Telehealth essential for keeping young people safe and engaged

YOUNG people, in particular, are doing it tough during this COVID-19 pandemic and they will be most affected in the months and years ahead. Even in normal times, there are barriers to their accessing care. Telehealth appears to allow easier health access for some young people and needs to remain available as an option for them.

Young people are in the midst of what Professor Patrick McGorry AO calls a “mental health shadow pandemic”. Health services are seeing increasing numbers of young people with depression, anxiety, substance use (here, here and here) and eating disorders (here and here). Stress related to inability to manage online learning, final high school examinations, loss of work, and to being locked down in a family with unhealthy relationships is skyrocketing. Those with pre-existing mental health problems are suffering exacerbations; others are experiencing symptoms for the first time. Social isolation has reduced ability to self-manage. Waiting times for help are increasing, while services are struggling beyond capacity.

Deady and colleagues have described the suicide risk of future widespread unemployment. Young people are faced with reduced end-of-school employment and career choices. Many have also lost the excitement normally due this time of life. The suicide rate for Australian youth is already high – it is the commonest cause of death for this age group. Modelling predicts that it will increase.

“In crisis periods, it can be the most disadvantaged groups that are disproportionately affected and marginalised and at-risk populations require specific attention,” wrote Deady and colleagues.

With COVID-19, we believe it is young people, with their whole lives ahead of them, who most need special care and attention, and we predict that these young people will need primary care services more than ever if we are to avert a dramatic increase in crisis presentations.

GPs can offer long term engagement and can be touchstones for young people trying to negotiate life’s obstacles and the health care system. They are appropriate first ports of call. They are already managing the surge in youth mental health but it is likely that some young people, possibly those most at risk, are missing out. Right now, when the stakes are so high, we need to ensure that access is as easy as possible for as many as possible.

Young people, especially marginalised young people, have high rates of non-attendance to GP appointments. The ACCESS 3 study reported that only 58.3% of young people (aged 12–24 years) surveyed reported having a regular GP. Barriers to health care for this sample included (in order) cost (45.8%) opening hours (31.7%), embarrassment (27.8%), difficulty getting there (23.7%), and need to ask permission from parents/carers to get there (22.1%).

An audit at one Headspace general practice (Young people’s attendance at face to face GP appointments compared to attendance at telehealth GP appointments: a retrospective audit at headspace Geelong — deidentified best practice data used with consent from Headspace Geelong manager and BCYF Director of Clinical services [unpublished]. Author: Dr Francoise Ode-Berryman) looked at non-attendance rates for face to face appointments compared with non-attendance for telehealth appointments. This was done by comparing attendances on April–June 2019 (face to face) with April–June 2020 (telehealth). Total non-attendance for face to face appointments was 33.6% and for telehealth appointments it was 16.1%, a result that is significant. It is understood that there are many confounding factors here, but such results, together with anecdotal reports from other Headspace services, from other practices, and with a survey by the Australian Bureau of Statistics which showed that people with mental health problems were more likely to use telehealth, suggest that telehealth may overcome some of the barriers perceived by young people trying to access care.

We strongly advocate for telehealth to be an ongoing option for young people. Medicare telehealth rebates should be continued. In addition, we urgently advocate for exemptions to the 12-month rule (currently in place only for the homeless, Aboriginal and Torres Strait Islander individuals, and those under 12 months of age) to be extended to young people aged 12–25 years as well as those accessing more specialised primary care, including mental health, reproductive and sexual health.

Telehealth is an opportunity to provide a soft entry point to primary care and, in turn, to mental health services, for a group of young people who otherwise may have found accessing primary health care difficult and who may be accessing care for the first time.

We must retain the capacity to see each young patient in person when appropriate and when preferred. We also need continuing scrutiny of telehealth, including extent of engagement and long term outcomes. And we need to know if better attendance holds true once COVID-19 has passed. But at least until research provides these answers, we believe that telehealth must remain an access option.

We will all need to be tuning in to young people, checking wellbeing and risks. The health system must play its part and get the groundwork in place.

Dr Sue Barker is a GP, and GP Advisor for headspace Geelong.

Dr Francoise Ode-Berryman, is a GP Registrar at headspace Geelong.

Dr Chris Sasse, is a GP at headspace Bendigo, and has worked in youth health and general practice for over 20 years.

Dr Karen Spielman is a GP in Paddington, and headspace Bondi, and has worked in youth health in various settings for over 20 years.

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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.