When I started working for a teen magazine in 2008, I was surprised and impressed by the way the problem pages were put together. We had four different, highly qualified agony aunts (one was an agony uncle), who were able to give advice in their specific fields. But every reply ended with “But do see a doctor, if you’re worried” or “It’s always worth talking to your GP, to be sure”. Even though one of them was a GP. The idea was that the magazine existed as a jumping-off point, a space to reassure our readers that they were not alone, while gently pointing them in the direction of all the practical help that was available.
Since the magazine closed, I’ve worked as an agony aunt for older people and I know that adults have just as many queries and concerns as teenagers. I also know that if you have a question or major health worry, you don’t need to write off and wait for an answer – you can take your queries to Dr Google. In the UK, “insomnia” gets an average of 74,000 searches a month (and diarrhoea is approaching 50,000). Advice is available at the touch of a button, but it’s often contradictory and confusing before it’s comforting. I’ve read letters from people who became even more concerned about their problems by trying to resolve them alone, online.
Now, users in the US who search for “depression” or “clinical depression” will have the chance to answer a questionnaire, enabling to determine whether they should seek professional help. Google has developed this initiative with the National Alliance on Mental Illness. Their CEO, Mary Giliberti, said: “The results of the PHQ-9 can help you have a more informed conversation with your doctor.” Google has made a statement assuring users that it would not store responses, explaining the information is “sensitive and private”.
As the very helpful NHS site explains: “Some people think depression is trivial and not a genuine health condition. They're wrong – it is a real illness with real symptoms.” So in many ways, the fact that Google is offering this service is a leap forward. It acknowledges that our mental health is just as important as our physical health. As mental illness is an escalating problem that many find debilitating, it’s imperative that we see more forward-thinking public-health initiatives.
The form Google will direct users to is the frequently used PHQ-9 questionnaire. Many of us will be familiar with this from counselling or therapy sessions. It asks about the frequency of feelings of hopelessness, extreme tiredness, fluctuations in appetite and the desire to hurt oneself. The PHQ-9 is recognised as being one of the more accurate and effective tools of diagnosis, but it’s far from perfect, with a fluctuating rate of false positives and, in some instances, “good sensitivity but poor specificity”, according to a 2010 study. In other words, another great jumping-off point to start establishing whether someone needs help – but not necessarily a foolproof or effective standalone indicator of depression. I know I sound horribly cynical, but I worry that Google is, at best, allying themselves with a newly fashionable cause and, at worst, going to use a loophole that allows them to exploit vulnerable users further down the line.
We still have a huge amount of work to do when it comes to tackling the stigma of mental illness and we need to keep raising awareness of the fact that it could affect any and all of us
I’ve struggled with anxiety and depression, and I’ve completed the questionnaire many times. I remember being talked through it by my kind, gentle counsellor, Peggy, and how she gave me the space to explain that I had been thinking about hurting myself, without making me feel as though I’d given the “wrong” answer, and allowed me to explain the nuances of my feelings when there wasn’t really room for it on the form. I remember completing it when in group therapy, and feeling pathetic and worthless because I wasn’t interested in doing anything, and felt far too tired to do it – then listening to the rest of my group speaking about their struggles and gaining some perspective on my answers, as not everyone was managing to eat, wash, work or leave the house. I remember when I was first referred for therapy, after weeping all over my GP in response to a fairly routine question about stress. I’m not sure how I would have responded to the questionnaire then and I don’t think I would have been comforted to be told that my feelings had been confirmed by a computer. Human kindness and common sense saved me. I felt a glimmer of hope because I’d just been told someone was going to help me.
We still have a huge amount of work to do when it comes to tackling the stigma of mental illness and we need to keep raising awareness of the fact that it could affect any and all of us. Even if you don’t go through it directly, there’s every chance that a friend or family member will. The more we know, the more supportive and helpful we can be. In many ways, Google’s impact here could be huge – it’s already making a headline out of mental health. However, awareness has been increasing significantly over the last couple of years. We urgently need better funding for mental health and greater resources. When you feel alone, scared and isolated, it’s not helpful to get stuck staring at a screen that is giving you information about yourself that you probably already know. Everyone’s experience of mental illness is different. It’s vital that we recognise this and put support systems in place for the people who feel moved to take the survey. After all, it ultimately only has two results. If you’re concerned about your mental health, there are some great sources of support online. There’s also plenty of incorrect, confusing and potentially damaging information. Please, please try to talk to your GP if you’re worried. It’s very easy to get an appointment with Dr Google, but when it comes to mental health, the best thing to prescribe is kind, informed human help.