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mindyourmind: An Overview andEvaluation of a Web-FacilitatedMental Health Program that AppliesEmpowerment Strategies for YouthTanya Halsall a , Christine Garinger b & Tanya Forneris aa University of Ottawa , Ottawa , Ontario , Canadab mindyourmind , London , Ontario , CanadaPublished online: 04 Nov 2014.

To cite this article: Tanya Halsall , Christine Garinger & Tanya Forneris (2014) mindyourmind: AnOverview and Evaluation of a Web-Facilitated Mental Health Program that Applies EmpowermentStrategies for Youth, Journal of Consumer Health On the Internet, 18:4, 337-356, DOI:10.1080/15398285.2014.952998

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mindyourmind: An Overview and Evaluationof a Web-Facilitated Mental Health Program that

Applies Empowerment Strategies for Youth

TANYA HALSALLUniversity of Ottawa, Ottawa, Ontario, Canada

CHRISTINE GARINGERmindyourmind, London, Ontario, Canada

TANYA FORNERISUniversity of Ottawa, Ottawa, Ontario, Canada

Many Canadian youth suffering from mental health issues do notaccess necessary services. There is a need for more evaluation ofexisting programs that promote access. mindyourmind is aweb-facilitated community mental health program with a Web sitedeveloped to improve access to services for youth dealing withmentalhealth issues. This article provides an in-depth description of youthengagement strategies used by mindyourmind and the results ofa preliminary evaluation to determine the characteristics and usagepatterns of Web site users and impacts on help-seeking behavior.

KEYWORDS Web site, child and youth mental health, evaluationcapacity building, stigma, service use, youth engagement, mentalhealth literacy, community mental health, program evaluation,web-facilitated programs

INTRODUCTION

Many youth experiencing mental health issues in Canada do not accessthe services they need (Cheung and Dewa 2007; Offord et al. 1989;Statistics Canada 2002). As such, there is a need to employ innovative

# Tanya Halsall, Christine Garinger, and Tanya FornerisReceived May 1, 2014; revised June 24, 2014; accepted August 4, 2014.Address correspondence to Tanya Halsall, University of Ottawa, Montpetit Hall, MNT 416,

125 University Private, Ottawa, ON, Canada, K1N 6N5. E-mail: twitt081@uottawa.ca

Journal of Consumer Health on the Internet, 18(4):337–356, 2014Published with license by Taylor & FrancisISSN: 1539-8285 print=1539-8293 onlineDOI: 10.1080/15398285.2014.952998

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solutions to reach out to this population. The Internet was identified as auseful resource to promote mental health for youth (Santor et al. 2009), andonline interventions are being developed to reach those youth who are notreceiving help. Despite the promise exhibited by technology-facilitatedinterventions for child and youth mental health, few of these initiatives havebeen evaluated (Boydell et al. 2013). The first section of this article providesan in-depth description of a web-facilitated community mental health programthat applies a youth engagement and stigma reduction strategy. The secondsection presents the results of a preliminary evaluation that examines theprofile and usage patterns of Web site users and impacts on their help-seekingbehavior.

In Canada, the prevalence of mental health issues in children andyouth is about 14% (Waddell et al. 2002). In a more recent survey con-ducted on high school students from grades 7 through 12 in Ontarioresearchers found that 13.7% of participants reported their mental healthas fair or poor and 33.5% reported experiencing symptoms of depression,anxiety, or social problems (Paglia-Boak et al. 2012). In addition, accord-ing to Statistics Canada (2002), approximately two-thirds of young adultsaged 15–24 years with a mental health issue reported that their symptomshad onset before the age of 15, and only 32% sought mental health ser-vices. Further, only half of Canadian adolescents and young adults whoexhibit serious mental health issues such as suicidality access mentalhealth services (Cheung and Dewa 2007). Research has shown that thereare a number of barriers that prevent youth from accessing mental healthservices. These barriers include stigma, low mental health literacy (Colesand Coleman 2010; Gulliver et al. 2010), as well as living in a rural areaand socio-economic status (Afifi et al. 2005). As a result, there is a criticalneed for those providing mental health services in Canada to find newways to reach young people.

The Internet has been described as a unique tool to promote mentalhealth in youth (Santor et al. 2009), particularly in regards to accessing andengaging youth who are in need of mental health services. Internet use isgrowing rapidly, and a recent survey found that 99% of Canadian youth haveInternet access away from school (Steeves 2014). Moreover, because ofanonymity and accessibility, many youth report that they would be opento using the Internet to access mental health information (Horgan andSweeney 2010).

Findings from the literature also provide early support for the use of theInternet for mental health promotion in youth in terms of assessment (Santoret al. 2007), self-screening, (Donker et al. 2009; Ercan et al. 2006) mentalhealth literacy (Burns et al. 2009; Santor et al. 2007; Larue et al. 2009), preven-tion (Calear and Christensen 2010), intervention (Bruning Brown et al. 2004;Crutzen and De Nooijer 2011; Fridrici and Lohaus 2009), and as a first pointof entry into a mental health care system (Haas et al. 2008). Moreover, due to

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the sensitive nature of mental health issues and youth propensity forself-reliance (Rideout 2002; Marcus and Westra 2012), the Internet presentsas a powerful resource for health promotion, especially around highlystigmatized health issues (Berger et al. 2005; Naylor et al. 2009).

Youth engagement is defined as ‘‘the meaningful participation andsustained involvement of a young person in an activity that has a focusoutside himself or herself’’ (Pancer et al. 2002, 49). Youth engagementinitiatives often involve the collaboration of adults with youth in order toachieve positive community outcomes. This collaboration should involve‘‘youth as valued partners in addressing, and making decisions about issuesthat affect them personally and=or that they believe to be important’’(Pereira 2007, 8).

Hart (1997) developed a ladder model to help describe the various waysin which children and youth can participate in their communities. The ladderinvolves eight levels of participation: 1) manipulation, 2) decoration, 3)tokenism, 4) assigned but informed, 5) consulted and informed, 6)adult-initiated with shared decisions with children, 7) child-initiated anddirected, and 8) child-initiated, shared decisions with adults. Each levelinvolves increasing responsibility and engagement of youth.

Meaningful youth involvement has been pivotal in advancing a numberof social issues including health and mental health promotion (Flicker et al.2008; Ramey et al. 2012; Ross 2010; Wong et al. 2010), the promotion of help-ing (Reavley et al. 2011; Haski-Leventhal et al. 2008), fostering communitychange (Campbell and Erbstein 2012; Zeldin et al. 2012), enhancing youthdevelopment (Christens and Peterson 2012; Fredricks and Eccles 2005),developing collectives between adults and youth (Ginwright 2005), advanc-ing youth-focused research (Jacquez et al. 2013), and creating organizationalchange within youth-serving organizations (Schulman 2006; Zeldin et al.2005).

Within the mental health field, youth engagement is used as an impor-tant strategy to improve mental health among children and youth since itcontributes to more youth-friendly strategies and it provides consumers aforum to advocate for themselves. For instance, Eysenbach’s (2008) workin consumer health informatics states that involving youth as co-creators isa fundamental way to communicate credible health information for youth,while Hamilton and Flanigan (2007) report that co-creation between youthand adults builds social responsibility. More recently, Marcus and Westra(2012) assert that since young adults often prefer self-reliance and informalsupport for mental health problems as opposed to solely seeking help fromprofessionals, initiatives should incorporate strategies such as nontraditional,youth-friendly options. For example, researchers suggest that the sharing ofpersonal stories reduce stigma, specifically reducing the perceived socialdistance between those with a diagnosed mental illness and those without(Corrigan and Wassell 2008; Stuart 2006).

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YOUTH ENGAGEMENT STRATEGIES AT MINDYOURMIND

mindyourmind is a cutting-edge non-profit program developed inLondon, Ontario, Canada in 2004 (mindyourmind.ca). In addition toface-to-face and web-based programs, it incorporates social networks toreduce the stigma of mental illness, increase mental health literacy, andincrease access and use of both formal and informal networks of supportfor Canadian youth ages 14–24. mindyourmind’s overall goals are to: 1)reduce the stigma around mental illnesses, 2) increase access and use ofservices and support for mental health and emotional problems, and 3)to partner with youth so they amplify their strengths and design for socialchange. mindyourmind makes evidence-informed tools and resourcesavailable to the user, on-line. It is hoped that, by accessing resourcesand tools, users become better informed about mental health, as well asabout resources and services available to them. The mindyourmind staffteam consists of mental health professionals, information communicationtechnology and design professionals, and youth assistants. Additionally,mindyourmind is part of a family serving organization called FamilyServices Thames Valley.

mindyourmind applies Hart’s ladder of youth involvement, specificallythe latter levels that place an emphasis on youth-adult participation. mind-yourmind’s youth-adult partnerships are based on values of authenticity,equity, collaboration, adaptability, and commitment. mindyourmind staffunderstand and respect that a young person’s world view is key and thatboth adults and youth are experts of their own experience and, as such, bothbenefit from an experience together. In addition, youth culture is a criticalelement of mindyourmind‘s program delivery and is expressed throughmusic, art, fashion, education, digital games, sports, social advocacy, andtechnology.

There are many ways that youth are involved with program and Website development. Youth can write their own narratives using poetry, blogs,story-telling, mixed media art, music, photography and video, which are allshared as Web site content. Youth determine the extent and timing of theirinvolvement, while mindyourmind coordinates participation using strate-gies that are appropriate for each participant’s developmental stage. Thisrelationship building and engagement provides growth opportunities anddevelopment for youth.

In addition, the program incorporates social marketing and permissionmarketing principles (Pirani and Reizes 2005; Godin 1999; Krishnamurthy2006). For example, web-based tools, resources, and platforms aredeveloped in partnership with youth. Balance and power dynamics ofyouth-adult relationships are considered with each interaction. As such,mindyourmind involves youth in the conceptualization, implementation,

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and evaluation of program initiatives and responds to requests from youth,creating youth-friendly tools and resources and providing growth opportu-nities for both youth who are directly involved and the youth who accessand utilize the tools and resources. Some novel programs and initiatives thathave been developed at mindyourmind are the Street Teams, DesignStudios, and GetReal Nationwide. The following section provides a detailedaccount of the Street Team initiative.

STREET TEAMS

‘‘ ‘Street teams’ are voluntary groups of people who promote an event, a pro-duct or a brand through word-of-mouth in urban contexts’’ (Vellar 2012,107). A sponsor would enlist these people to join a Street Team to promoteand participate in various activities in their communities thereby accumulat-ing points to be traded for merchandise, concert tickets, or a chance to meetthe band as well as gain status within their Street Team community (Vellar2012). mindyourmind uses this approach within a philanthropic lens bycreating local, provincial, and national Street Teams that are designed to pro-mote positive mental health initiatives within their own communities (Smithand Reynolds 2008).

The stages of the mindyourmind Street Team approach begin whenproject-based funding has been approved. Next, a volunteer coordinatorand graphic designer develop a recruitment poster that details the StreetTeam focus, criteria for involvement and prerequisite skills needed. Approxi-mately ten applicants are chosen to participate based on an interview pro-cess. When teams reach capacity, additional participants are involved inother ways, such as Web site content creation or involvement in other events.Street Teams are typically composed of youth between the ages of 14 and 24years. The youth must express an interest in being involved in avolunteer-based project that aims to benefit other youth and must expresscommitment to the project timelines. Specific disclosure around experiencewith mental health issues or illnesses is not a requirement for participation.The Street Team meets weekly over the course of approximately threemonths. The first team task is building partnerships within the youth–adultteam and to collectively set the course of the project, which includes a reviewof the project’s funding directives. In general terms, the objectives of mind-yourmind Street Teams are 1) to create a safe space to explore new infor-mation toward attitude and behaviour change about mental health issues,and illnesses and accessing supports as needed; 2) to strengthen social andcommunication networks about the issues at hand and develop strong peerto peer relationships and youth-adult partnerships; and 3) to leverage the cul-turally relevant strengths and skills of youth in the areas of graphic design,

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web design, usability, and content creation in order to help spread mind-yourmind’s mission. mindyourmind Street Team adult partners embody astrengths-focus, encouraging all team participants to draw on personal assetsand choices.

For example, in the ‘‘Define Hope’’ Street team, six youth, ages 17–25,met weekly over six months to create a series of videos targeted to challengestereotypes and stigma associated with mental health issues. The videos alsoserved to advance messages of inclusion in order to build youth hope andinspire them to seek help. The videos were created using a collaborative pro-cess where the youth team members conceptualized the themes in each ofthe videos, developed content and performed as the central roles in thevideos. For example, the public service announcement ‘‘Define Hope’’(<http://youtu.be/pPu2jXHXHOk�) expressed how experiences of loneli-ness or stress can be difficult to verbally communicate. This public serviceannouncement has been used in public education and outreach activitiesand was aired for 2 weeks on Much Music & MTV Canada-Bell Media throughCTV. It has been viewed more than 1,000 times on the mindyourmindYouTube channel.

The following are some quotes that capture the experience of the StreetTeam youth:

The dynamic of the team was awesome. There was no sense of youth vsadult, it was working WITH adults as equal players. The adults workingas facilitators, guides, and resources and the youth working as developersand active participants in creating. (mindyourmind volunteer)

I think the best thing I’ve learned from mym is how to state youropinion; it sounds like such a small thing but after being in such acomfortable atmosphere and respectful place, it’s easier. Especially sinceour opinions always differ I found a new way to strongly state my opinionwithout offending anyone. (mindyourmind volunteer)

Finally, the following is an excerpt from a blog written by a young personthat has been involved with mindyourmind for several years. It detailsher growth and her learning about how to find the positive in her experiencedealing with mental health issues through education and advocacy aboutmental health:

The first time [I] volunteered at mindyourmind office four years ago, [it]involved me and some other volunteers playing the Reach Out game,where mental health questions are asked in a Jeopardy-style layout. Iknew the answer to every single question but only contributed my voiceto the discussion a few times.

I left the mindyourmind office feeling so sad and self-loathing thatday, because I felt like a truly crazy person for knowing so much about

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mental health. My knowledge was all from personal experience like mysuicide attempts. I hated myself for having such a dark history.

Yet, four years later, I’m speaking at conferences with mindyour-mind, sharing my story and helping service providers in Ontario reachyouth at times of crisis, bringing them the resources they need.

It is awesome. I love it! And at such events, I’m told that my input isvery appreciated and I’m applauded for sharing pieces of my story. Iknow the mental health system as well as the rest of the people do in thatroom, except I know it from a patient perspective instead of as someonewho works in that field. My voice is important!

The only thing that’s changed since that first day at mindyourmindwhen I felt so awful about myself is my perspective. In working withmindyourmind I’ve started to see my mental health knowledge as anasset, not a defect. My nights spent alone crying, self-injuring, wantingto die; the days in the hospital, wishing I could go outside for some freshair; the scars I wear that sometimes cause people to stare at me–I’veturned all of these things into something good. Something that canbenefit others.1 (mindyourmind volunteer)

Currently, mindyourmind has more than 7,500 followers on Twitter andmore than 2,600 ‘‘likes’’ on their Facebook page and it continues to identifynew and innovative ways to incorporate youth engagement strategies. Thefollowing section will present a preliminary evaluation of the website usageand impacts on website user behaviours.

PRELIMINARY EVALUATION OF MINDYOURMIND

This research was accomplished through an evaluation capacity-building part-nership developed betweenmindyourmind and the Ontario Centre of Excel-lence for Child and Youth Mental Health (Centre of Excellence) in Ottawa,Canada. The Centre of Excellence (www.excellenceforchildandyouth.ca)mandate is to facilitate improvements in mental health services for children,youth, and their families. This is achieved through the promotion of partner-ships, capacity, and use of evidence-informed practices. This strategy serves todevelop sustainable evaluation practice through the participatory involve-ment of organization members and the development of critical thinking andsystemic change (Danseco et al. 2009; Sundar et al. 2011).

The purpose of the evaluation was to determine Web site user charac-teristics and usage patterns and to identify whether website users with mentalhealth concerns accessed supports as a result of using mindyourmindweb-based resources and tools. The following research questions weredeveloped through stakeholder consultation: 1) What are the characteristicsof the online user population? 2) Do Web site users with mental health con-cerns access mental health supports as a result of using mindyourmind

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resources and tools? 3) What kind of help do users with mental health issuesaccess?

It was hypothesized that more users would be between the ages of 14and 25 and located in Ontario. For participants with mental health issues,it was hypothesized that there would be a significant difference inhelp-seeking between new visitors to the Web site and those who have beenusing the Web site for a period of time.

METHOD

Evaluation capacity building has been defined as ‘‘the intentional work tocontinuously create and sustain overall organizational processes that makequality evaluation and its use routine’’ (Stockdill et al. 2002, 14). Evaluationcapacity building can be a beneficial alternative to traditional evaluationactivities because it establishes organizational understanding and fosters alearning culture so that the information and experience developed duringthe evaluation can be applied in a more effective way.

To facilitate evaluation capacity building of the mindyourmind Website program, the Centre of Excellence dedicated funding, training, consulta-tions, partnership development, and educational supports to this specificproject. Important areas of focus were the development of staff buy-in forevaluation, internal research skills and knowledge, evaluation-relatedinfrastructure and protocols, dedicated time and responsibilities for evalu-ation, processes for communication and use of findings, and engagementof relevant stakeholders.

An Evaluation Team at mindyourmind was created. They tookresponsibility for collaborating with the Centre of Excellence consultant todevelop the evaluation plan. The Evaluation Team was led by themindyour-mindpro Coordinator and Educator, and involved the Program Director, theYouth Projects and Volunteer Coordinator, the Administrative Officer, theComputer Graphics and Web Designer, youth advisors and volunteerresearch assistants. Continuous feedback was solicited from stakeholdersincluding program staff, youth participants, collaborating agencies and fun-ders. In addition, the Alberta Research Ethics Community Consensus Initiat-ive (2010) Ethics Screening Tool was used as a guideline in developing andexecuting evaluation procedures.

Procedures

A web survey was posted on the mindyourmind Web site on high traffic webpages, such as the home page, the Toolbox landing page, the Celebrity Gallery,and Blog page. The survey appeared as a pop-up with a stock photo image anda text invitation to take the survey as well as a link tomindyourmind’s privacy

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policy. A function to close the pop-up and decline the survey was included. Thesurvey was hosted on a third-party web-based survey platform (SurveyMonkey). mindyourmind’s professional account included secure, passwordprotected, and anonymous data collection as well as VeriSign certificateencryption to ensure strong security.

Measures

As mentioned above, this study used an online survey. The eight-questionweb survey was based on questions regarding Web site usage, mental healthconcerns, and mental health care decision making adapted from a StatisticsCanada (2002) Canadian Community Health Survey (examples include: Inthe past 12 months, have you seen or talked to a health professional aboutyour emotional or mental health? Whom did you see or talk to?). The surveywas reviewed and piloted by youth advisors. In addition, skip logic wasapplied to the survey for those individuals who were visiting the Web sitefor the first time. In this situation the survey routed first time users to the lastquestions in the survey asking about demographic information only. The sur-vey was posted on the mindyourmind Web site for approximately fivemonths with the skip logic design edits made after the first month.

Analysis

Frequencies regarding age, gender, mental health status, and location werecalculated in order to get a better understanding of the characteristics ofWeb sites users. Frequencies were also calculated to identify the type of helpsought as a result of using the Web site.

To assess whether there were more repeat users with mental healthissues who were accessing help compared with those who were new users,a chi-square test of independence was performed. The independent variablewas usage duration and the respondents were grouped into first time users,and those who had been to the website previously. The dependant variablewas help accessing behavior and respondents were aggregated into groupsbased on whether or not they were receiving services.

RESULTS

User Characteristics

A total of 515 participants responded to the web survey. Since participantshad the option to opt out after each question, the total responses decreasedafter the initial question regarding usage duration which explains the varyingN for the different analyses. Within this sample, 80.1% were female(N¼ 336), 18.3% were male (N¼ 76), and 0.7% were transgender (N¼ 3).

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Sixty-seven percent were under the age of 25, and most users resided inOntario (56.6) (see Table 1 for details).

The majority of participants were first-time users of the Web site (seeTable 2 for details). Sixty-eight percent (N¼ 315) of users reported that theyhad experienced a mental health issue, 19.3% (N¼ 90) of users reported thatthey have not experienced a mental health issue while 13.2% (N¼ 62) ofusers reported that they did not know whether they had a mental healthissue.

Help-Seeking Behaviors

The second research question addresses whether youth access mental healthsupports as a result of using mindyourmind.ca. Among repeat users whoreported having a mental health issue, 65% reported accessing professionalhelp, and 36% stated they sought professional help as a result of using the

TABLE 2 Frequency of Usage Duration for Survey Respondents

Usage Duration (n¼ 515) Frequency Percentage

First time user 375 72.8Up to three months 30 5.8Three to six months 15 2.9Six to 12 months 32 6.212 months or more 63 12.2

TABLE 1 Age and Geographic Location of Survey Respondents

Demographic (n¼ 415) Frequency Percentage

Ageunder 14 51 12.315–17 125 30.118–20 60 14.521–24 41 9.925–30 36 8.730þ 102 24.6

Geographic LocationNewfoundland 1 0.2Nova Scotia 16 3.9New Brunswick 6 1.4Quebec 10 2.4Ontario 235 56.6Manitoba 9 2.2Saskatchewan 8 1.9Alberta 22 5.3British Columbia 27 6.5Northwest Territories 1 0.2United States 54 13.0Other country 26 6.3

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Web site. Overall, 86% of repeat users who responded that they had a mentalhealth issue were accessing some kind of formal (e.g., professional) or infor-mal (e.g., family and friends) help.

In survey respondents with mental health issues, the results of thechi-square analysis that examined whether there was a relationship betweenduration of Web site use (first time, repeat user) and help-accessing behavior(nonhelp-accessing, help-accessing) indicated that the relationship was notsignificant (v2(1)¼ 1.07, <.30).

With respect to the third research question which sought to understandwhat kinds of help survey respondents sought (see Table 3), 9% (N¼ 39)went to their family doctor or a general practitioner for help, 11.6%(N¼ 50) saw a psychiatrist, 6.5% (N¼ 28) saw a psychologist, 19.7% (85)saw a social worker or counsellor and 52.5% (N¼ 227) said that they soughtout other avenues of support. When asked what alternative sources of helpwere sought, 38.5% (N¼ 74) said that they went to a friend for help.

DISCUSSION

The purpose of this evaluation was to determine the characteristics and usagepatterns of the mindyourmind Web site users and their resulting help-seeking behavior. The results of this research indicated that 65% of surveyrespondents who indicated they were repeat users of the Web site with amental health issue mindyourmind.ca reported accessing professional helpat the time of the survey, and 86% reported that they had accessed eitherformal support services (e.g., psychologist) or informal support (e.g., friendsand family). These findings are higher than national statistics, which indicatethat only 32% of youth with self-reported mental health concerns accessformal mental health supports (Statistics Canada 2002). Although chi-squareanalyses did not show that repeat users of mindyoumind were significantlymore likely to access help for the difficulties they were experiencing, therewas a higher ratio of repeat users accessing help (7:1) in comparison withfirst time users (4.8:1). Moreover, it should be noted that the non-significantresult may be due to the low percentage of repeat users.

TABLE 3 Type of Formal Help Sought by Survey Respondents

Type of Help Sought (n¼ 432) Number Percentage

Family doctor or general practitioner 39 9.0Nurse 3 0.7Psychiatrist 50 11.6Psychologist 28 6.5Social worker 85 19.7Other 227 52.5

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Related to the specific impact of the mindyourmind program on helpseeking behavior, results from the survey showed that 36% of survey respon-dents who were repeat users with mental health issues stated that they hadaccessed professional mental health services as a result of their use of thetools and resources on mindyourmind.ca. This finding demonstrates thatrespondents intentionally pursued help for their mental health issuesbecause of using the Web site. Furthermore, these results indicate thatmind-yourmind.ca is reaching those in need of mental health information as wellas providing the resources and supports needed for them to take the initiativeto find professional help. There are several mechanisms that may be attribu-ted to this finding. Users may gain a better understanding of their mentalhealth needs and apply this knowledge to pursue corresponding therapeuticstrategies. It may also be an indication of users overcoming the fear related tothe stigma of mental health issues since the Web site content is designed toempower users and encourage them to reach out and find help. It may alsoindicate that users are better able to identify appropriate communityresources because of the information provided on the Web site. Thesemechanisms were not examined in the current study and therefore it is sug-gested that future research be designed to help to better understand howwebsite programs such as mindyourmind can lead individuals to accessmental health services more frequently.

Our findings support previous research that has found that youth seek-ing mental health information on the Internet are significantly more likely tohave seen a mental health professional or to have called a crisis line thannon-Internet help-seekers (Gould et al. 2002). Moreover, other researchhas found that individuals who are experiencing mental health issues aremore likely to use the Internet to find mental health information (Bergeret al. 2005; Gallagher and Doherty 2009; Gould et al. 2002) and thathelp-seekers with anxiety and depression were better able to navigate thehealth care system because of information learned from accessing theInternet (Berger et al. 2005). Therefore, the results of the present study alongwith past research underscores the potential of the Internet to provideoutreach for youth who may be reluctant to seek traditional forms of help.

More than two-thirds of the participants self-reported a mental healthissue or concern (67.5%). Such a high frequency may indicate that youth hav-ing mental health difficulties are seeking out Web site programs such asmindyourmind as it offers a more informal resource that is also self-reliantin nature, it allows for anonymity and it is a resource that is easily accessible.As a result, it appears that mindyourmind may be helpful in decreasing thevarious barriers to accessing mental health resources such as stigma, lowmental health literacy, living in rural areas and lower levels ofsocio-economic status (Afifi et al. 2005; Coles and Coleman, 2010; Gulliveret al. 2010; Horgan and Sweeney 2010). The Internet may also be aparticularly useful resource since many youth must often deal with sensitive

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personal issues and may not be in contact with a health care provider otherthan their family doctor (Rideout 2002). Moreover, based on our results,although a high proportion sought out formal mental health services, a num-ber of users also reported seeking help from friends (38.5%). Research with asample of Australian youth found that 73% of youth seeking help for mentalhealth concerns chose to reach out to friends (Reavley et al. 2011). Thisunderscores the importance of promoting helping behaviors of peers(Reavley et al. 2011) and further supports the importance of stigma reductionmarketing.

In this study, over half of the survey participants were in the target agerange of 15–24 (55%). However, there was also a high participation rate inadults over the age of 25 (33%) This may indicate that Web site programssuch as mindyourmind may also appeal to a broader age-range. It may alsobe the case that equivalent resources do not exist for adults who have agedout of youth targeted resources and that these users are taking advantage ofwhat is available and relevant to them. In addition, research has found thatCanadians in rural areas (Afifi et al. 2005; Boydell 2006; Dias-Granados2010) and with low SES (Steele et al. 2006) are less likely to access mentalhealth services. In some cases, this is the result of a lack of available services(Afifi et al. 2005), high cost of transportation and cost of accessing pro-fessional services (Boydell 2006). As a result, Web site programs such asmindyourmind may provide a valuable resource that adults can access fromany location and free of charge.

Although the majority of the program users were located in OntarioCanada (57%), there were many users from across the country including eightother provinces and one territory, as well as 19% of users reported that theylived outside of Canada. These results reflect that the Internet can overcomegeographic barriers and the exponential nature of the reach of this inter-vention is highlighted. More importantly, there are no limits or subsequentprogram costs related to how many users can access and benefit from theinformation and resources provided. As researchers have noted, the Internetmay be more accessible because it is available around the clock and over-comes geographic barriers (Greidanus and Everall 2010). This is particularlyrelevant in Canada where there are often longer wait times to be able to accessmore traditional mental health service resources (Kowalewski et al. 2011).

The results of this study also indicated that 28% of the survey parti-cipants were repeat users. This finding could be viewed from two differentperspectives. On the one hand, the high percentage (72%) of first time usersmay speak to the wide reach of the Web site and also provides strategicdirection toward the importance of retaining repeat users. On the other hand,it could be troubling that just over one quarter of the users were those thatcontinued to return to the site. What may help explain these specific findingswas the fact that prior to the evaluation, mindyourmind had experienced abrief off-line period and this may have caused repeat users to drop off.

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Another explanation may be that youth seeking help often use the Internet incombination with other sources rather than as a substitute for other help(Gould et al. 2002). It may be the case that past users of mindyourminddo not return because they have moved on to other supports for mentalhealth issues. Also, it has to be recognized that users may not return to thewebsite because they do not find the content engaging or useful after theirinitial introduction or that there may be a number of repeat users who accessthe Web site but who may have not been interested in completing the survey.As a result, the underlying reasons for why individuals either become or donot become repeat users should be further examined.

Strengths and Limitations

This evaluation provides an example of the results of a project to developresearch capacity within community-based organizations. It also demon-strates the potential impacts of a cost-effective and sustainable resource toaccess hard-to-reach youth within the community to facilitate access to care.The results of the evaluation also helped to support mindyourmind inachieving fiscal sustainability. Although these findings are promising, moreresearch is needed to assess the effectiveness of mental health promotionWeb sites for youth. This study represents a preliminary evaluation of themindyourmind Web site, and so there are limited conclusions that can bedrawn from the findings. Due to fiscal constraints, the data were collectedover a short time period. Since the web-based survey was completed volun-tarily and uses convenience sampling it is not possible to know how rep-resentative it is of the entire user population (Burns et al. 2009). Inaddition, survey responses were self-reported so actual help-seekingbehaviours were not measured. Furthermore, mental health issues may nothave been reported accurately since many of the participants had not seena mental health professional and had not received a diagnosis.

CONCLUSIONS

This article describes a successful community initiative that addresses acritical mental health need for and with Canadian youth. It also outlinesthe use of technology, specifically web-based resources to engage youth increating their own mental health states. Technology is considered to beone of many tools to foster youth involvement in social change and inyouth-adult partnerships. The power of youth culture, personal stories, andpeer-to-peer voice lends credibility to youth seeking information and sup-port for mental health issues and are key benefits of using technology asan engagement tool. Providing online, accessible tools and resources thatcan be used anonymously contributes to youth preference for youth driven

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information. In sum, this research contributes to the expanding literature onmental health resources for youth on the Internet as well as programevaluation of technology-based mental health programs and services andprovides new insights regarding youth help-seeking behaviors online.

ACKNOWLEDGMENT

This research was supported by the Ontario Centre of Excellence for Childand Youth Mental Health.

NOTE

1. Daisies and bruises: The art of living with depression. 2014, February 24. Planting roots & speaking

up: Your story matters [Blog post]. http://daisiesandbruises.com/2014/02/24/planting-roots-speaking-up-

your-story-matters/

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ABOUT THE AUTHORS

Tanya Halsall (twitt081@uottawa.ca) is a PhD student at the University ofOttawa, Montpetit Hall, MNT 416, 125 University Private, Ottawa, ON, K1N6N5, Canada. Christine Garinger (christine@mindyourmind.ca) is Researchand Evaluation Lead at mindyourmind, 355 Wellington Street, Unit 285,London, ON, N6A 3N7, Canada. Tanya Forneris (tforneri@uottawa.ca) isAssociate Professor at the University of Ottawa, Montpetit Hall, MNT 376,125 University Private, Ottawa, ON, K1N 6N5, Canada.

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