Risks and rewards of digital therapeutics in treating mental disorders

More Americans than ever before are suffering from mental and emotional distress. In the U.S., the mental health problem is exacerbated by issues across infrastructure, government, and culture. However, because the resources for those living with mental health issues are constrained, startups could have a big impact.

In particular, we believe that digital therapeutic-approaches offer great promise in overcoming the problems inherent in traditional approaches to mental and behavioral therapy. Such problems relate to stigma, cost, and general inaccessibility of cost-effective treatments for the general population.

We are starting to see new energy behind innovators in the mental health space. Examples include Enlyte (discussed in greater detail below); Talkspace, an online therapy app that connects users with licensed therapists; Calm, a sleep and meditation app; and Feel, a wearable designed to monitor the user’s emotional state. Other examples are listed in the Appendix at the back.

Each of these companies—whether they aim to provide easy access to mental health professionals, to promote overall mental wellness, or to better monitor the user’s mental state—has the potential to be highly impactful as well as profitable.

In our view, the time is right to invest in mental health and digital therapeutics. In this paper, we provide an overview of the field of digital therapeutics for mental health, as well as the legal, regulatory and ethical issues that should be considered by entrepreneurs and investors.


Table of Contents


The big four mental health afflictions: Stress, anxiety, addiction, depression

Image via Getty Images / Feodora Chiosea

The mental health crisis costs companies around the world over $1 Trillion in lost productivity and increased health care insurance premiums annually. The productivity losses are primarily caused by absenteeism, and turnover and replacement costs.

In addition, the costs attributable to the family members and loved ones of employees (employee ecosystem) cost employers approximately 250% more in lost productivity than their direct employees. According to a report from the World Health Organization (WHO), 450 million people are currently suffering from mental health disorders leading to illness and disability.

The Lancet Commission on mental health predicts that by 2030, mental illness will cost the world USD 16 trillion. If we look at the US alone, 40.3 million people are affected by the disease of addiction. Twenty percent of US deaths are attributed to addiction to tobacco, alcohol, drugs and other substances.

Stress

The National Institute for Health (NIH) defines stress as a “physiological response to challenge or demand”. There are two forms of stress: acute and chronic. Acute stress is frequently referred to as your body’s fight-or-flight response.

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Another study points to link between '13 Reasons Why' and increased youth suicides

A new study found an association between increased youth suicides and the first season of the Netflix series '13 Reasons Why.'
A new study found an association between increased youth suicides and the first season of the Netflix series ’13 Reasons Why.’
Image: Beth Dubber/Netflix

Last month, researchers published a study that found an association between the debut of Netflix’s teen drama, 13 Reasons Why, and a subsequent uptick in youth suicides. The show depicted the grisly suicide of its protagonist, which alarmed mental health experts who were worried about the potential effect on young, vulnerable viewers.    

A new study, conducted by different authors, came to a similar conclusion: In the three months after 13 Reasons Why launched, the youth suicide rate for 10- to 19-year-olds rose unexpectedly by 13 percent. Based on historical trends dating back to 1999, 94 more American adolescents and teens died by suicide during the three-month period than otherwise expected. Similarly, the study published last month looked at suicide deaths in the nine months following the show’s launch and found an additional 195 fatalities. 

The researchers who authored the latest study, published Wednesday in JAMA Psychiatry, used the same suicide data from the Centers for Disease Control and Prevention and similar methodology. They looked at the suicide rate amongst adolescents and teens between 10 and 19 years old, whereas the previous study analyzed trends amongst 10- to 17-year-olds. The new study found an increase in suicide in both male and female youth while the previous research observed that association only in boys. 

“But both studies essentially have the same main finding — a clear increase of suicides among adolescents after the release of the series [at the] end of March 2017,” Thomas Niederkrotenthaler, lead author of the JAMA Psychiatry study and an associate professor at the Medical University of Vienna, wrote in an email. 

“So, there is now evidence from two independent teams who found the same main result. We hope that both of these studies’ findings will now encourage collaborations between the entertainment industry and suicide prevention. We also hope that this will be a wake-up call to those who have not considered the relevance of these kinds of collaborations in the past.”

Niederkrotenthaler and his co-authors looked at potential exposure to the show between April 1 to June 30, 2017, when the first season of 13 Reasons Why had just debuted and was most popular on Twitter and Instagram. Using social media data as a proxy for understanding peak interest in the show, the researchers suggest the show’s portrayal of suicide created a “contagion effect.” The phenomenon can happen when media coverage of suicide leads to suicide clusters. 

“This study provides additional strong evidence of the importance of using best practices when portraying suicide in the media.”

While the researchers couldn’t determine whether the children who took their own lives watched the series, an accompanying editorial written by researchers at Harvard and Stanford argues the study provides “strong evidence” that the Netflix show may have led to that increase. 

“One cannot draw definitive causal conclusions from such data, but that no similar increase was seen in suicide rates other than for the age group to which the media portrayal pertained provides some further compelling evidence that the excess suicides may indeed have been owing to the series,” the editorial’s authors wrote. 

Jeff Bridge, lead author of the study published last month, found the new research compelling. 

“This study provides additional strong evidence of the importance of using best practices when portraying suicide in the media,” Bridge, director of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital, wrote in an email. 

Meanwhile, those affiliated with 13 Reasons Why continue to reject negative findings about the show’s potential impact on certain viewers. The show’s creator, Brian Yorkey, and Rebecca Hedrick, a psychiatrist and series adviser, published a column Tuesday in the Hollywood Reporter refuting the recent study last month as well as past research that found a spike in internet searches about suicide methods. 

They rightfully point out that there is no single factor that causes suicide, but marshal in their defense Hedrick’s clinical anecdotes of patients who felt the series was helpful. Yorkey and Hedrick also suggest alternate explanations, including the “detrimental impact” of the current political debate.  

“We think that this response is unsatisfactory and disappointing.”

“We think that this response is unsatisfactory and disappointing,” Niederkrotenthaler said of the Hollywood Reporter column. 

In an interview with Mashable, Hedrick said she knew about but hadn’t reviewed the forthcoming research when the Hollywood Reporter column was published. She said their pushback reflected frustration that the studies appear to suggest there’s no benefit to watching 13 Reasons Why. Indeed, the authors of the study released in April wrote, “There is no discernible public health benefit associated with viewing the series, and caution regarding the exposure of children and adolescents is warranted.” 

Hedrick said research indicates the show positively influenced some viewers. A study published last month, for example, surveyed more than 500 college students who’d watched the series and found some developed greater knowledge about suicide as a result. 

A Netflix spokesperson, who contested the studies’ findings, said in an email that the show “tackles the uncomfortable reality of life for many young people today and we’ve heard from them, as well as medical experts, that it gave many viewers the courage to speak up and get help.” 

Niederkrotenthaler said he hopes the entertainment industry takes seriously its power to promote “help-seeking and recovery” by creating more responsible depictions of suicidal thinking and behavior that offer hope. He recommended guidelines designed specifically for Hollywood and issued last year by the National Action Alliance for Suicide Prevention.

“Netflix said they wanted to start a conversation about suicide, but what they started was a conversation on their responsibilities in safely portraying suicide,” said Niederkrotenthaler.

If you want to talk to someone or are experiencing suicidal thoughts, text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. Here is a list of international resources. 

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DC's 'Doom Patrol' helped me take ownership of my trauma

Image: Jace Downs / Warner Bros. Entertainment

Superhero stories have taught us that surviving the worst circumstances can be powerfully transformative, like Tony Stark building the first Iron Man suit or Bruce Wayne becoming Batman. But the reality is not so glorious. There’s nothing noble about living with trauma. Usually, it’s messy and painful and littered with regressions and false steps.

Doom Patrol is a show all about the parts that aren’t so easily squared away. The titular superhero team may have remarkable abilities, but their unruly powers came at extreme cost. For each of them, their mutations are a result of a life-altering incident that irrevocably altered their life.

They’ve been brought together over the span of decades by Dr. Niles Caulder (Timothy Dalton), dubbed “The Chief,” who saves them in one way or another, and brings them to stay in his mansion. He gives them a safe space surrounded by others as fragile as they are so they can regain their sense of self. 

When he’s captured by Mr. Nobody (Alan Tudyk) at the start of the season, the group is forced to move from fragile co-existence to co-dependence, throwing them into disarray as they contemplate facing the outside world without The Chief’s guidance and support.

During the team’s first excursion away from the mansion, Larry (Matt Bomer), wrapped in bandages head-to-toe to hide his burned skin, anxiously stares out from the safety of the team’s bus. He hadn’t left the mansion in years, and going out into society was never his strong suit to begin with. He gathers his courage and makes a move. 

It’s a process I’m very familiar with.

Doom Patrol -- Ep. 101 --

Image: Jace Downs / Warner Bros. Entertainment

When I was a teenager, I was bullied to the point of becoming suicidal. Starting as a friend’s boyfriend, my bully tore through my social circle in a violent haze of entitlement and adolescent rage over the course of a year, with me one of his main victims. I’d miss school because he was waiting outside my mom’s apartment to attack me. He’d send menacing texts and turn any interaction into an attempt at coercion. I’m still not sure why I became one of his foremost targets. I think a lack of self-esteem just made me easy prey. He knew he could, so he did.

Doom Patrol is a superhero show that understands that the longest, greatest battles we face are against ourselves.

Most of the Doom Patrol’s squad are products of questionable decisions, unfair choices and some astonishingly bad luck. Cliff’s (Brendan Fraser) adultery tore his family apart, the fateful crash that made him a brain in a robot suit tragically occurring as he and his wife were starting to reconcile. Rita (April Bowlby) may have been hard-nosed and manipulative, but she was playing by the patriarchal rules of classic Hollywood. Larry was living a double-life because being a successful Air Force pilot and queer were incompatible with each other in the 1960s.

Traumatic events can leave us wishing we’d done things differently, blaming ourselves within warped perceptions of who we even are anymore. There isn’t always a better choice, and victims are not to blame for the behavior of abusers. I wasn’t the nicest person, I’d a selfish streak not unlike Rita’s, but that doesn’t make what happened right or excuse the friends that sat idly by. “Ah, lads, be friends,” one quipped after I was told to kill myself. They probably didn’t think he was being serious, but I knew he was, and I have their indifference as mentally ingrained as anything my bully did.

He assaulted me twice – once punching me to the ground outside the local girl’s high-school when I lost my temper with him, and again at a Blink-182 concert three years later. Finding me in the audience, he blamed me for him ending up in prison and elbowed me twice in the face so hard it broke the skin. I still have the scar.

I’d considered fighting back that second time. I decided against it in the moment because I figured if I let him do what he was going to do he’d stop. I’ve seen him twice in the nine years since then, and despite him shouting to make sure I saw him, he hasn’t laid another finger on me.

Doom Patrol -- EP 108 --

Image: Bob Mahoney / Warner Bros. Entertainment

What makes the Doom Patrol remarkable is that, when we first meet them, they’re people similarly downtrodden. They’re broken and beaten down, taking life day by day with as little discomfort as possible, trying to get used to these weird powers they’ve been cursed with. Existence has become its own kind of morose punishment for who they were. 

Their triumph — their heroism — is in the slow march towards accepting that what they’ve become doesn’t lessen who they are and deciding to face their demons, and Mr. Nobody, regardless of the outcome. If it all goes wrong, well at least they tried, and did so on their terms.

Nowadays, I’ve become used to the tinge of fear when I leave the house. Most times I shrug it off, like Larry leaving that bus. But some days are like Jane (Diane Guerrero) defiantly screaming at the massive internal projection of her abusive father in “Jane Patrol.” Others, I’m too exhausted to bother. Doom Patrol is a superhero show that understands that the longest, greatest battles we face are against ourselves.

Our disparate protagonists resist connection because solitude is comfortable when living with this kind of anguish. Vulnerability might lead to people wanting to talk about it, like Cliff does to Jane after seeing the underground, and that means risking more manipulation and heartache. But being alone eventually becomes a cage from which you watch the rest of the world with only your pain for company. 

I feel Jane’s level of discomfort, though not quite with the same animosity. This piece, in itself, is an exercise in rebutting my own secrecy and making what happened to me known. Silence only favors the oppressive, and I am tired of keeping myself down.

“I assure you there are many monsters in this world, and none of them, not a one, is you,” Dr. Caulder tells Cliff in the opening episode. Perhaps Doom Patrol‘s most heroic accomplishment is making one believe that that just might be true.

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As a founder, I mistook my work for self-worth

These days, most days are good days. My clients are founder and executives, I set my own schedule, and I live in a city I love. As an executive coach and advisor, I work with founders and CEOs of companies who have raised more than $100M. Like any enterprise, it’s taken a lot of building, planning, and failing for me to get where I am.

What I’m supposed to tell you is that I worked hard and persevered – and I did.

But what I’m not supposed to tell you is how it felt to do all that failing, and above all how, for years, shame was the primary emotion that guided my life and career. How, at my lowest point, I felt worthless. How I even contemplated self-harm.

It takes a herculean energy to start a company, which is maybe why, so often, our stories sound like myths. Mine went something like this: If I could just raise money from a top-tier VC, get to $1M in revenue, and sell the business for more than $5M, then I’d be good enough. I’d be the successful young adult I wanted to be. Then, once I had made my first million, I could take a swing and start a billion-dollar company.

The fact that I didn’t feel worthy of love, that I lacked inherent value, drove my decisions. My failure to reach the goals I set reinforced the belief I that I was unworthy. Luckily, I eventually found the self-awareness to realize that blindly pursuing goals I couldn’t achieve was unhealthy.

But I didn’t expect that walking away from my job as CEO would break me, nor did I realize how far I would sink.

I thought that if I was “successful,” people would see that I wasn’t flawed, and I’d finally be worth something.

After extensive therapy, it’s easy for me to see how misguided I was from the outset. Shame, most of the time, is a thing of the past. But for a long time, it fueled every decision I made yet never seemed to exhaust itself – there was always more. In the business world, this is more common than we’re led to think — almost every entrepreneur I meet shares an experience “otherness.” We glorify failure, but we don’t have the patience to honor the pain that turns into the shame of feeling “I’m not good enough.”

We are supposed to be resolute, driven, and resilient. To that end, I want to share what I’ve learned so others who struggle with worthlessness know they aren’t alone, and that happiness – and enjoying success – is still possible.

Accidentally Starting a Company

At 19, I didn’t have a grand plan to change higher education. I was simply a pissed off freshman in college. In an interview with the Chronicle of Higher Education, Jeff Young asked me: what would I do with UnCollege, the site I’d just put online?

UnCollege was a fledgling website I’d created out of my frustration in college. It was designed to create a community of people who were frustrated with the status quo in higher education. In that pivotal moment, when Young asked about my plans for the site, I immediately tied my self-worth to its future. It was, after all, the reason I was being interviewed by a major publication. I had to turn UnCollege into something, or else I’d be a failure – and worse, everyone would know it, because now it was public.

From then on, I started a mental list of what I needed to do to be a successful entrepreneur. My list grew quickly and each item carried a familiar caveat. I must write a book or I’m worthless. I must start a company and raise $1M or I’m worthless I must speak at conferences around the world or I’m worthless.

I did raise money. I did start the company. I got to $1M in revenue. Each time I checked one of these boxes, I wasn’t happier. I started to be afraid I would never feel I was enough. I didn’t feel “successful,” especially in the way I saw success portrayed by others, both online and in the industry.

I thought that if I was “successful,” people would see that I wasn’t flawed, and I’d finally be worth something. What I didn’t know is that each time I checked something off my mental checklist, I’d be consumed with shame and insecurity, needing to check the next item off the list in order to feel worthy.

Instead, I felt trapped. I didn’t yet know that self-worth must come from within.

Mistaking my work for self-worth

I realized quickly that I’d committed myself to starting a company because I was afraid of failure, not because I had carefully considered what problem I wanted to dedicate the next ten years of my life to solving. Nonetheless, UnCollege enrolled its first students in September 2013.

That fall, I began to suspect I’d made a mistake. But I was afraid to tell my investors, and those that had supported me to get the business this far. My survival skill was to smile and act like I knew better than everyone else. If only I’d had the courage to sincerely ask for advice.

One consequence of not asking for help was I had to let go of two of the first people I hired, and layoff two more because we didn’t have the cash.

The first cohort was a disaster. I hadn’t designed a properly structured curriculum, and students were dissatisfied. The students liked the community of self-directed learners, but the company wasn’t delivering value beyond the community. Two weeks before the end of the semester, the students declared mutiny and demanded to know what we were going to do to improve the program.

I was terrified and wanted to leave, but we’d already taken money for the next cohort of students. I believed I didn’t have any other choice. We created a coaching program, hired coaches, built two dozen new workshops, and started working to get students placed into internships. The coaching model we built worked, and we spent the next two years improving it.

In the spring of 2015, I called my lead investor, my voice shaking. He knew that I had my share of fear and insecurity, but I told him clearly that day “I can’t do this anymore. It’s going to break me.”

Ignoring my feelings was a survival skill as child. Ignoring the doubt and anxiety caused by early critics allowed me to push through and launch a company. But it was also my achilles heel.

At the same time I was experiencing burnout, the company was pivoting from a college alternative into a pre-college program. The board agreed: it was time to hire a CEO.

After hiring a CEO, it became more difficult to motivate myself to go to work every day. Getting out of bed became a chore. One morning, after a breakfast with a prospective investor at the Four Seasons, I sat down on a bench outside and began to cry. Looking up, I saw one of our previous students waving at me, and quickly wipe away my tears to give him a faint smile.

I felt embarrassed, weak, and helpless.

Deriving identity from my work wasn’t working, and I knew I had to put an end to it. But what were my alternatives?

I was excited for my company and its new leadership, but I was anxious. I was empty. I didn’t know where the company stopped and I began. At my 25th birthday dinner, I couldn’t eat. I was consumed by shame, by fear. I managed to hold off all through dinner, but as soon as I arrived home I broke down sobbing.

Shame is a Habit

In December, I was no longer CEO of my own company. Six months later, I couldn’t get out of bed.

Those first few months I spent catching my breath. I was still on the board of the company, but I didn’t control it. As I began constructing a life post-UnCollege, I had no idea where to start. I didn’t yet realize it, but I needed to go through the individuation process – to figure out who I was and what I believed, independent of my family of origin. Already 25, I’d managed to avoid these questions. The irony is not lost on me that most of my peers faced them in college.

Shame is a consumptive state of being. The longer I went without answers to questions tied to my selfhood, the more shame ate me up. What did I care about? Did I make the right choice? Was the sacrifice I’d made to start this company worth it? Had I taken the wrong path? Was all the pain I’d been through a waste? Would I ever learn to feel happy again? I was beginning to feel as if I had no self at all.

Without a job to make me feel useful, I spent most days drinking at Dolores Park in San Francisco. I knew this wasn’t healthy, but I convinced myself I deserved it after years of hard work. Again, I was only 25. Life had lost its color. Things that once brought me joy no longer did. I could no longer grin and bear the pain. Believing my own bullshit about how I was going to be OK was no longer working. The more this cycle continued, the stronger it got, and the weaker I felt – all the more trapped.

Even the most successful people carry trauma, and often lash themselves onward with its whip

One Monday in October, I found myself completely unable to function. Alone in my house, I realized I hadn’t gotten out of bed or eaten a meal for several days. I was supposed to get on a plane to fly to Minneapolis, and I just couldn’t bring myself to do it. Instead, I called my dad, who encouraged me to message my doctor and say, “I think I might be depressed.” I was still too scared to pick up the phone, and it would be another few months before I uttered those words out loud. I started therapy, but things got worse before they got better.

Beyond “I’m sad that my company didn’t turn into what I wanted,” I didn’t have names for my emotions. A lightbulb moment came when my therapist asked, “When have you felt anxiety?” The only example I could think of was the time my company was only a few days from running out of cash.

“Have you ever considered that you only feel your emotions at extremes – a 20, for example, on a 1-10 scale? It’s human to feel anxiety in day-to-day life.”

That opened a door. I wasn’t just sad about leaving my company: I felt shame that I wasn’t “successful.” It wasn’t only my identity I’d tied to the business, but my self-worth. Deep down, my core belief that I – myself – wasn’t good enough. This is shame by definition: a hole that forms in our deepest selves we can never fill because it seems permanent; it seems, by nature, that this is who we are, not what we have done.

Shame often comes from feeling different as a child. In my case, I stuttered as a child. My voice was too ugly to be heard, so I concealed it. I used synonyms to avoid the sounds I couldn’t make. I did this because I couldn’t handle the intense shame of not being able to say my own last name without stuttering. In doing so, I learned to ignore, to numb those intense feelings of shame. I coped, and because I learned to cope so early in life, I learned to numb the rest of my feelings along with it.

By the time I launched a company, all those feelings that tell us “something’s wrong” – sadness, exhaustion, frustration, embarrassment, anxiety, guilt, and so on – were so buried and so unnamed that I could only tell myself “You are what’s wrong” when I hit a block, when I encountered the normal and natural failures that entrepreneurs face every day, no matter how successful in the long run.

Ignoring my feelings was a survival skill as child. Ignoring the doubt and anxiety caused by early critics allowed me to push through and launch a company. But it was also my achilles heel. It led me to derive my identity and self-worth from my work.

A CEO, the story goes, has it all together: a CEO is a visionary who sees around corners without any help. Because of this, I couldn’t give myself permission to ask for help, and when I left the company, I lacked the vocabulary or awareness to describe my feelings. My perfectionism, which long ago enabled me to ignore my stuttering, had associated help with failure, and failure with shame.

All these years later, I still couldn’t allow myself to ask for help.

Learning to tame trauma

Stress, overwhelm, burnout: these were the closest words I had to describe my feelings. This is startup lingo for things you cycle through now and again, and the story goes that we push past them and keep working. But these aren’t emotions. They are coverups for feelings of pain and shame. Ultimately, they describe trauma.

When most people think of trauma they imagine a car crash, or maybe a natural disaster or physical assault. An event that curtails your ability to function entirely. But trauma is simply a piece of the past we carry with us in the present that shapes us — in both positive and negative ways.

In my coaching career, I’ve worked with entrepreneurs and executives who felt too pretty, too ugly, too gay, too fat, too foreign, too dumb, too smart, too dark, or too light. These were the holes of shame they couldn’t fill and believed would always be there. They weren’t by any means failures: even the most successful people carry trauma, and often lash themselves onward with its whip. But shame is something even the best of us can’t outrun. Eventually it catches up with you. It took me years to understand this, and being compassionate towards myself will be a lifelong journey.

Once I had the vocabulary to separate my self-worth from my professional ambitions, UnCollege was a failure I could be proud of, not to mention a learning experience I could bring to my next project: Helping others learn to love themselves, and as a result, build wildly successful companies.

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Mental health text line launches in UK with a little help from the royals

Anyone can text the free service in a crisis.
Anyone can text the free service in a crisis.
Image: MASHABLE / VICKY LEta

A free text line for anyone suffering a mental health crisis has launched in the UK, backed by the royals.

The Duke and Duchess of Cambridge, William and Kate, and the Duke and Duchess of Sussex, Meghan and Harry, have helped to bring a version of the U.S.-founded Crisis Text Line to the UK, investing £3m in an offshoot service called Shout.

Launched in 2013 by Nancy Lublin, former CEO of social change organisation DoSomething.org, the Crisis Text Line aims to reduce stigma around mental health and provide aid with its free messaging service.

You can send a message to the 24/7 text line in a moment of need — they’ve processed over 100 million messages — and a trained volunteer crisis counsellor will respond, usually within five minutes depending on traffic. To send a message, text 85258, and while the first two responses are automated, you’ll then be connected to a volunteer for a chat.

Prince William appears in a new video about the service, in which he details how Shout will work.

“As texting is private and silent, it opens up a whole new way to find help,” he said. “It provides instant support. You can have a conversation anywhere, at anytime: at school, at home, on the bus, anywhere.

“I am incredibly excited to be launching this service, knowing it has the potential to reach thousands of vulnerable people every day.”

The Duke of Cambridge said the service had been in development over the last year.

“Catherine, Harry, Meghan, and I have been able to see the service working up close and are very excited for its future,” he said, before taking the opportunity to invite people in the UK to apply as a volunteer crisis counsellor.

“It is not for everyone. There are some very difficult conversations, and you need to be able to listen without judgement on a range of issues, from suicidal thoughts to bullying, abuse, sexuality, self harm, and relationships.”

According to the BBC, Shout launched a 12-month pilot last year, which saw the sign-ups of 1,000 volunteers, and 60,000 conversations.

The royals have spent many years working to end the stigma around mental health. William, Kate, and Harry launched the Heads Together initiative to  encourage speaking openly about mental health in 2017. It’s part of The Royal Foundation, which encompasses all their charitable work.

Shout is available in the UK, including England, Scotland, Wales, and Northern Ireland. 

The Crisis Text Line team expects to launch in Ireland next, then Australia and South Africa before the end of 2019, then Latin America early 2020. 

Text lines like this and others have proven effective means of giving people an accessible avenue to communicate during a mental health crisis. They’re one of many types of helpful resources available, and have in the past turned up useful data to help open up conversations about suicidal thoughts and how to assess suicide risk, for example.

The more tools at our disposal, particularly within our regular means of communication, the better.

If you want to talk to someone or are experiencing suicidal thoughts, text Shout at 85258 or call 999 for emergency help in the UK. You can also contact the Samaritans on 116 123 or Childline on 0800 1111. If you’re in the U.S., text the Crisis Text Line at 741-741 or call the National Suicide Prevention Lifeline at 1-800-273-8255. Alternatively, a further list of international resources is available here.

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