Mental health issues affect one in every five Australians and accounted for 7.7% of total healthcare expenditure in Australia in 2015–2016.
The CRC for Mental Health works to reduce the burden of mental health by studying biomarkers: biological indicators that aid preventative treatment and early diagnosis of diseases such as Alzheimer’s or Parkinson’s.
Postgraduate researchers at the CRC have developed a program to improve mental health issues in their fellow PhD students, with a focus on recognition and preventative action.
The Write Smarter: Feel Better program was informed by studies that suggest 50% of PhD students experience psychological distress during candidature. Few are likely to seek help.
“When we looked at the research, it was concerning that one in three [PhD students] will develop a mental health disorder during their candidature,” says PhD student and registered psychologist Karra Harrington, a co-developer of the program.
The program focuses on the importance of social connection. Monthly online meetings connect students from five different universities around Australia.
“Communication about mental health is paramount for overcoming stigma and supporting people to flourish,” says Harrington. Her background as a practising psychologist provided the drive to investigate practical processes for combatting the ‘PhD blues’.
Sabine Bird is another PhD student working with the CRC for Mental Health. “Feeling ‘stuck’ while writing is an experience every PhD student goes through,” she says. “If not dealt with, it easily leads to ongoing procrastination, a lack of progress and even a sense of failure.”
In working with the CRC, students recognise the importance of communication in maintaining good mental health, but also to convey their research to foster real-world outcomes.
Melanie Carew, Head of Education at the CRC, says they’ve been pleased with the mutually beneficial outcomes of the PhD program for the CRC and the participants.
“Our education program focuses on developing our students’ ability to think broadly about their research and the skills they have developed during their PhDs, then use them in different settings,” she says. “Write Smarter: Feel Better is a fantastic example of how our students can apply their scientific training and work collaboratively to solve problems.”
Recently, the program has been adopted by The University of Melbourne. It will be offered to all higher degree research students. Harrington attributes this success to their platform of communication with the CRC. “Communication of our research helped to highlight the value and benefits of Write Smarter: Feel Better for PhD students, their loved ones, PhD supervisors and universities or other research organisations such as CRCs.”
World-first research by beyondblue and the Bushfire and Natural Hazards CRC will invite up to 20,000 current and former personnel from 34 police and emergency organisations across Australia to participate in a survey about their mental health and risk of suicide.
As part of the National mental health and wellbeing study of police and emergency services, beyondblue is working closely with employers, personnel and their families on practical strategies to improve the mental health of police and emergency services workers and volunteers.
It is the first time data is being collected on a national scale from police and emergency service organisations. The emergency services health research is being conducted in three phases after qualitative analysis was gathered in phase one last year.
From August 2017, police and emergency service workers will be surveyed about their wellbeing; common mental health conditions; suicide risk; stigma; help-seeking behaviour; and factors supporting, or jeopardising, mental health in the workplace.
The University of Western Australia and Roy Morgan Research are working together on phase two of the emergency services health study, which is expected to conclude in December.
The Bushfire and Natural Hazards CRC has provided a funding contribution to the study and will support beyondblue’s work.
“The only national statistic we have about the mental health of police and emergency service workers is a devastating one – 110 Australian police and emergency services workers died by suicide between 2010 and 2012,” says beyondblue CEO Georgie Harman.
“Beyondblue’s reputation is based on its use of scientifically sound, evidence-based research from which we build and develop programs to promote a better understanding of depression and anxiety and suicide prevention.”
Bushfire and Natural Hazards CRC CEO Dr Richard Thornton says the project will provide important information to understand both the number of people affected and the range of issues they face.
“The understanding we gain will be used to design interventions to support them and their families and improve personal, family and agency outcomes,” says Thornton.
In phase one, completed in November last year by Whereto Research, current and former police and emergency service employees, volunteers and family members were interviewed about their experiences of mental health conditions in which participants felt at risk of suicide.
Initial findings suggest:
the nature of the stigma associated with mental health conditions differs across police, fire and rescue and ambulance services;
although exposure to trauma is seen as an underlying cause for post-traumatic stress disorder, workplace culture and practices also contribute to the prevalence of mental health conditions;
working in police and emergency services, particularly for volunteers, can support workers’ mental health.
“In phase three, beyondblue will work alongside police and emergency service organisations to identify strategies to practically address the issues raised by the findings of this research,” says Harman.
These evidence-based strategies will support individuals, improve organisational culture and address systemic concerns that impact on mental health and wellbeing across the sector nationally.
They will be developed in collaboration with a cross-section of the police and emergency services sector including agencies, unions, government departments, individuals and family and community groups around Australia.
Gaining industry experience and seeing how their research can have practical applications is important to early career researchers. Universities and industry are now working together to help provide graduates with the opportunity to work on commercial solutions for real-life problems.
“The partnership allowed me to do things that haven’t been done before, like use optical fibres as sensors instead of electrical sensors,” says Allwood, who will work with Bombora Wave Power to test the sensors.
There are other, similar Australian programs. CRCs offer a number of scholarships across 14 different fields of research, giving PhD students a chance to gain industry experience.
The Chemicals and Plastics GRIP has 20 industry partners offering training and funding, including Dulux and 3M. One student is treating coffee grounds to create a fertiliser to improve the soil quality of agricultural land.
Romlie Mokak, CEO of the Lowitja Institute for Aboriginal and Torres Strait Islander Health Research, is a man with a vision.
“We’ve got a clear agenda for the future and it’s for just 15 years ahead: 2030. This agenda has been agreed upon by governments and Aboriginal and Torres Strait Islander leadership as part of the ‘Close the Gap’ campaign,” said Mokak.
The aim is to eliminate the difference in life expectancy between Aboriginal and Torres Strait Islander people and other Australians by 2030. It’s a big ambition that will take a lot of work.
“It’s essential that solutions in Aboriginal and Torres Strait Islander health and wellbeing come from the people themselves,” he said. A vital step is explicit recognition of Indigenous people in the Australian Constitution, supported by the Recognise Health coalition launched by the Lowitja Institute in March 2015.
“If we hit the target, then by 2040 we will have had 10 years with no gap. We will have a high quality, accessible health system that is culturally appropriate for Aboriginal and Torres Strait Islander people.”
Since 1997, the Lowitja Institute and its predecessor CRCs have led a substantial reform agenda in Aboriginal and Torres Strait Islander health research by working with communities, researchers and policymakers. In partnership with 21 participants, the CRC is poised to make a substantial contribution to the goals for 2030 and towards a 2040 that sees Aboriginal and Torres Strait Islander participation and leadership in all walks of Australian life.
You are 16 years old and have a secret, which you’ve been carrying around for what feels like your whole life. You feel trapped so you turn to marijuana and alcohol to numb the pain. Your grades begin to slip and your parents are worried so they send you to a psychologist. During your first visit, the clinician in the waiting room starts asking questions, and all you can hear is your heartbeat ringing in your ears.
When it comes to receiving effective mental health treatment, early diagnosis and non-judgmental support are essential. In order to assess what types of treatment options are available, many clinicians start with a verbal assessment. However this verbal assessment is a barrier for many young people, preventing treatment. Psychologist and PhD candidate Sally Bradford recognised that young people between the ages of 12–25 could benefit from a different kind of assessment.
“They’re going into an environment where they’re expected to verbally relay everything that is going on in their lives – to tell their deepest, darkest secrets that they may have never said out loud before,” Bradford says. “It can take a long time for them to find the words – especially if the clinician doesn’t ask the right questions,” she says.
As part of her PhD focusing on the use of technology in face-to-face mental health care with young people, Bradford created the electronic psychosocial assessment app called “myAssessment” that helps clinicians evaluate young people quickly and easily. Speaking to the National Mental Health Commission’s review of Australia’s mental health system, this new screening process underscored the need to improve health services and support through innovative technologies.
“The app could be beneficial in any field where you’re needing groups of people to be truthful, and give answers in a way that they do not feel judged,” Bradford says.
Based on the strides Bradford made in youth mental health with the invention of myAssessment, she was awarded the $5000 top prize at the CRC Association Early Career Research Showcase at the CRCA’s Excellence in Innovation Awards Dinner in Canberra.
The app was developed in close conjunction with the Young & Well CRC, youth focus groups and clinicians, and subsequently trialled at a headspace Centre in Canberra over nine months in 2014.
“The app was designed with significant input from young people and clinicians, and puts their needs and requirements first. For clinicians, it follows an evidence-based format and doesn’t require changes to the way they currently provide services. For young people, it’s interactive, engaging, and easy to use,” Bradford says.
The way it works is a patient arrives for their appointment. Prior to seeing a clinician, patients complete myAssessment on an iPad in the waiting room. The app is a simple survey, but with a range of different response options. Topics include alcohol and drug habits, sexual preference, eating habits and anxiety and depression. Questions include screening and probing questions. Screening questions can be a yes or a no answer that prompts further questioning: Do you drink? Smoke? Have you tried or used drugs? What have you tried?
A probing question allows for a more comprehensive understanding of the issue, such as, how do you (and your friends) take them? (drugs). After answering and submitting these questions, a personalised ‘Clinician Summary’ details the patient’s risks and strengths, providing the clinician with a foundation for the first interview.
Bradford’s trials proved to be particularly enlightening, with an 87% response rate, and ¾ of patients reporting that myAssessment provided them with an “accurate” representation of themselves. The results also showed that young people were up to 10 times more likely to open up about drug and alcohol use, sexuality, and self-harm when the application was used, in comparison to a verbal assessment with the same questions.
“There was a wealth of data generated over the course of the trial, which could be particularly useful for policy reform in the future,” Bradford says.
When paramedics or emergency personnel discover a patient who has suffered massive facial or airway trauma, often in situations like a car crash, they may have to perform a cricothyrotomy, which involves stabbing a tube into the patient’s throat so they can breath.
It’s a procedure you want them to get right.
But in these life-threatening situations a paramedic or doctor may have only ever performed the procedure on a training device. It’s therefore doubly important that this device teaches them the correct technique in an accurate and realistic way – it’s life or death.
Many doctors will now be training for complicated cricothyrotomies on a German-built Crico Trainer called ‘ADELAIDE’ designed by Robert White and Daniel Weiss in South Australia.
“The procedure, it’s not something that most doctors will have to use,” says White, one half of the WHITE + WEISS design team.
“No one really wants to stick a tube through your throat, but if you need it, they need to know how to do it properly, to prevent you from dying.”
A cricothyrotomy involves sticking a needle and cannula through the Adam’s apple, inserting a guide wire through the cannula in to the windpipe, removing the cannula, making a small incision at the base of the guide wire, threading a Melker Crico kit (an airway catheter and curved dilator) on to the wire, and finally removing the wire – thus clearing the patient’s airway.
Medical students practice the procedure on any number of trainers, simulators and manikins, but as Daniel Weiss says, they are not all very realistic.
“Beyond just the student learning it, it’s about muscle memory,” says Weiss. “In an emergency when you don’t have time to think, you need your muscle memory to work.”
The realistic Crico Trainer ADELAIDE was conceived by White and Weiss during their Masters of Industrial Design at the University of South Australia in 2012. It’s a practical course with real clients who have real design problems.
“This particular project started with the University of Adelaide medical school. They teach their students all sorts of procedures on all sorts of medical trainers. They found that there’s a number of these trainers they weren’t happy with,” White explains.
White and Weiss both decided to tackle the cricothyrotomy device, although they were working separately at the time. They were put in touch with Dr Chris Acott, the Southern Hemisphere’s foremost throat and neck expert.
The two designers attended Dr Acott’s workshops at the Royal Adelaide Hospital, training with doctors, seeing how they use the simulators and using them themselves. They had access to Dr Acott’s collection of Crico Trainers, many of which they realised were “pretty average”.
“The existing trainers were pretty basic,” says White. “There was a basic neck shape with an Adam’s apple and a skin that stretches over the top. They were missing obvious stuff – like a chin – which seems like a really basic thing.”
As they watched some doctors insert a tube and the designers realised they were coming in at an angle that would be impossible on a real person because the chin would be in the way.
“Dr Acott would catch it and remind them that they’d have to come in at an angle,” says White. “But if an instructor missed that, they student is going to learn that procedure incorrectly.”
After eight weeks of designing their individual versions of an improved Crico Trainer, White and Weiss took their prototypes to Dr Acott. He liked aspects of both, and suggested they combine the two.
In 2013 the men decided to continue the project outside of their Masters course, receiving a grant from ITEK, the University of South Australia’s commercialisation arm, to develop a prototype.
They worked through eight prototypes with Dr Acott before arriving at a model everyone was happy with.
It was a significant improvement on the available devices. The chin was an obvious addition, but many other smart touches also improved the usability and accuracy of the trainer.
“It was very cumbersome to put the skin on the old devices,” says White. “Ours is slotted where it can slip through and pull taut. You can use it again and again. We also added multiple layers of skin to add more realism.”
Feel is an important part of the procedure – doctors have to find the Adam’s apple quickly and accurately to perform a cricothyrotomy. The team also added additional layers of skin and a squishy adhesive layer to enhance the feel.
“A lot of simulators are designed to simulate the perfect case scenario,” Weiss says. “But you’re not going to be looking at the perfect 30 year old male every time – there might be damage or irregularities. That’s something we tried to incorporate, making the throat adjustable.”
Once the device was finished, ITEK started to shop the idea around to medical simulation companies. German company VBM Medizintechnik GmbH took an interest.
A licensing agreement was written up, and VBM redeveloped their Crico Trainer from the ground up based on White and Weiss’ design. With a nod to the simulator’s South Australian origins, they named the trainer ADELAIDE, after the capital city of the state, and attached a label crediting White + Weiss and the University of South Australia for the design.
The team also won a number of awards for their design. They received a Gold Student Award from the Design Institute of Australia, a Premier’s Award from the Premier of South Australia, Jay Weatherill, and were national finalists in the James Dyson awards last year.
Their current project is a nurse call device for aged care residents living with arthritis. Current devices are ill suited for elderly people with dexterity issues.
“They can use this type of device ten to thirty times a day. Most have small, fiddly buttons. They can have a lot of difficulty pressing it,” White says.
Their device doesn’t have a traditional button but rather a soft, flexible silicon bulb with an air pressure switch. Residents can squeeze it with minimal dexterity, use their whole hand or press it against an object. It’s an attractively designed device that lights up when activated – the result of nearly a year’s work.
“It’s currently making its way towards production. It should be underway in the next couple of months, once the tooling is ordered and underway. It should be in production and on the market later this year.”
Young and well CRC researcher Dr Daniel Johnson and his team at the Queensland University of Technology’s Games Research and Interaction Design Lab are exploring positive links between gaming and wellbeing. Johnson completed a year as a postdoctoral fellow at the University of Cambridge Well-being Institute in the UK before returning home to Australia to work at QUT.
“Historically, there has been a huge focus on the potential negative impacts of video games,” says Johnson. “So as a first step, we undertook a large-scale review of the literature relating to the positive impacts.”
In their experimental trials, the team monitor biometrics, such as brain activity, heart rate and muscle activation, in participants playing video games.
They have found clear evidence of a positive link between gaming and self-esteem, optimism and relationships. In collaboration with Smiling Mind, a not-for-profit initiative to engage young Australians in meditation, the results are being applied to improve physical and mental health.
“We are working towards a more broad-ranging view of the potential benefits of gaming and a deeper understanding of what types of games and features of games have a positive influence for which people,” says Johnson.
His overall advice is to “enjoy video games as part of a balanced diet. But think mindfully about what you play, how you play and how it makes you feel.”
IN THE HEALTH SECTOR, big data has been harnessed with remarkable success. One high-profile example is Google’s Flu Trends website, reported in a paper for the journal Nature in 2009 for accurately predicting the spread of epidemics based on the frequency of disease-related search queries.
Associate Professor Trish Williams, who heads the eHealth Research Group at Edith Cowan University in Joondalup, WA, says that unlike a lot of health research, projects using big data don’t focus on ‘cause and effect’. Instead, they tap into the huge potential of predictive analytics.
That’s an area where collaborative research can come to the fore, she says. Williams adds that big data research is most effective when done by cross-disciplinary teams who can both interpret information and present the findings to a broad audience.
“In health, it is really important that the semantics of the data are well-understood before you start analysing things,” she says. “You’ve also got to work out how to use some very big datasets, perhaps in ways that they weren’t necessarily intended to be used.”
“We’re working to improve the algorithms that detect what kind of problem the person has.”
This conundrum is very familiar to Associate Professor Jane Burns, CEO of the Young and Well CRC. When her team compared the results of a national survey that used ‘traditional’ computer-assisted telephone interviews with those from a similar Facebook survey, they expected both datasets would reveal similar trends.
“We found that the results were not similar at all; the internet results showed far higher levels of psychological distress,” she says, adding that there’s no sure way to work out which survey style had less bias. “Possibly, people are far more honest over the internet than they are over a telephone interview.”
Researching suicide indicators in social media is in its early stages, with researchers from the Young and Well CRC working with key industry partners such as Facebook, Twitter and Google.
“We’re trying to understand from a suicide prevention perspective, how we might be able to use big data to understand trends in the way in which people respond to things, to see if we can look to algorithms to capture some of the risks,” says Burns.
Social networking media holds a wealth of information on the public’s mental health.
With more than 500 million short messages going out through the Twitter network daily, Burns says that finding algorithms to uncover keywords for suicide risk is a huge challenge.
Included in the research is suicide contagion – where one suicidal act within a community increases the likelihood of more occurring. Burns says a key focus of their research around suicide contagion, as well as identifying early warning symptoms or signs, is initiating support networks.
Within the Young and Well CRC, Associate Professor Rafael Calvo of the University of Sydney is working to design tools that help moderators in online health-focused communities, such as youth mental health support service ReachOut.com, to provide appropriate feedback and support for their members.
Thousands of forum posts can be automatically processed, generating a report that prioritises more serious problems so moderators can respond immediately. The team has also developed suggested ‘intervention’ templates, which link to helpful resources.
“We have built the interface for the moderator, and we’re now working on improving the algorithms that detect what kind of problem the person has,” Calvo says.
One of the hopes for big data analysis is to uncover measurable biological indicators for devastating mental health disorders.
Social media is just one of the big data examples in health. At the CRC for Mental Health, researchers are looking for biomarkers – measurable biological indicators that might enable early intervention for people at risk of Alzheimer’s disease, mood disorders, schizophrenia and Parkinson’s disease. Datasets include the Australian Imaging, Biomarker & Lifestyle Flagship Study of Ageing, which has genomic information for more than 1500 people – some with normal cognitive function, others with mild cognitive impairment and others who have been diagnosed with Alzheimer’s disease.
Dr Noel Faux, a bioinformatician at the Florey Department of Neuroscience and Mental Health, says that the vast amounts of information already available include blood measurements of thousands of hormones and proteins. Cognitive and clinical assessments are also being gathered.
His team is working with software developer Arcitecta to help researchers capture clinical data on-site and feed it into a data repository that can be used by multiple research institutions.
HealthTracks, a web-based tool built by the CRC for Spatial Information, has been used by researchers at Western Australia’s Department of Health to merge health data with spatially-based datasets. The aim is to identify populations at risk of disease and gaps in the location of essential health services.
So far, hospital and regional health data has been combined with public datasets via the WA Landgate Shared Land Information Platform. When rolled out nationally, the tool will include modular enhancements for the analysis of mental health, child health and environmental health data.
