As the COVID-19 pandemic continues to impact our lives and the cost of living steadily inclines to the tune of inflation, the need for mental health support in Nova Scotia is rising. 

Although mental health resources have evolved significantly and become more accessible over the years, the pandemic has pushed Nova Scotia practitioners to find alternative solutions to provide ongoing mental health support while ensuring everyone’s safety. 

This led to the launch of Text4Support — a text-based mental health service that sends automated daily text messages written by mental health therapists to patients. Based on studies in Cognitive Behavioural Therapy (CBT), the initiative is a collaboration between the Department of Psychiatry at Dalhousie University, Nova Scotia Health’s Mental Health and Addictions Program, the Nova Scotia Health Innovation Hub and the QEII Foundation.

“The text messages are condition-specific, which means that we have text messaging banks that address different mental health conditions,” says Dr. Raquel Dias, a research associate with Nova Scotia Health and an assistant professor with the Department of Psychiatry at Dalhousie University. “We have messages to address anxiety, depression, bipolar disorders, schizophrenia, addiction disorders, personality disorders and many other mental health conditions.” 

The Text4Support initiative was created by Dr. Vincent Agyapong, the chief of psychiatry at the QEII Health Sciences Centre, while completing his PhD in Ireland in 2009. The idea came to him by chance when a family member sent him a supportive text message during a time of stress.

Dr. Agyapong felt daily messages like this would be an effective addition to the follow-up care for patients who have been recently discharged.

“We thought this can serve two functions,” explains Dr. Agyapong. “First, we can close the access gap, in terms of there not being enough psychologists and mental health therapists in the system. With this, you can reach out to many people simultaneously. 

“The second is the geographical barrier to access. If you live in a more rural area, where going from one city to the other is two hours or so, then Text4Support can provide psychological support for people in a way that doesn’t require them to travel between services.”

Currently, the service is available to Nova Scotians accessing community-based or emergency mental health services or those who’ve recently been discharged from inpatient care. Upon completing an initial questionnaire, participants are matched with the best group of text messages that suit their condition.

Joselyn Nelson joined Text4Support to help with her bipolar disorder after hearing about the program from her father. She thought it would be a more accessible way to get mental health support. 

“I find the information, the little reminders and the hope-providers really helpful,” says Joselyn. “It’s important to be reminded that I can reach out to friends and family if I’m feeling overwhelmed because I’m the kind of person to just take it all on myself.”

Joselyn sees a psychiatrist and a therapist to aid in managing her condition, but she needed more support to augment her sessions. She says she is grateful to have something that provides affirmation and helps her monitor her mental health on a daily basis.

Joselyn’s situation is not a surprise to Dr. Agyapong, who has observed the rising demand for mental health support. 

“In most jurisdictions in Canada and around the world, if you contact a mental health and addiction program today saying that you want to speak with a therapist, they will put you on a waitlist to see somebody in several weeks or months,” he says. “So, by the time you get to see a therapist, you might not even need to talk to someone anymore. Or, in the worst-case scenario, things may have gotten worse.” 

The Text4Support program now has more than 1,500 participants and has been recognized by the World Health Organization as a first-of-its-kind mobile-based tool in addressing mental health. 

Meanwhile, Dr. Agyapong says other health practitioners are looking into adopting the service to augment other forms of health care. 
Dr. Dias feels Text4Support is the next step in modernizing mental health services, and in normalizing conversations surrounding mental health. 

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