Who benefits from eMental Health?
“The system benefits,” the cynics say. “Online mental health support in the form of web-based resources and online treatment programs is far cheaper than face to face care and takes the heat out of the mental health care budget at the expense of patients and practitioners.”
(I’m summarising and paraphrasing here but that’s the cynical view in a nutshell.)
Wouldn’t it be nice if that assertion were true that eMental Health (eMH) use would make the mental health care budget affordable!
But what we might just end up doing is spend less money on people with less severe conditions so that more can be spent providing higher intensity care for those who need it.
The second half of the sentence does not make sense. It implies that digital resources are not effective (“at the expense of patients”) and that there are not enough people with more complex mental health conditions to fully occupy the existing mental health workforce. Oh, if only this were true! Currently, the number of people with complex mental health problems far outstrips the ability of the system to support them.
We do need to address the question of efficacy.
What does the research say about the efficacy of online mental health treatment programs?
There is a large body of evidence about the effectiveness of available online treatment programs in Australia that suggests these programs are as effective as face to face care for many people – especially those with mild to moderate common mental health conditions and especially when compared to manualised treatment. Some of the research suggests it is even better than manualised face to face CBT for anxiety conditions.
There’s a repository of that research on the e-Mental Health in Practice website - you might like to take a look at that if you remain unconvinced.
What the researchers also say is that their biggest problem is always engagement and adherence, even in research trials, but it’s especially true in community trials. So, it seems that if there is a problem with the efficacy of eMH it’s not the programs themselves that are the problem, but the way these programs are used in clinical practice.
How do GPs benefit from knowing about eMH?
Digital mental health resources provide GPs and their patients with a whole range of new options for treatment of common mental health conditions as well as specific aspects of more complex conditions.
GPs who use it say that eMH
- provides some form of treatment when there is nothing else available
- encourages resilience building in people they identify as vulnerable to mental health problems,
- provides excellent low-level intervention for less severe problems
- provides interim treatment whilst the patient waits for face-to-face care
- and improves their own efficiency by providing psychoeducation and simple interventions that they would otherwise spend significant face to face time providing or, depending on their own mental health skills, not be able to provide at all.
What are the benefits for psychologists and allied mental health workers?
Fortunately, the fear that eMH will undermine the ability of psychologists and allied mental health workers to earn a living has slipped away as this group of health professionals comes to realise just how wide and deep the pool of people with mental health difficulties really is. That means if eMH can help reduce the number of very mild mental health problems in the queue, more people who really need face to face care ( by virtue of the severity of their illness, the complexity of their situation or simply their inability to use online resources) can move up the queue more quickly.
The other thing that’s happened is that the clever people amongst the mental health professionals have worked out how to integrate digital resources into face-to-face care. They have recognised that using these resources helps them make more efficient use of the limited number of sessions available under Medicare. Some mental health professionals are asking people to do some basic online training in CBT before they come to see them, some are alternating face to face sessions with online sessions and some are integrating specific apps and parts of online courses into their treatment programs. It all adds up to efficiency and better use of the face to face time available.
What about the users? How does eMH benefit them?
Users who really engage with eMH like the convenience of accessing good quality resources any time of day with no waiting times. No more waiting for appointments, getting time off work, organising child-care, travelling many kilometres to regional centres or any of the other inconveniences of face to face care. Telehealth helps with some of this, but it doesn’t solve the range of problems of access to face to face care that eMH can solve. Combining the two may, in fact, be an excellent treatment approach for many.
Contrary to all our beliefs about the importance of the therapeutic relationship, some users also say that they like the anonymity of online treatment and the lack of stigma in accessing it. Others like the support of programs (like MindSpot) that provide regular guidance without having to talk deeply to someone. Some like being able to explore a range of programs via the Head to Health portal and choose the one that suits them best. Some like the sense of self-efficacy that being able to control their treatment options brings.
Digital mental health treatment options may not be for everyone, but they certainly have potential benefits for everyone in the community if they wish to use them.
Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.
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