, 21-41.

Grohol, J.M. (1998). Anonymity online: Central factors in anonymous communications. Online at http://psychcentral.com/

Grohol, J.M. (1997). The insider’s guide to mental health resources online. Guilford: New York.

Humphreys K. & Noke J.M. (1997). The influence of posttreatment mutual help group participation on the friendship networks of substance abuse patients. Am J Community Psychol, 25, 1-16.

King, S. (1996-1998). Essays and articles by Storm A. King.

Klein, S. (1997).

Kyrouz, E.M. & Humphreys, K. (1997). A review of research on the effectiveness of self-help mutual aid groups.

Lester, D. (1995). Counseling by telephone: Advantages and problems. Crisis Intervention, 2, 57-69.

Mad Nation. (1998). Online at http://www.madnation.org/

Madness Group, The. (1998). Online at http://www.peoplewho.org/Madness/

Metanoia. (1998). Online at http://www.metanoia.org/

Support Coalition. (1998).