In recent weeks, the Medicare Benefits Schedule Review Tasforce’s Mental Health Reference Group published its report and recommendations, part of a wide-ranging review of services subsidised by Medicare.
They recommended a massive expansion of the $1.5 billion Better Access program, which enables Medicare-subsidised visits to psychologists and other health professionals.
But simply striving to get more people into face-to-face care with health professionals is a limited and expensive strategy.
If we’re serious about improving access to mental health care, we need to look to online therapies. The evidence says they can be effective instead of, or as well as, seeing someone face-to-face.
Digital approaches to mental health care
Some studies have found online therapy to be as effective in reducing symptoms as therapy delivered face-to-face by a clinician. This evidence is strongest in relation to depression, stress and anxiety.
One meta-analysis of data from 3,876 adults found those who underwent internet-based cognitive behavioural therapy to treat symptoms of depression had better outcomes than those who didn’t use online therapies. They were also more likely to stick to their treatment.
So self-guided internet-based cognitive behavioural therapy is a viable alternative to current first-step treatment approaches for symptoms of depression and anxiety.
Online approaches vary, but they commonly present a course of psychological therapy structured so the participant can track their progress over time and seek further assistance if their situation deteriorates.
As an example, Mindspot offers a three step online process of therapy, beginning with information, followed by assessment, and finally, treatment.
Treatment consists of online courses across several areas, depending on the user’s needs. These courses might cover mood issues, obsessive compulsive disorder, and post-traumatic stress disorder.
People can elect to do a course independently, or could be referred by a health care professional, such as their GP. When health practitioners refer their patients into Mindspot they receive patient progress reports.
Other key advantages of these stand-alone digital approaches include 24/7 availability of care, and the absence of the fees that would otherwise be paid out-of-pocket for a face-to-face consultation.
The range of online mental health tools available has expanded enormously over recent years. This has spawned review sites that help users navigate to online mental health therapies that best meet their needs.
And new research is looking at how digital technologies can be used for the prevention of mental illness as well as its treatment. The Black Dog Institute’s Future Proofing Study will engage 20,000 year 8 students to see how they can use their smartphones to prevent anxiety and depression.
We can facilitate team-based care online
Perhaps the greatest opportunity for enhanced mental health service delivery is to start to use digital technologies to drive new models of care specifically designed to meet the needs of each individual.
For people with more complex, disabling and persisting conditions, the international evidence clearly indicates bringing together a team of professionals is best practice.
For example, a person with an eating disorder is likely to benefit from integrated, multidisciplinary care provided by a GP, a nurse, a dietitian, a psychologist, a peer worker, and so on.
There are already some efforts to foster this online. An example of this can be found in the InnoWell platform, which service providers can use to bring together different professionals and resources tailored to suit each patient’s needs.
Using online assessment tools at the point of service request, those with milder needs are connected to a range of evidence-based apps and e-tools matched to their needs. Meanwhile, those with more complex needs are connected to care which will benefit them, including face-to-face services.
As a proportion of the total, new clients into Better Access were 68% in 2008, 57% in 2009, and just 32.6% in 2016-17. This increase in repeat customers suggests two things. First, perhaps people did not get the help they needed or had problems too complex to be managed within the program. And second, there may be limits on the extent to which the program can continue to meet its stated goal of increasing access to mental health services.
While the Medicare review relegated online therapies to “longer-term” reform, new digital and team-based approaches are key to driving improved models of increased access, at relatively low individual cost, to high quality mental health care.
Australia’s e-Mental health strategy needs action. The Medicare review into mental health represents a significant opportunity to get future investments right.
This means shifting from a focus just on access to instead considering how best to provide high quality, individualised services at scale – particularly to those who are disadvantaged economically, socially or geographically.