Bridging the Gap

By Alex Piazza
apiazza@umich.edu

Ailsa was unable to advance her career because of social anxiety.

“It kept me from going after promotions I wanted or felt I deserved,” said the Detroit native. “I was just the quiet girl who came in and did her job and didn’t draw attention to herself. You have to talk to people to get noticed, and I wasn’t good at that.”

Ailsa is one of 15 million adults with social anxiety disorder, a chronic mental health condition that can trigger fear in situations where they may be judged—a symptom that severely impacts their ability to land a job.

A new multidisciplinary lab at the University of Michigan is embracing technology in an effort to improve the lives of people, like Ailsa, with untreated mental health needs. The Treatment, Innovation and Dissemination Lab (TIDL) brings U-M researchers in fields ranging from social work to psychiatry together with community partners to develop technology that helps increase access to mental health treatment for underserved populations.

“It’s unacceptable that some people don’t have access to mental health care,” said Joseph Himle, TIDL co-director and associate dean for research at the U-M School of Social Work.

Himle is leading a multi-site project that tests a specialized form of cognitive behavioral therapy designed to help unemployed adults in Detroit whose job attainment efforts have been undermined by social anxiety disorder. Through the project, funded by the National Institute of Mental Health, vocational service professionals administer therapy using a program that guides them with real-time, computer-generated assistance when delivering the group sessions—a novel approach that addresses a shortage in trained mental health clinicians.

“We are focused on closing the mental health care utilization gap, and we are particularly devoted to helping people with mental health trouble return to work, and then maintain employment over time,” Himle said.

Support services provided through the project helped Ailsa secure a culinary internship at the Detroit Rescue Mission, where she is now a chef.

“They opened up a crazy opportunity for me, one that I thought I’d never be able to pursue,” said Ailsa, who someday plans to open her own restaurant.

Virtual Interview

Meet Molly Porter.

Molly works in human resources at Wondersmart and she will conduct job interviews today.

But there is a catch—Wondersmart is a fictional store and Molly is not real.

She is the face of virtual reality job interview training. With funding from NIMH, U-M researcher Matthew Smith helped develop Molly to assist people with psychiatric disorders polish their interview skills.

The need is evident—research shows young adults with high functioning autism spectrum disorder have an unemployment rate between 50 and 75 percent.

“Anyone that has a disability has a hard time finding employment,” said Smith, TIDL co-director and associate professor of social work. “The first line of offense when you’re trying to get a job is getting through the interview process. If you stall there, you’re not going to get a job.”

To gauge its effectiveness, Smith invited 79 people who were diagnosed with depression, bipolar disorder, schizophrenia or autism spectrum disorder to test Molly.

Participants logged into an online portal to access the virtual reality job interview training, where Molly asked about their previous work experience and computer proficiency. Molly then tailored her feedback based on individual responses.

If a participant said they are not good with computers, Molly responded with: “There are better ways to share your lack of skills. Asking about training or stating that you think you could learn if you had a chance would be a better option.”

After the interviews, participants reviewed their scores and received constructive feedback from Molly. They completed five sessions of virtual reality job interview training, and then conducted mock job interviews with a professional actor.

Six months after training, Smith and his colleagues surveyed participants to measure their success on the job market. Their findings suggest that participants who completed virtual reality job interview training were twice as likely to accept a job offer when compared to those who did not undergo training.

Smith plans to expand the availability of Molly at social service agencies nationwide, while modifying the training tool to target new audiences like high-school students with autism or other disabilities.

“For me, as a social worker and just as a human being, my mission in life is to help as many people as I can,” Smith said. “If this Internet-based tool works, I want to get it in as many hands as possible because that’s how you help promote social change.”

Place of Worship

It’s Sunday and the local church parking lot is crowded as residents assemble for religious service.

Churches remain the heart of many rural communities, and residents there often turn to clergy for social and emotional support.

For years, Addie Weaver has focused her research efforts on improving access to mental health services for people living in rural areas. Rural Americans are just as likely to experience mental illness as their urban counterparts, but they are less likely to receive any type of mental health treatment.

Research shows just 52 percent of individuals with a diagnosed mental health disorder visit a mental health specialist in their lifetime.

This is where churches come into play. Weaver is working with community partners in Hillsdale, Mich. to develop a group-based depression treatment, administered in a church setting, for residents of the rural community with mental health needs.

As part of the Raising Our Spirits Together (ROST) project, Weaver and her colleagues work with church pastors to facilitate group cognitive behavioral therapy sessions. A large part of each therapy session will be delivered through a computer-based platform so residents can benefit from professional expertise that often is unavailable in rural communities.

“The challenges in improving access to mental health care are significant and the consequences for not meeting these challenges have detrimental effects for rural residents with unmet mental health needs,” said Weaver, TIDL co-director and assistant professor of social work. “Our intervention seeks to provide evidence-based depression treatment in a way that is acceptable and sustainable in rural community settings.”

The project also addresses a common culture within rural communities, where values like self-reliance and independence can lead residents to believe they should be able to address any problem by themselves.

“Many people in small towns have anxiety that someone may see them walk into the counselor’s office on Main Street,” said Pastor Mark Elliott, who is partnering with Weaver on the project. “The stigma of mental illness is definitely exacerbated in rural areas. By opening my church and other places of worship in Hillsdale County, we hope individuals will take advantage of these important health services.”