Bridging the Psychological Treatment Gap Using Peer Support and Supportive Text Messaging
Creators: Shalaby, Reham Abdel Hameed
Publisher: name: University of Alberta Library
Year: 2022

<p>Background: Most discharged psychiatric patients in Alberta are offered follow-up appointments with Alberta Health Services (AHS) Addiction and Mental Health (A&amp;MH) community providers. It is typical to wait weeks or months for a follow-up appointment, resulting in a substantial psychological treatment gap. The significance of this treatment gap became more evident during the COVID-19 pandemic.<br>
Objectives: 1) Evaluate effectiveness of innovative peer support worker services (PSWs) and of supportive text messages (Text4Support) provided to the patients discharged from acute care, in Edmonton, Alberta.; 2) Implement and evaluate effectiveness of a supportive texting service (Text4Hope) provided to the general public during the COVID-19 pandemic; 3) Identify the prevalence of mental health conditions during this pandemic.<br>
Methodology: Through a prospective, rater-blinded, four-arm controlled observational pilot trial, we examined the use of PSS and text messages (TxM) of Text4Support for post-discharged patients from acute psychiatric care. Patients (n=181) with mental health disorder were recruited and randomised to either (1) PSWs alone; (2) PSWs + TxM; (3) TxM alone; or (4) treatment as usual (TAU). <br>
During the pandemic, we provided a three-month supportive TxM to the general public (Text4Hope) service to support and monitor mental health in Alberta. Validated self-report questionnaires were used to assess mental health conditions. Data were collected at baseline, program midpoint (6 weeks), and endpoint (12 weeks). Statistical analyses including descriptive, correlational, inferential statistics and longitudinal data analysis, using SPSS, and thematic analysis using NVivo software.<br>
Results: Sixty-five patients completed assessments at each time point of the pilot study. Improved scores were reported for PSW+TxM compared with TAU condition on the total recovery assessment score and willingness to ask for help and personal confidence and hope domains, along with environment domain (physical safety and security) of WHO-QOL scale, and the functioning domain of CORE-OM scale. The PSW+TxM group consistently achieved better outcomes on CORE-OM recovery, clinical and reliable improvement. TxM and PSW+TxM arms significantly reduced prevalence of risk of self/other harm symptoms after six-month intervention. <br>
After one-year of Text4Hope service, participants providing valid responses to baseline, six-week, and three-month surveys comprised groups of 9214, 4110 and 1286, respectively. Statistically significant reductions mid-point reductions were observed for likely prevalence and mean scores of moderate or high stress and likely anxiety but not likely depression. After 3 months of using Text4Hope, there were significant reductions of prevalence and mean score compared with baseline on: the GAD-7 by 22.7%, PHQ-9 by 10.3%, and PSS-10 scores by 5.7%. Similar reductions were reported after one year of the service, with the largest reduction in anxiety (32.9%).<br>
By the time of exiting the service, 89.4% subscribers reported high satisfaction with Text4Hope, and 60.6-85.7% agreed that the service helped them in diverse ways. Messages were read and well-perceived by more than 90% of the subscribers.<br>
Conclusions: Positive outcomes were reported after implementing PSW and TxM programs in terms of clinical and functional improvements, customer satisfaction; and effective surveillance methodology for tracing changes in mental health, during the COVID-19 pandemic. Free mobile-based services such as Text4Hope or Text4Support can overcome financial barriers, while maintaining essential physical distancing required during pandemics, and providing means of support for those with no access to conventional mental health services. This work indicates the potential value of incorporating such interventions in routine service.</p>