By Meike Bergwerff - Ehealth could provide much needed care to people exposed to traumas in any part of the world, according to Dr. Joe Ruzek, Co-Director of the Center for m2 Health at Palo Alto University in California, US, and a former Director of the National Center for PTSD. His goal is to create a worldwide network that provides online assistance for people experiencing trauma in low and middle income countries.
Dr. Joe Ruzek kwam visited Minddistrict in Amsterdam, he gave a lecture on his plans to create an international network for trauma interventions. The lecture can be seen in the video below. We also interviewed Dr. Ruzek, the interview can be found directly below the video.
An interview with Joe Ruzek on digital trauma care
Dr. Ruzek on trauma care. When Joe Ruzek talks about his plans, he talks without pausing. He gave his ideas a lot of thought and will be trying to execute them as effectively as possible.
Why do you think that digital interventions are useful for psychological trauma survivors globally?
“Within 10 to 15 years almost everyone on the planet will have a smartphone and will be internet connected. So there’s an opportunity to provide the world’s trauma survivors with digital self-management tools. In most of the world there are no mental health services, or the services are very small or largely inaccessible. Even in the West, we’ve not been very successful in reaching people with mental health problems or engaging them in mental health treatment.
When it comes to ehealth, we now have emerging research showing the effectiveness of web–based interventions for many mental health problems, and I expect that to generalise into phone interventions soon. Once designed, this can intervene many different problems in living. We now talk about mental health problems, depression, anxiety, PTSD. But this can be applied to other problems too: how to reduce conflict, how to be more successful, how to be better in the work place.”
Why is the West also still figuring out how to treat people with psychological trauma?
“Many people don’t seek mental help services. Also, we’re not very good at identifying traumatic stress problems. People have all sorts of complaints and might go to their GP. But the source of these complaints, the traumatic experience, is often not found. Plus there is still a stigma connected with use of mental health services. Another problem is that most researchers focus on an individual level of interventions, but that’s a very inefficient way of helping large numbers of people."
"If we could build effective technology-based assistance, it could go out to maybe 10 million people. Even if only 3 or 5 percent of users stick with the program and benefit from it, you’re helping far more people than you can ever help with even the best individual psychotherapy.”
What’s the biggest challenge when it comes to creating these digital tools?
“We need to be able to give these tools away for free because most users in low and middle income countries are impoverished people. My own feeling is that we should try to develop and deliver such services now, so we can learn how to do this, fail quickly and try new things. Also, we are in a time of rapid development of many, often competing, apps and interventions that attack the same problems. The developers have to be on the same team and figure out how to make their programs work for the large numbers of people who may benefit.”
What kind of digital interventions are we talking about?
“Right now, we’re talking about internet interventions that are almost like educational classes and self-management tools. If we look at a face-to-face behaviour change intervention that’s effective, the chances are pretty good that we can move many key parts of it on to the internet. These interventions include a lot of didactic educational information, setting goals, setting targets and self-monitoring. They help people change their activities and learn skills to manage stress. We may be able to help many people in the countries where there’s not a lot of human help available by strengthening their abilities for self-care.
But in other countries we don’t want technology to replace human services. We want it so supplement and add to human services and increase the convenience and effectiveness of in-person support.”
What are your next steps in trying to make this worldwide network happening?
“I’m exploring a partnership with Minddistrict to make their platform available to those in need in low and middle income countries, because at present there is no suitable technology platform that can be widely used. I’m also talking to researchers in the trauma field who are interested in this space and I’m trying to find partners in developing countries. If we get access to a platform we will develop at least two interventions: a generic traumatic stress intervention and another that focuses specifically on disaster mental health for use in crises of all kinds. Then we will have a prototypical set of materials than can be adapted and used in different international contexts. If i have enough initiatives going on in different ways, i would like to begin to explore whether groups in Silicon Valley, or organisations in other parts of the US or the world, would like to help fund the platform. In the long run it would be great to establish a non-profit organisation that has some stable funding for a small staff to enable the system and build international programs.”
What’s the most important thing to keep in mind during this process of creating a platform?
“We need to make sure that not only are things culturally adapted as appropriate, but also that we build partnerships with the countries and the institutions who are in a position to assist locally and sustain delivery of the ehealth interventions. I have a rather strange hypothesis: it may be possible to reinvent and really innovate in mental health delivery in more interesting ways in the countries that don’t have an existing mental health delivery infrastructure. We’re not competing.
There’s going to be more scope for radical innovation. That might mean that what happens on the other side of the world, may be imported back to the West to improve services in ways that are really out of the box. It’s optimistic, but it’s worth having these conversations. In the long run this has to happen over the next few years. People do see that there’s a global need for this.”