Behavioral health support and online peer communities: international experiences

Abstract

Online peer support communities play an important part in many people's experience of healthcare. They can be particularly significant in behavioral health/mental health due to the difficulties that people may experience in accessing face to face care for these conditions. There is considerable diversity of practice in service management, target group, and moderation practices of online peer support communities. People using the communities also appear to have diverse aims and experiences. This heterogeneity contributes to a relative lack of data about the value and effectiveness of online peer support in behavioral health, although there is significant research into some aspects of these communities. The digital behavioral health service Big White Wall was launched in the UK in 2007, and in the US in 2015, and is focused on delivering moderated peer support. There are considerable differences in health systems between the two countries, and this has been reflected in different experiences of implementation. The value of online peer support could be maximized if systemic challenges to implementation and adoption were addressed more effectively.

The potential of peer support to extend the reach of digital health

“…16 More specifically focussed peer support in the digital domain has largely remained limited to encouraging compliance with online programmes. 17,18,19 Potential benefit may be gained however through the involvement of peers in enabling access to and participation in a range of digital health innovations such as online platforms and apps that provide information, help with decision making, or aid self-management and self-monitoring.…”

Harnessing Technology to Address the Global Mental Health Crisis

“…182 Though, more research needs to be undertaken, particularly on how to mitigate risks associated with users extending directive support, and ensuring that global experiences shared can be contextualized to local health care systems and practices. 183 Virtual Peer Support for Mental Health…”

A web-based mental health platform in individuals seeking specialized mental health care services: multi-centre pragmatic randomized controlled trial (Preprint)

“…The developers advocate that the BWW can improve mental health symptoms through increasing social engagement, normalizing experiences, educating, and equipping with skills to manage difficulties. All participants maintain anonymity on the site through a unique non-identifiable user alias and use is participant dependent [15]. The BWW is monitored 24/7 by 'Wall Guides' who are trained mental health professionals employed by the BWW and based in the UK and New Zealand.…”

“…Studies using modular interventions, however, did report that module completion led to better outcomes. Conversely, one of the main features of the BWW used more often by the higher engagers is its moderated virtual community of peers [15], an intervention for which the evidence has yielded some very mixed results [27,28]. Some authors have described a potential harm through aggravated symptoms and what Takahashi et al termed the 'downward depressive spiral' which was linked to higher depressive tendencies at baseline [29].…”

“…As a part of a series of demonstration projects being implemented by leading stakeholders in digital health and telemedicine in Ontario, Canada's most populous province, the Big White Wall™ (BWW) was selected as a potential solution for mental health. The BWW [15] is a multi-component moderated internet-based intervention with peer support that provides anonymity. At the time this trial was conducted, there had been no prior randomized trial evaluating the BWW.…”