Mental health “grey zones”: “tele-tech” offers choices

THE mental health crisis is as much a systems crisis as it is a modern, behavioural human problem, with deep biological, psychological, social and existential roots.

We refer to this combined problem as the “mental health grey zones”, which denotes the various challenges encountered by each individual from the onset of dysfunctional psychological distress to complete resolution and return to functional normality or a well managed state of chronic illness.

These zones include:

• insight and recognition of the problem – encompassing education, self-awareness, culture and cognitive capacity;
• decision and commitment to seeking help – including motivation, emotional resilience, support structure, and reasons behind the decision;
• access barriers – such as geography, time, cost and stigma with regard to physically visiting a GP and/or psychologist or psychiatrist; and
• momentum on the pathway, including compliance with ongoing care requirements – such as in-session therapy and additional “at-home” work.

Currently, for most of the psychological distress present in our society, we know what works: high quality, evidence-based, psychological therapy delivered by qualified, registered mental health professionals.

However, we also know more than half of people living with mental illness do not access any treatment over the course of their illness. Furthermore, the well, at-risk, and mildly at-risk populations are the largest population groups experiencing psychological distress.

The systems issue can be best described as a lack of timely connection between mental health professionals and patients in need of support.

Australians who are seeking help are experiencing long wait times or closed books to access mental health support, with those in regional, rural and remote areas facing even greater challenges accessing the support they require (here and here).

Research reveals that geographical, temporal and cost-based access barriers form a large proportion of the most obvious part of the systems problem, with regard to connecting patients with mental health professionals and therapeutic intervention (here, here and here).

The next barrier is the dark cloud of stigma hovering over the seeking and receipt of mental health support.

While significant work is being done to both address and overcome the misconceptions surrounding mental health and psychological distress, we cannot wait for society to catch up. We need an immediate solution for those in psychological distress.

The provision of tele-mental health care, which we refer to as “walking through the side door” to access support, helps to circumvent some stigma-associated barriers to seeking support services (here and here).

Evidence suggests that if performed correctly, and geographical, temporal, financial and stigmatic access barriers are positively modified, this form of psychological care is at least non-inferior to, and can prove, in some circumstances, superior to, face-to-face care.

Fortunately, recent years have seen an increase in Australian platforms offering varying levels of virtual mental health support, including HeadSpace, Beyond Blue, the Black Dog Institute and the Australian Government’s Head to Health platform, helping to greatly expand Australians access to these services nationwide.

Furthermore, the emergence of the COVID-19 pandemic has resulted in an unparalleled uptake of, and need for, telecommunication videoconferencing technology in health care, in both regional and metropolitan areas.

This new generation of telehealth technology (“tele-tech”) offers improved health care efficiencies, integration and exciting opportunities not possible via face-to-face modes of care (here and here).

However, critically, it also brings new challenges in patient privacy, data security and platform interconnectivity.

Just last week, Scientia Professor Helen Christensen AO and colleagues discussed the need for a transformative policy framework to advance these technologies and drive digital success in mental health in Australia.

Innovating upon current telehealth care models to address security and privacy considerations, while seamlessly integrating new technologies within the health care system, is crucial to ensuring we are fully harnessing the capabilities of these digital platforms to optimise patient outcomes.

A “tele-tech healthcare model” is able to seamlessly provide evidence- and value-based care via the mechanisms of modern software platform and communications technology. In its highest quality form, this model is driven by expert, organisational clinical governance to support safety, efficacy and security, while continuously striving to evolve future, evidence-informed iterations for best-practice outcomes.

The potential of such a “tele-tech” model to deliver seamless, quality virtual care, is the foundation of our digital mental health clinic start-up, My Mirror. When developing this platform, a critical focus was to ensure data privacy and security through functions such as end-to-end encryption, onshore storage and adherence to General Data Protection Regulation (GDPR) data protection standards, to provide our patients with the confidence that their personal information would be secure.

The US National Security Agency (NSA) recently assessed multiple security control areas of commonly used online videoconferencing solutions. This revealed significant variability in security capabilities and functions across the different platforms, signalling the critical need for careful selection of such services by tele-mental health providers.

However, once these platforms have been effectively configured for secure exchanges, this empowers mental health care providers to fully harness digital capabilities that may not be feasible or relevant in face-to-face care.

By curating a seamless, end-to-end, virtual therapeutic experience via an online platform, with optimised autonomy, privacy and convenience, a “tele-tech” model provides an immediate and convenient solution to further expanding access to highly personal digital mental health care.

Digital mental health platforms can facilitate increased patient ownership through secure, online patient portals, for example, with the ability to provide indefinite access to their session information, progress tracking, education and highly relevant resource tools. Such functionality could prove useful in encouraging progress between sessions, and improving compliance and continuity of care.

However, another important consideration in optimising continuity of care is the necessity of ongoing access to care, whenever required. It is clear from first-hand experience in Australia’s emergency rooms that the need for medical care does not stop when the sun goes down. So why should this be the case for Australians’ access to mental health support?

Those who experience severe episodes of mental illness can access immediate support through the emergency room or crisis services, such as Lifeline. However, access to support from an accredited psychologist for those in psychological distress who do not require emergency care can be limited outside of business hours.

This represents another opportunity for “tele-tech” models of mental health care to transform how and when we can deliver this level of care. For example, through our virtual clinic, patients can access consultations with accredited psychologists 21 hours a day, 7 days a week, helping to ensure availability whenever it is required or convenient to the patient.

This near-consistent access to care and early intervention for at-risk patient groups (those with early symptoms or previous illness) plays a key role in helping to deal with issues before they escalate and require acute or crisis care (here).

Furthermore, an effectively implemented “tele-tech” model can provide sustainable, flexible and meaningful work structures for health care practitioners. It can offer a system that suits their schedule and location, while increasing both the flexibility and autonomy associated with their workplace practices and hours.

Addressing the mental health grey zones comprises seamless integration of these newer technologies, with holistic and expert organisational responses, including the vital lens of correctly applied clinical governance to ensure the safety and efficacy of this new mode of care.

By applying a “tele-tech” mental health model as a distinct and powerful mode of care that seamlessly integrates videoconferencing technology with secure encryption and evidence-based care, we can help to support a data and experience-driven journey for all Australians experiencing psychological distress.

Dr Matthew Zoeller is an intensive care specialist and the Director of Education and Training at the Northern Beaches Hospital, Sydney. He is also the founder, CEO and Director of My Mirror – a digital mental health start-up.

Ms Kate Blundell is a clinical psychologist at The Mind Clinic in Sydney and the chief psychologist and co-founder of My Mirror. She has experience practising as a clinical psychologist in a variety of settings, including telehealth, face-to-face private practice, research, hospitals and schools.

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.