Online mental health therapy delivers fivefold improvement in vocational outcomes, halves hospitalis

Online mental health therapy delivers fivefold improvement in vocational outcomes, halves hospitalisations and emergency visits

11 May 2021


Young people accessing a specialised online therapy while recovering from first episode psychosis have a 5.5 times greater increase in their likelihood of finding employment or enrolling in education compared to those receiving treatment as usual, Orygen research has found.

They are also 50 per cent less likely to visit emergency departments or be admitted to hospital after completing the world-first digital intervention than young people receiving standard treatments.

Lead author of the paper, Director of Orygen Digital, Professor Mario Alvarez-Jimenez, said the Horyzons online platform provided psychoeducation, evidence-based therapy, pathways for achieving vocational outcomes, and real-time access to online peer workers, clinicians and vocational support workers.

“Horyzons is basically a one-stop online shop where young people can get all the support they need to get well and stay well, and where young people can support each other through peer-to-peer social networking,” Professor Alvarez-Jimenez said.

“What we're doing with this platform is supporting young people in the community so they can deal with their concerns and get on with their lives, rather than needing to go to hospital or emergency departments.”

Participants in the study were 170 young people aged 16–27 who were in clinical remission and nearing discharge from Orygen’s specialist service for first episode psychosis, the Early Psychosis Prevention and Intervention Centre. Half of the participants used Horyzons.

The study is published today in World Psychiatry.

Among the Horyzons users was Anh, now aged 27, who said being able to access a wide range of real-time support from the comfort of home made a big difference for her.

“It helped me get through because I knew that I wasn't alone and there was always someone to turn to – I was able to interact with moderators, staff and peers who had been through the same kind of thing,” Anh said.

“The toolkits, therapy comics and little step-by-step guidelines helped with things like how to stop, breathe, relax, and go one step at a time.”

The other half of the participants received standard treatments delivered by generic medical and mental health services, or by adult tertiary community mental health services.

The study found Horyzons users had a 5.5 times greater increase in their likelihood of finding employment or enrolling in education compared with young people receiving the standard treatments. Meanwhile, study participants who received the standard treatments were twice as likely to visit emergency services or be hospitalised than Horyzons participants.

Anh was one of the many Horyzons users to experience positive outcomes.

“I actually improved in my studies and didn’t have to drop out of university. I was also able to find work and know that, even though I had this mental health condition, I had a job where I was treated the same as everyone else,” Anh said.

“It showed me that I was a fighter – that even though I have hard times I'm able to pick myself up and continue moving forward.”

Professor Alvarez-Jimenez said the findings were important because vocational outcomes and relapse rates had a significant bearing on the lifetime trajectory of young people with first-episode psychosis.

“Vocational outcomes are a hallmark of achieving long-term recovery. Once young people lose their job, lose contact with their peers or drop out of university that has a whole host of implications in terms of long-term disability – at some point they may never catch back up,” Professor Alvarez-Jimenez said.

“Hospital admissions and visits to emergency services are incredibly disruptive, costly and very stressful for young people. The more relapses you have, the more likely you are to accumulate disability and also to experience another relapse. Preventing hospital admissions and use of emergency departments is one of the core goals of early intervention services for young people with psychosis.

“We know that the outcomes that are achieved in the first few years of treatment and recovery are likely to reflect how people are coping 10 to 20 years down the track.”

Following the success of Horyzons in Australia in 2013–2017, the program was rolled out in North Carolina, New York, Canada, Ireland and the Netherlands.

Professor Alvarez-Jimenez said Horyzons had been shown to provide efficient, effective and sustained outcomes for young people.

“Traditional interventional services for psychosis work but they are too short – we can really only provide that intensive specialised support for two years, and once young people run out of that support research shows their social, educational and vocational recovery often falters and their risk for relapse and hospital admissions is high,” Professor Alvarez-Jimenez said.

“With Horyzons, we've been able to show that not only we can sustain gains, we can actually improve some of those core outcomes for young people well beyond two years.”

Horyzons has since been developed and expanded to other areas of mental health, becoming Orygen’s Moderated Online Social Therapy (MOST) platform.

MOST now provides digital therapy blended with face-to-face care for young people aged 15–25 and is being rolled out across Victoria thanks to a $6m grant from the Victorian Government, and a $1m grant from the Telstra Foundation to iterate and improve the MOST technology platform.

Young people can sign up to MOST at a participating Victorian headspace centre, or go to their specialist youth mental health service and ask their clinician for a referral to MOST. Visit for details.

The Horyzons study was funded by the Victorian Government’s Mental Illness Research Fund and the Australian National Health and Medical Research Council.