Internet Support for Adolescents With a Mentally Ill Family Member

Children from families affected by mental illness are at elevated risk of developing a serious mental disorder themselves. In the Netherlands (population 16.5 million), at least 700,000 adolescents grow up with a parent or parents with mental illness. Most Dutch community mental health centers offer preventive group care for these young people to learn to cope with the home situation and to find peer support. However, this target group is difficult to reach; in 2007 only 670 adolescents (<.1%) participated in these groups.

Because the Internet has been shown to improve young people's well-being and is so commonly used by them, we created www.Survivalkid.nl, a Web-based preventive intervention. This online resource, which launched on June 7, 2006, offers support to young people aged 12–24 years who have a parent or sibling with mental illness.

A literature search provided guidance for developing the intervention. On the basis of prior evidence, we aimed to make it attractive, easy to understand, individualized, and interactive. Access to the site is secure, and the service is well publicized in the catchment area of our institute, which is a rural mental health district of 486,000 inhabitants. On the public home page, interested people can find an explanation of why the intervention was developed and for whom and how it works. Registered visitors, in turn, are given access to restricted areas of the site.

The intervention is based on modules previously used in preventive groups. It includes explanations about mental illness, instruction in coping skills, opportunities for mutual understanding, and a feature that allows the user to contact a staff member. Eight group facilitators from the community mental health center (three psychologists and five nurse practitioners) were trained as online counselors. Psychoeducation is presented as short blocks of text, real-life stories, interactive games, and quizzes. Peer support is offered in monitored chat sessions. Site users can contact a professional prevention counselor for a private chat or correspond via the secure e-mail service. A manual details staff responsibilities and explains how the content management system operates.

Clinicians in the area are asked to draw their adult patients' attention to the online support for their offspring. Posters and flyers advertising the service are displayed in public places.

In Survivalkid's first three years online, there were 10,000 hits and an average of 600 unique visitors each month. During this period, 534 visitors (83% of them female) registered to use the restricted areas. Users' mean±SD age was 17±5, and their education level was similar to that of the general population. We tracked the number of visits per visitor and the duration of each visit. Of all the visitors, 19% visited only once; over two-thirds two to 15 times, and 14% returned even more often. Almost 90% of site visitors spent more than five minutes there, with roughly half of visitors spending more than a half hour on the Web site. Current usage continues to be robust.

Almost 80% of the 188 participants who completed a questionnaire designed to detect psychosocial dysfunction obtained a score in the clinical range. Twelve percent of all visitors requested contact with a counselor by e-mail, 19% participated in 178 monitored chat sessions, and 6% asked to chat privately with a counselor. Three-quarters of the visitors or their parents lived in the area. This means that approximately 200 youngsters from the area registered to use the site and visited it at least twice—four times the number of individuals who attended face-to-face preventive services at the local mental health center during the previous ten years.

All of the monitored chat sessions included a discussion of how to cope with a family member's illness. Participants who disclosed a problem were encouraged to seek help. In some cases, they revealed that they were already seeing a professional but were reluctant to talk about their difficulties. The online counselor would advise them to print the story they had just told and give it to their psychologist to read. Several of the visitors had to be encouraged more than once before they took action; this required special skill on the part of the eight counselors. It was gratifying, however, to see that some of the visitors later communicated the relief that they had experienced (“Thanks for giving me confidence”).

Although Survivalkid has increased the target group's access to information and support, some difficulties still exist. One problem is the gap between the services that Survivalkid provides and the more intensive services that some visitors need. There are also issues about how to sustain funding for the site and how best to demonstrate its effectiveness.