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Australia could lead the world in digital mental health if new platforms were paired with appropriate in-person clinical care, writes clinical psychologist Dr Peter Baldwin …
The rise of digital programs brought so much promise to the concept of mental health treatment. We were told it would revolutionise mental health care, making it faster, with more equitable access for consumers, and reaching more people at lower cost.
Today we have thousands of mental health smartphone applications (apps), numerous digital clinics, and dozens of government-funded mental health websites.
Yet, a recent Evaluation of Better Access report by the University of Melbourne shows waiting lines are longer than ever, co-payments are higher, and more than half of Australians who need care are having difficulty accessing it. If the digital revolution is here, why are more people not well?
The digital mental health market is stuck in a quality quagmire.
Of the more than 10 000 mental health apps on the market, only about 4% have any data behind them. A few self-help apps are effective on their own, but most people struggle to complete a full course of treatment using a mobile phone app.
Research shows that the best results occur when blending digital tools with human support — consumers get the immediacy and convenience of an app, with the expert care and human connection of a clinician. Sounds perfect, right?
In my experience, this type of care — called “blended care” — is easier to preach than to practise.
Different digital health systems do not share data between each other, let alone sharing data with digital health records. Even if a clinician were willing to adopt a blended approach and took the time to find the right tools, they would still end up with five or six digital platforms that they would have to manually input data into and pay for separately. Not exactly revolutionary.
A true digital mental health revolution will need more than a disjointed marketplace of apps and websites.
We will need integrated systems where clinicians can access science-based digital therapeutics, prescribe these with a click, and have artificial intelligence monitoring progress between sessions.
I envisage a system where patients, therapists, GPs and specialists can access the same data in the same place, placing everyone on the same page. Truly intelligent systems could even become part of a person’s mental health care plan.
Drawing on my years of digital mental health research at the Black Dog Institute, I believe this type of platform could revolutionise mental health care.
A person with anxiety could log on, be assessed, matched with a therapist, and access digital supports before their first appointment.
Therapy would then accelerate recovery, offering an expert guide through the higher intensity parts of treatment.
Round-the-clock access to digital guidance could be ongoing, preventing relapse. Real-time patient data could sharpen treatment planning. Perhaps most importantly, more efficient care will free practitioners to offer more consultations.
Based on current Australian Bureau of Statistics and Medicare data, if a clinical psychologist gave their patients with milder symptoms a 50/50 blend of therapy and digital support, rather than only using face-to-face therapy that practitioner would be able to see 16% more patients each month, at 18% less cost to the Medicare system, all without lowering clinical standards. And if we had 1000 clinicians move to this blended care model, Black Dog Institute modelling shows it would be able to save $28 million in Medicare costs per year.
This would free up clinician time to take on more severe and complex patients and save patients’ money out of pocket. From the clinician’s perspective, they would still be earning the same amount, just providing more care, to more patients, targeted to those who need it the most.
This need not be some imagined future. European countries, such as Germany, have piloted similar programs with encouraging results. We can do it here in Australia as well. We have the systems and technology to make it happen today. We also have the expertise — Australian researchers are global pioneers of digital mental health. Given more targeted investment, we could lead the world in translating this science to treatments that benefit all Australians.
Now that’s a digital mental health revolution I could get behind.
Health professionals wishing to access Black Dog resources can visit www.blackdog.org.au/cop
Dr Peter Baldwin is a clinical psychologist, Senior Research Fellow and Head of Clinical Research at Black Dog Institute.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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Thanks for the feedback, Donald. The editors will consider this carefully.
This is a great example of the problem in mental health we keep focusing on psychologists rather than mental health clinicians including accredited mental health nurses and mental health nurse practitioners. So long as funding models are biased towards psychologists we are never going to meet demand and we are limiting patient choice. We need a system that allows fair renumeration for consultations if we are going to increase participation and increase productivity.
There is a limit to how much difference efficiency can make, digital or analogue, when there are too few psychologists in Australia to service its population. And before one starts again recommending reducing Medicare-rebated therapy as a method of shortening waiting lists (as the Minister for Health has done), the absurdity of this becomes evident when it is recognised that all health and medical services across the country have been overwhelmed by demand since Covid started. Try getting an appointment with a psychiatrist or paediatrician .. even your preferred GP. The bottom line is that we need more clinicians. We also need these clinicians to be trained to a world standard – or would you prefer seeing someone with part-training only? All clinical psychologists in Australia are trained to an international standard. This is monitored by AHPRA. As with Medicine, the course of training and supervision is long and expensive. The Government does not say to the medical association, “reduce the number of years of training so we can put more of you into the field”. But this is what is happening with Psychology at this time. The number of training positions at universities around Australia have reduced owing to reduced government subsidies, which has forced universities to stop offering the post-graduate training that is necessary to qualify. The solution needs to be seen to be long-term – training more world class equivalent professionals – not instant, by rushing semi-trained people into service.
It is frustrating when you read a well written article but it includes the line “GPs and specialists”. As GPs are also specialists the standalone term specialist means nothing. You might as well use the term worker as that gives about the same amount of information.