Don’t waste this crisis, scale up digital mental health care

ALONG with the outbreak of coronavirus disease 2019 (COVID-19) came a move away from the traditional face-to-face mental health care delivery. In the blink of an eye, the nation’s health care system made a significant transition to telehealth and digital delivery.

The Australian Government moved swiftly to provide new measures. New COVID-19 call lines were set up for mental health charities and a financial boost was provided for existing ones. By the end of March, the government had doubled the primary health care bulk-billing incentive for telehealth. This transformed the health system as we knew it.

And new initiatives flowed.

In May, the federal government granted $1.4 million to the Black Dog Institute to develop a digital pathway to care, through an app for frontline health professionals.

As Australia battles with curve flattening, and restrictions are alternately eased and tightened, the effects of COVID-19-related anxiety will fluctuate. Best estimates are that at times of lockdown, psychological distress may affect 50% of the population. The financial stressors associated with it will continue and most likely increase over the next 12 months.

Evidence from previous pandemics shows suicide rates are likely to rise and mental health problems peak months or even years later. Previous work indicates that a 1% decrease in employment is associated with an increase in suicide rates of 0.79%. Although the circumstances of COVID-19 are unique, we need to be prepared for increases in mental ill health and to have new ways to deliver best practice patient-centred mental health care, delivered (where it can be) digitally. Many have argued that the mental health system is not sufficiently able to cope with current demands, let alone new incident cases as a result of COVID-19. Even if we reach elimination, to revert to traditional service delivery would be a wasted opportunity and a potentially dangerous strategy, given the predicted increase in large natural disasters and the expected greater frequency of pandemics.

Digital interventions, such as online therapies, are highly efficient, allowing more people to be “seen” by the one therapist in the time taken to have one-on-one consultation. To address safety, the National Safety and Quality Digital Mental Health Standards, have been designed to improve quality and protect service users, across the delivery of the digital services (draft available).

Automated digital therapies can be beamed out through the internet at a population level to everyone who needs them. Some medical digital services operate already in Australia, such as MindSpot, This Way Up and the Black Dog Institute’s online clinic. However, Australia has minimal multidisciplinary, collaborative, patient-centred care for patients delivered either digitally or face-to-face.

The appetite for digital has also been strong during COVID-19, under the telehealth measure. In April 2020, there were 5.8 million telehealth consultations across Australia funded by the Medicare Benefits Schedule, with around 90% of these via telephone and over 9% via videoconference. As a category, mental health consultations had the highest ratio at just over 50%. One in six Australians (17%) used a telehealth service in the previous 4 weeks, with persons with a mental health condition more likely to do so than those without a mental health condition (33% compared with 15%). Not all people have access to digital devices, including many without smartphones. Many people may prefer face-to-face help, but access is more difficult in lockdown. Working with and subsidising software and telecommunications companies to provide free subscriptions and data to access the evidence-based tools is a solution to the access issue, and we have seen local efforts to provide devices to those without them during the COVID-19 pandemic.

Now is the time to create digital care services that not only increases capacity but takes the best of both face-to-face and digital capabilities.

By doing so, we could potentially change the way we deliver mental health care into the future, through:

• Improving collaborative and patient-centred care – an online approach could link multiple professionals digitally to the same patient, with both patients and clinicians able to share health plans. With patient approval, appointment and health information data could be recorded and shared, and decisions could be collaborative and connected.
• Creating greater health care autonomy. It is estimated that 52% of mental health care is self-management and that self-management interventions have benefit for people with low health literacy and low income. Patients armed with appropriate evidence-based tools will have more autonomy.
• Freeing up health professionals – self-management means health professionals can help more people and in turn have more time to help those severe cases needing acute one-on-one care.
• Providing greater access to immediate support – digital interventions are available 24/7 through the internet. Less than a third of people who die by suicide have been in contact with mental health support in the past 12 months. Direct access through the web or apps to programs specifically designed to lower suicide ideation, and then through to integrated health services may prevent deaths.

The government’s telehealth Medicare incentive arrangements will be in place until 30 September 2020 and will be reviewed dependent on the need for continuation. What we have here is an opportunity to revolutionise our nation’s mental health care system.

Let’s not let this opportunity slip through our fingers.

Scientia Professor Helen Christensen AO is Director and Chief Scientist at the Black Dog Institute and a Professor of Mental Health at UNSW. She is a leading expert on using technology to deliver evidence-based interventions for the prevention and treatment of depression, anxiety, suicide and self-harm.

If this article has raised issues for you please reach out to any of the following resources:

DRS4DRS 

• NSW and ACT … 02 9437 6552
• Victoria … 03 9280 8712
• Tasmania … 1800 991 997
• Queensland … 07 3833 4352
• WA … 08 9321 3098
• SA and NT … 08 8366 0250

Lifeline 
13 11 14

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.