Craig DeLarge is a principal at the Digital Mental Health Project, a consultancy that seeks to develop education and research that supports responsible adoption of digital technology in the mental health space. With a career spanning over three decades, Craig has held healthcare marketing and digital health roles within a number of reputable organizations.
He recognizes through his work that a sense of community, connection, and peer support are critical for both those susceptible to and also struggling with mental illness.
I had the immense privilege of sitting down with Craig, who has a broad range of knowledge in the field of mental health. We talked about the power of community and how social support—beyond psychotherapy and drug therapy—can play a significant role in maintaining resilience and recovering from mental distress.
Can you tell us a bit about your experience in the field of mental health? Where is your focus now?
I started out in the pharma industry, working in marketing, and then migrated to digital health. In that time, I had the occasion to work on psychoactive drugs. During this time, I also became a mental health advocate educator working with a Philadelphia Chapter of the National Alliance on Mental Illness. Currently, I am a candidate for a Master’s of Public Health with an emphasis on global mental health.
My connection to the field of mental health is further personal, as I participate in the care of a loved one who is mentally ill. I understand how hard this role is for families, so right now, I’m also training to be a Family Peer Support Specialist. With this training, I’m looking forward to helping families care more effectively for their loved ones and for themselves. Because caregiving is overwhelming, knowing others who have gone through what you’re going through can help lessen feelings of caregiver distress and loneliness.
Currently, my focus is on growing the project’s advisory, research, and education practice in support of Mentaltech founders, investors, implementers, and consumers. Also completing my Master’s of Public Health.
What have you found to be common factors among those struggling with mental health issues and what are the most commonly used tactics to address these factors? What is working and what is not?
Distress caused by social and economic insecurity, loneliness, fatigue, etc. probably most contributes to mental health imbalance and disorder. We live in a world where these factors are increasingly endemic, and lately, they have only been made worse as our society grapples with COVID-19. Extreme social inequality, economic insecurity, and mental health are all interconnected. Environmental factors related to our air, water, noise, food, relationships, etc. also have an impact on mental health as much as they do on our physical health.
What works to address these factors? First of all, a sense of security. People feel less stressed when they are treated with respect, exist in a more equitable society, and have a community that gives them a sense of security, belonging, connection, and meaning. Of course, pillars of stress reduction like the foods we eat and movement (aka exercise!) as well as rest and relaxation also have an effect on our mental health.
When there is inadequate security to keep us well, we can regain wellness via drug therapy and psychotherapy. Both take a good degree of experimentation to find what works. Both also require follow-through on the part of the user in order for benefits to be realized. Drug therapy can help if the patient and doctor are able to find a plan that works for them and there is good follow-through on adhering to therapy. Psychotherapy—whether it’s formal or informal, one-on-one or in a group setting—is an effective form of community. Of available psychotherapy approaches, cognitive behavioral therapy, aka CBT, is one of the best proven methods and can be delivered by both human and robotic means. In my opinion, this is one of the most successful strategies.
But among the largest hurdles to people addressing their mental health needs is lack of access, and this is complicated by stigma. These techniques don’t work unless the people who need them are able and willing to access them.
How has the peer support model been employed in an effective way? What have the results been?
Peer support is about matching those with the same or similar lived experiences so that they can lend the support of expertise, resources, and encouragement to one another. People who experience mental illness feel stigmatized and cast off by society. Even the relationship between patients & clients and their doctors and therapists can be strained because of stigma. By connecting someone who is struggling with a like-afflicted peer, a relationship is fostered built on equality and compassion. There is a sense of personal connection and one has a resource to reassure that they can get better, even amid relapses.
The success of this process is twofold. For the person struggling, they have a resource and a sense of community with their peers. For the peer who is matched with them, they are able to turn their pain into purpose. Their struggle then becomes a vehicle to help someone else who is suffering. In many cases, peer support can also be a job opportunity for those who otherwise may not be able to gain employment.
The peer support model is further effective in its scalability because it can be done through a number of mediums: face-to-face; digitally and virtually via platforms like Zoom; or chat, like 7Cups.
As for results, there is a robust literature showing the value-added effect of mental health peer support. Mental Health America’s Center for Peer Support and SAMHSA are among the most credible supporters and certifiers of this method. Beneficial effects of peer support include reduced re-hospitalization, reduced days of inpatient services needed, reduced cost of services, increased outpatient services use, and increased quality of life and engagement outcomes. It is important to note that peer support is a complement to—not a replacement for—clinical care in moderate to severe cases of mental illness.
How is the peer support model affected by COVID and what strategies are being employed to address this hurdle?
COVID has only accelerated the need for the peer support model, as the burden of mental illness has grown owing to the distress the pandemic has caused. Mental Health America certifies peer support professionals who increasingly do a lot of work through digital chat, which has expanded the scope of access and connection for many. What COVID has done is increased funding into the space and the volume of mental health support resources and temporarily relaxed regulations surrounding HIPAA.
While it’s unfortunate that COVID has increased the burden of illness, there are more resources than ever available through peer support that are friendly to physical distancing, largely through digital means.
When the pandemic began, I began working with local mental health [peer] support groups to help their transition to online formats via Zoom. This has been an essential lifeline for many who struggle with mental illness as well as their families. An unintended positive outcome of COVID-19 normalizing online peer support is that people began going to support groups for the first time online when they did not before COVID-19 forced the matter. Greater need and convenience is served by online options.
How can the peer support model obtain more widespread use in the field of mental health?
The peer support model can be scaled through additional channels and contexts, which span from one-on-one to group, synchronous face-to-face to virtual reality, and asynchronous chat and messaging. COVID has also increased the sense of urgency for innovation in mental health.
Important factors to aid scale are 1) destigmatization of support through social influence and learning so that more seek this model, and 2) the closing of the “digital divide,” which increases access to devices and bandwidth and allows peer communities to connect with one another to a broader degree.
Additionally, as new digital channels increase adoption, there will be opportunities to increase the availability of peer support through these channels. An emerging example of this is virtual reality, where peers meet in immersive 3-D, even 4-D environments that foster a deeper sense of connection than on a flat screen or chat dialog box. Recently, I learned about a company, ForeTell Reality, which designs environments for support groups to meet in virtual reality spaces. This can be a more comfortable option for those who fear being stigmatized.
Methodologically, while this model can always get incrementally better, the greater opportunity is in the discovery of more points of access, finding the funding to develop them, and making them a social habit that people can stick with.
Our propensity as human beings is to think that if we’re suffering, we’re alone in our suffering. This isn’t true. With increased innovation and accessibility, the peer support model can strongly employ the power of community in combating mental health struggles prevalent in our society today.
We are deeply appreciative of Craig DeLarge and his work to make mental healthcare more accessible to those in need. Through the peer support model, it is so encouraging to know that those who are mentally ill and their families are not alone in times of struggle. To connect and learn more about Craig DeLarge and the Digital Mental Health Project, visit www.digitalmentalhealthproject.com, or follow him on Twitter at @dmentalhproject.