‘Log On’ to better mental health

An oft-cited beyondblue report shows medical students report higher rates of distress and burnout than the general population, and 19.2% have experienced suicidal thoughts in the past 12 months. Only 56% of students with depression sought treatment, and just 37.4% for anxiety; this number drops to less than 10% for doctors. Students perceived that the medical community still stigmatises doctors with mental health conditions, and the perception that they would be viewed as incompetent or suffer repercussions on their career was a major barrier to seeking treatment. Additional barriers included fear of impact on their registration, confidentiality concerns, lack of time, and cost.

We have dedicated so many resources to raising awareness, to starting conversations, to deconstructing the stigma surrounding mental illness. But seeing the benefits of those efforts requires massive cultural change, which takes time. What happens in the interim? What happens to the people who fall between the cracks? We need a treatment option that can operate outside of those barriers.

For many years, the conventional wisdom was that cognitive behavioural therapy (CBT) had to be delivered face-to-face for that human connection. This year, I started doing research at St Vincent’s Clinical Research Unit for Anxiety and Depression (CRUfAD). CRUfAD specialises in internet-delivered CBT (iCBT). The courses are sophisticated, illustrated modules which follow the story of patients being treated, while simultaneously teaching you skills to manage, and treat, your illness.

The advent of iCBT has changed the game when it comes to access to, and distribution of, treatment. It can be clinician-guided and prescribed by your GP, or taken in self-help form where you register yourself. It’s been a boon for the general community in terms of convenience, privacy and cost, and the same benefits can – and should – be realised by the medical community. The cost of an iCBT course varies; some are free, some cost up to $60 – significantly less than the cost of seeing a therapist. You can do it at home, on your phone, virtually anywhere in the world. More importantly, it’s been shown to be equally as effective as face-to-face therapy.

But, of course, we’re all data nerds, so I won’t expect you to take my word for it. There’s a wealth of evidence demonstrating the efficacy of iCBT, and over 30 randomised control trials conducted by CRUfAD alone. I’m currently updating a meta-analysis done in 2010 looking at the efficacy of any iCBT program worldwide in major depression and the anxiety disorders. Spoiler alert: it’s pretty effective. The results indicate there was no significant difference between iCBT and face-to-face-therapy. These results confirmed those of the original meta-analysis, and concur with the literature more broadly.

Clearly, we need to work on the stigmatising culture that surrounds mental illness, particularly in the medical community. But in the interim, we need to find solutions – because if only half of our students and a tenth of our doctors feel comfortable and able to seek treatment, we are failing them.

Ashna is a 5th year medical student at UNSW, and the President of the NSW Medical Students’ Council.