Internet-based cognitive therapy in the treatment of patients with mental health problems in general practice. A novel collaborative model.

The objective of the project was to investigate whether the Internet program MoodGYM could be used in GP practice as a tool to improve the treatment of patients with depression. The program was originally developed in Australia and has been translated into Norwegian. The program is a self-help program with 5 modules. The problem has been that many depressed did not complete the program. Our question was therefore whether motivational interviewing between each module will improve the implementation and outcome. As the interviewing should be done in general practice each consultation should not last more than 20-25 minutes and the conversation would be most motivating and not really cognitive therapy. One hundred and six patients were divided into an intervention group and a control group. The control group received treatment delayed compared to the intervention group. The intervention consisted of a short motivational conversation with a psychologist as no GPs were available to do the scientific study. We found that treatment resulted in improvement of depression and the treatment was satisfactory for patients. We have also made a qualitative study of the factors that motivate patients to start with the program and which motivates them to continue with the program. Finally, we have now conducted a qualitative survey of what influences doctors' use of MoodGYM in their practice. Our experience from the research project is now used in a very large EU project (Mastermind) with 9 countries, 13 regions and 23 partners in Europe. This is an implementation project where we will try to implement MoodGYM combined with video consultations and video aided GP training as they treat their patients. The Mastermind project Europe is planned to recruit 5,000 patients that will be treated with computer-based cognitive therapy and in some places backed up with video consultations. Here in Norway we will try to integrate internet-based cognitive therapy and video consultations in a comprehensive mental health system (comprehensive, stepped care system for mental health care). As a new development it seem possible to integrate video consultations in both mental and somatic health as a standard treatment possibility in the whole of Northern Norway. Finally, today (26.04.16) it was announced that a substantial grant was given to INTROMAT in Bergen may result in a new generation of internet programs for treatment of mental problems. We work together with Bergen on this endeavor.

In Scandinavian general practice one third of all consultations are due to mental health problems. Many GPs find it difficult to treat psychiatric patients. Specialist mental health care services suffer from many referrals with varying quality. There is a lack of psychiatric specialist health service. Patients will have to wait 3- 6 months for specialist treatment. This delay often aggravates patient symptoms. To overcome varying quality by GPs and referral delay, we need new approaches to patient treat ment followed by a more efficient use of the limited resources in the specialized health care. In Northern Norway, 32 % of the population live in rural areas and there is 0,59 psychologist per 1000 inhabitants compared to 1,11 per 1000 in the urban areas of Oslo and Akershus. Long travelling distances to regional hospitals, longer waiting lists, and fewer psychiatric spesialists add to patient sufferings. This also applies to many rural areas in the other Scandinavian countries. By slightly modifying and applying an already existing and well tested internet self help programme for treatment of mental problems and combined with visits to GPs, we will investigate a novel approach of collaboration between patients, GPs and specialist mental health care prof essionals. The aim is to obtain a more efficient and more qualified patient treatment, better referrals to specialist and safer transition from specialist health care back to GPs. Research questions 1: Can the use of the internet-based self-help program B lueMood result in a novel approach of cooperation between patient and general practitioners and yield improved diagnostics and treatment of patients seeking help for depression? 2: Will the use of BlueMood in general practice, result in more efficient re ferral practices and novel ways of collaboration between GPs and mental health care professionals? 3: Will the use of the BlueMood increase GPs` coping skills in treating patients with mental health problems?