Podcast: Support for Mental Health with Jay Court

Episode: 28
Guests: Jay Court
Duration: 28:32
Tags: Mental health, online support, iCBT
Soundcloud: Listen to Episode 28

On this episode of the Nurse & Midwife Support Your Health Matters podcast we speak to Jay Court about This Way Up, a digital program to support the mental health of nurses, midwives, and students.

Jay Court is the Digital Mental Health Engagement Lead for This Way Up at the Clinical Research Unit for Anxiety and Depression (CRUfAD), St Vincent's Hospital Sydney. Jay has dual backgrounds in mental health nursing and communications. 

Jay discusses the importance of nurses and midwives taking care of their mental health, some of the challenges and barriers to this and how online digital mental health support removes access problems. This Way Up provides evidence-based programs and resources developed and run by clinical psychologists, psychiatrists, researchers, and web technicians based at the Clinical Research Unit for Anxiety and Depression (CRUfAD) — a joint facility of St Vincent’s Hospital and the University of New South Wales.

The This Way Up program and resources are based on iCBT, which is internet-based cognitive behaviour therapy. Jay discusses the This Way Up programs and how a nurse or midwife experiencing a mental health concern can access them. This Way Up offers specialised resources to support you during the pandemic, including five simple steps to calm your emotions, and tips for getting through.

In this episode we talk about the importance of accessing support. I hope you find this our discussion informative and useful. Look after yourself and each other!

Your Health Matters.

Mark Aitken RN
Stakeholder Engagement Manager
Nurse & Midwife Support
 

Mark Aitken [0:09] Welcome to the Nurse & Midwife Support podcast: Your Health Matters. I'm Mark Aiken, the podcast host. I'm the Stakeholder Engagement Manager with Nurse & Midwife Support, and I'm a registered nurse. Nurse & Midwife Support is the national support service for nurses, midwives and students. The service is anonymous, confidential and free, and you can call us anytime you need support. 1800-667-877, or contact us via the website: nmsupport.org.au.

On this episode of the Your Health Matters podcast, we will discuss digital mental health support for nurses, midwives, and students. I'm delighted to say my guest today is

Jay Court . Jay is a registered nurse, and Digital Mental Health Engagement Lead with This Way Up. This Way Up is a great digital program to support the mental health of nurses, midwives and students. Jay is going to talk about this program today. It's an evidence-based online program for mental health and wellbeing. Jay works as part of the clinical research unit for anxiety and depression. Welcome, and hello, Jay.

Jay Court [1:29] Thanks, Mark. It's a pleasure to be here.

Mark Aitken [1:32] Great to have you on the podcast today, Jay. Looking forward to discussing all things mental health for nurses, midwives and students. Jay, would you tell our listeners about you and your career, and your expertise in mental health nursing and the work you do with This Way Up?

Jay Court [1:51] Okay, so my name is Jay. As you said, I'm the Digital Mental Health Engagement Lead at This Way Up. I'm a registered mental health nurse, but I have a dual background in communications as well. My role is at the Clinical Research Unit for Anxiety and Depression. That's based at St. Vincent's Hospital in Sydney. It's a joint initiative from the hospital and the University of New South Wales. It was through this unit, where we have an anxiety disorders clinic—that's a tertiary referral center—and it was from that clinical work that the digital product came. Our digital service is called This Way Up.

Basically, it's based on iCBT, which is internet-based cognitive behavior therapy. From our randomized control trials, we've done over 30, we've found that internet-based CBT is as effective as face-to-face CBT. That research is replicated elsewhere. So now we have this digital service called This Way Up, we've got over 18 tailor-made...we've got a suite of programs and disorder-specific wellbeing programs, transdiagnostic, and we've got a another course which I really like for clinicians, which is called the 'iCBT Foundations for Clinicians'. That's a really good introduction to the concept of CBT, and also how to integrate digital mental health tools into routine face-to-face or telehealth care.

Mark Aitken [3:24] Thanks, Jay. That's a really good introduction, or overview. What an interesting career you have. I'm sure a lot of nurses and midwives don't know about nurses and midwives being able to work in digital areas of health care. How did you get into this area? And what was your inspiration to go here?

Jay Court [3:46] That's such a great question. My original career was in the media. I was a producer of television documentaries, and I started to become interested in health stories. A lot of the stories that I was pitching had a health focus. Maternal health became a big passion of mine. I was living in Ethiopia and Kenya for a few years, and I started to get a real passion for social justice issues and realizing that health was not about access and poverty as much as it was about, for instance, the maternal health issues. It's a lot about women's position in society, and that being the barrier to receiving the care that they deserve. So that sparked my interest in health.

I thought I would go back, and I did a two-year Master's in Nursing with the view to potentially becoming a midwife. But as I completed my program and started to do placements, from my first mental health placement, I realized that all of my communication skills that I've been developing over 12 years in my previous career, translated very well into mental health nursing. I was just fascinated. I did a graduate program in mental health nursing, and in that time, I worked in an acute inpatient setting, a high dependency unit, and in the community mental health acute care team. This job popped up, Digital Mental Health Engagement Lead. I thought, what is that?

To be honest, I didn't know the difference between telehealth and digital mental health treatment. I now try to communicate that to people because I think we just assume that people know the difference. I certainly didn't, until I came across This Way Up. One of the ways I like to communicate it now is by saying that digital mental health treatments work really well blended with telehealth or face-to-face treatments. But they are kind of a different thing. The way that digital mental health treatments work is the service user can log in online to our site, and work their way through our programs in a self-paced manner. You really get introduced to the idea of cognitive behavior therapy, through these comic strip characters that normalize and validate the experience that you might be going through.

For instance, we've got a program, a course called the 'Mixed Anxiety Depression Course', which is one of my favorites, because you see two characters, and one is experiencing depression, and one is experiencing anxiety. Through the course of the program, you learn how these characters learn to manage their symptoms. As a result, you can kind of translate that and apply that into your own life and try to use some of the CBT skills. What we know about CBT is that you can teach it, but until you apply it, that's where you're going to see the real change.

So that's an introduction to one of our programs. But like I said, we've got 18 tailor-made courses, including some that are more wellbeing focused, all based on cognitive behavior therapy principles. But you know, for instance, our 'Introduction to Mindfulness'...you may not identify as having a disorder, or having anxiety or depression, but we feel that everyone can benefit from learning some of these CBT skills.

Mark Aitken [7:21] Really interesting, Jay. We're gonna talk a bit more about the courses and the way it works shortly. But a bit more about background, if you don't mind, Jay, in relation to the program. Obviously, it's part of a clinical research unit for anxiety and depression, so there's obviously a body of research that led to the development of this program. Would you share some of that research with us, and how the program came about as a result of the research?

Jay Court [7:50] This Way Up was developed by the Clinical Research Unit for Anxiety and Depression. The work really came out of the anxiety disorders clinic that we run. That's a face-to-face and telehealth tertiary referral center. Around 10 years ago, the waitlist at the ADC was quite long. So what they did was digitised the cognitive behavior therapy modules, and rolled that out to people on the waitlist. We've done over 30 randomized control trials, to check the efficacy. What we can say that iCBT, or internet-based cognitive behavior therapy is as effective as face-to-face therapy. That's indicated in the clinical practice guideline guidelines for anxiety disorders, and also for mood disorders. So, iCBT is a recommended first line treatment for anxiety and depression.

What we like to advocate for is a blended approach. So for clinicians to use digital mental health tools in combination with face-to-face or telehealth care. Digital tools are a great option to have in the ecosystem, but they're not going to be the right fit for everybody at every time.

Mark Aitken [9:06] That's really interesting background. Jay, thanks for that. This Way Up, I guess, was born from the very rich research but also a recognition that people need different types of services and that digital mental health support is an important part of the services that exist in the mental health and mental health support space. I know that many people struggle to get in to face-to-face appointments in the pandemic era. Digital mental health has been a really important part, as you say, of the suite of services. I think it's very exciting. How long has the service been going and has This Way Up been available, Jay?

Jay Court [9:51] This Way Up was originally called CLIMATE, or Clinicians' Mate, and it's been around for over 10 years now in its current form. But the Clinical Research Unit for Anxiety and Depression has been actually around since the 60s, and was headed by Professor Gavin Andrews. So we do have that kind of long history of technical clinical research expertise. I suppose one of the big aims of This Way Up and of digitising mental health treatments is about increasing access, as you mentioned, a lot of people struggle to get the care they need. That was definitely something that I witnessed in my time, particularly in the community mental health team. Seeing people discharged, either after an acute inpatient admission, or on presentation to the emergency department, and then linking those clients up with their supports in the community.

But there are so many gaps in the mental health system. I think digital mental health treatments can be part of that solution. We know that things like cost is a huge barrier. Wait lists are a barrier, geography, transport, stigma, there are just so many reasons and ways that getting the help you need at the time you need it, can be very challenging. That's why I'm really passionate about This Way Up, because I think it's a really good option to throw into the mix. It's a really good option to have there when you need it.

We hear from service users, people write in and tell us about their experiences. We had a woman write in and say that in a regional area, that her husband left her unexpectedly after 22 years. She was so shocked and grief-stricken that she didn't feel that she could leave the house. She didn't feel like she could go and see a psychologist. What she did was ring GriefLine, and she undertook a This Way Up program. She said that after six weeks, she finished the program, felt well supported, and then was able to go and seek out a psychologist. But for that time when she didn't feel able to do any of those things, This Way Up really helped her at that time. I think it just goes to show that digital tools are not a replacement for other types of treatment, but like I said, can be a good option to throw into the mix.

Mark Aitken [12:26] I think access is the key here. Any service that provides accessible evidence-based services and support is a really vital part of the suite of services that we can offer people seeking mental health support. So well done to the Clinical Research Unit, and congratulations, Nurse & Midwife Support love This Way Up, and we often use it as a referral pathway for nurses and midwives.

So if any nurse, midwife or student out there is struggling and needs support, Nurse & Midwife Support is available 24/7. Anonymous, confidential and free, no matter where you are in Australia, 1800-667-877, or contact us for the website, nmsupport.org.au. Please don't hesitate to get in touch. This Way Up might just be one of the referral pathways we talk to you about.

Jay, thank you for that. I'll give you a scenario-based question now. Say I'm a nurse, and I'm struggling with anxiety, and I want some support from a This Way Up program in relation to anxiety. How would I go about accessing that?

Jay Court [13:49] That's a great question. On our website, thiswayup.org.au, there's a taker test tool, or we also call it the 'course pickup'. This is based on validated outcome measures. If you complete that online survey, at the end of it, it will direct you to which of our 18 tailor-made courses might be appropriate for you. So if you're feeling a little bit stressed out at the moment, it might send you to one of our wellbeing courses, such as 'Coping with Stress', 'Introduction to Mindfulness', 'Student Wellbeing'. If you're scoring in a different way, it might direct you to say, one of the disorder-specific courses, like our 'Social Anxiety' course. It just depends on those scores, I suppose. But that's a really good tool and a good starting place if you don't know where to go. The other idea I would suggest is our 'Mixed Depression and Anxiety Course' is a really good one because we know that depression and anxiety like company; they often occur together. I think for me, I really enjoyed doing that course because you get to see two characters with different symptoms, but learning CBT and how to apply it in different scenarios. That can be a really good introduction as a starting point.

Mark Aitken [15:09] Do you take self-referrals, Jay? Or do you have to be referred by a practitioner, like a mental health practitioner, such as a doctor or a nurse, or an allied health professional? Or could I just go onto your website, access a program? Is there a cost for it?

Jay Court [15:31] We like to provide a lot of choice with our programs. So there are a few different options there. The wellbeing programs can be accessed in a self-paced, self-guided manner for free. Our more disorder-specific programs do cost $59, as a one-off fee. For six lessons, if you work that out, that's less than $10 a lesson, which is not that much in the scheme of things, and certainly less than a gap fee for a single psychology session, I mean the $59. But the other option is that you can see a health professional, and that could be your allied health professional, nurse, practice nurse, GP, a specialist or psychologist. If they prescribe the course for you, that waives the fee. So that's another way to access our programs.

I guess in terms of providing choice, what we know is that around 50% of our users access the programs outside of office hours. Nights and weekends, those kinds of things when your therapist may not be available, if you happen to be seeing one. We know that people use our programs on discharge from other services, or while on wait lists for other services. As I mentioned earlier, blended with face to face or telehealth care.

Mark Aitken [16:56] Thanks, Jay. Say I'm a nurse, and I'm undertaking one of your courses, and it really unravels some particular issues that I'm experiencing, and I feel acutely unwell in relation to my mental health. How is that managed?

Jay Court [17:17] This Way Up is a digital mental health service. It's not a crisis service. But if you report in some of our validated outcome measures that you're experiencing distress, you will receive an email suggesting some crisis services you may want to engage with. And if you're being supervised through the course with a clinician, the clinician will also receive an alert. Our website has those details for other crisis services as well.

Mark Aitken [17:48] Thank you. If you do experience an issue while doing one of these courses, and you need support for that issue, or you'd like to talk to a nurse or a midwife while you're doing the course, please feel free to call Nurse & Midwife Support, 1800-667-877, and we'll support you through that process and refer you appropriately, if indeed, that's what you require.

Thanks very much for that, Jay. Jay, many people in society are experiencing the impact and the challenges of the uncertainty of the prolonged pandemic. It feels like we've been dealing with COVID-19 for quite a long time now, and it seems a bit of a rollercoaster. I wrote in my blog on the importance of reflection during times of crisis, that it's a marathon, not a sprint, and that's a hard place for many people to find themselves in. We know that many people are experiencing mental illness or mental health challenges as a result of the impact of the pandemic. What are you connecting with Jay, from people accessing your courses in relation to the impact on their mental health? Do you have a particular module that would support people with specific mental health concerns related to pandemic impact?

Jay Court [19:18] What I would say is that on our site during the pandemic last year, we developed a range of coping tools resources so if you go to thiswayup.or.au and click on the coping tools page, we have developed there a range of expert tips and free online tools to help you navigate challenging times. There's some infographics there, which some nurses have told me they like to print for their clients who may not be able to engage with the digital mental health service and just have those coping tools on their fridge, for instance. One of them is about five simple steps to calm your emotions, those kinds of things. Effective ways to express yourself or five helpful steps for tackling your problems. That would probably be a good place to go.

Our website actually has a huge amount of resources, activity worksheets and the like. So using our site as a bit of an anchor in those challenging times might be helpful, to browse through and see which resources might be helpful. In terms of the courses, you know, our 'Coping with Stress Course' might be a good one to start with, because I mean, who isn't stressed living in this pandemic world? That's what we advocate for, everybody can benefit from CBT skills.

The CBT cycle, cognitive behavior therapy cycle is really about acknowledging that your thoughts, behaviors, and physical sensations, can work in a really vicious cycle to self-perpetuate, and CBT is all about interrupting that cycle and getting it back on track. The really hopeful thing that I find about the CBT model is that by improving one element of that cycle, you can have an impact on the whole thing. Just by increasing your physical exercise, for instance, we know that that can improve mood or just by challenging some of those negative thoughts that you might be having about yourself that can improve your physical sensations, and improve the overall system.

I would really advocate for any of your listeners to sign up as clinicians on our website for free. If they're interested, a good starting point could be to undertake the 'iCBT Foundations for Clinicians Course'. Within that you will gain access to an introduction to CBT and the format for our programs.

Mark Aitken [21:57] That's great, Jay. I know many nurses and midwives listening to this podcast would be really interested in that. Our audience of nurses and midwives love resources. We'll provide those resources as part of these podcasts and the link for you as well. If you missed them today, or you don't want to go back and listen, we'll provide those links on our website as part of our podcast.

Jay, we support all nurses, midwives and students, but we hear from a lot of students and early career nurses setting up their career. They're curious about how to set up their self-care and their wellbeing as a habit, so that it becomes part of their toolbox of resources that they can utilize to support their career. I'm particularly interested in the This Way Up wellbeing program as a means of early career nurses and students being able to do that. Can you talk a bit about that wellbeing program and how it might support those early career nurses and midwives?

Jay Court [23:06] Yeah, I really love that idea. We've got four wellbeing programs, one is 'Coping with Stress'. One is 'Managing Insomnia'. We've got our 'Introduction to Mindfulness' and 'Student Wellbeing Course'. That student course is really focused at a tertiary level, we do have a 'teenSTRONG' program as well, for adolescents. But what I would say is that all of those wellbeing programs are still based on the principles of cognitive behavior therapy, there's still evidence-based. And what a great idea to build self-care into your professional development from the ground up, because there's so many occupational hazards of being a healthcare worker. We know that healthcare workers are at a greater risk of suffering from mental ill health. Not to mention the stigma. I mean, even working in mental health, I know times when I struggled, there was huge stigma about admitting that even as a mental health nurse. I mean, we've got a long way to go.

I really advocate to do one of these wellbeing courses. It's great psychoeducation. We know that psychoeducation is an intervention in itself, it's helpful to know, to normalize, to validate the things that we're feeling and thinking. The other thing that I think our courses are really helpful for early career health professionals, is in better communication skills with your patients and clients. If you're able to identify that somebody might be catastrophising or feeling acopic, because you've done one of our CBT courses and kind of learnt a few of those terms, or you're better able to kind of frame some behaviors that you're seeing. I can only see that benefiting your clinical care as well.

Mark Aitken [25:04] That's great, Jay. Fantastic resources for students and early career nurses. We'll put that link and that information up on our website as well. Jay, I can't believe we've come to the end of this podcast, you've been a great guest. This information is really vital to the health, wellbeing and mental health of nurses and midwives. Lastly, for me, is This Way Up only available to healthcare professionals or can any person access This Way Up?

Jay Court [25:37] That's a great question. Anyone can access This Way Up's programs. When you're talking about people with severe mental illness, like the patients that I used to see, I do think this kind of resource can be really helpful for the family and carers of people in those situations. I certainly know from in-services I've delivered at since in hospital, that nursing staff have asked us about the utility of these programs for the family and carers of a cancer patient, for instance, and the stress that brings into a family. So anybody can access our courses.

I really see our programs being very helpful at a population level, at an early intervention, primary prevention kind of level. If you start one of our courses, and it doesn't work for you, you can stop it. I don't feel that that would cause much harm. I think they're worth having a shot at and seeing if it's right for you. It's not right for everybody. Obviously, some people will need face-to-face or telehealth and specialist care. I should mention that a couple of our courses can only be accessed with the guidance of a clinician, and that's our 'Chronic Pain Course'. Also our 'Post-Traumatic Stress Course', and it's really important to work through those courses with a qualified health professional.

Mark Aitken [27:08] Thanks, Jay. Do you have any final words of wisdom?

Jay Court [27:13] If you're interested in learning about digital mental health treatments, I would just say, sign up. It's free for clinicians, have a look around, see what you think. See if any of the resources are helpful. And take it from there.

Mark Aitken [27:28] Thanks very much, Jay. You've been a great guest. I really appreciate your time, your expertise, and really so grateful that you and your team do the work you do and provide such a great service. Thank you very much, and thank you from all of our listeners. If you found this podcast useful, please share it with others, that really helps get the message out. Please remember that if you need support, Nurse & Midwife Support is available 24/7, no matter where you are in Australia, 1800-667-877, or via the website www.nmsupport.org.au. Look after yourself and each other. Your Health Matters. I'll speak to you next time.