e-Mental health - A guide for GPs

Executive summary

Last revised: 03 Sep 2018

The term electronic mental health (e-mental health) refers to the use of the internet and related technologies to deliver mental health information, services and care.1–3 The use of online interventions for the prevention and treatment of mental illness is one of the major applications of e-mental health.

There is strong evidence to suggest that these e-mental health interventions are effective for use in the management of mild to moderate depression and anxiety,4–14 and can be disseminated in the primary care setting.15,16

The Benefits to e-mental health include:

  • Convenient and flexible – can be accessed anytime and anywhere, and material can be reviewed as often as required.
  • Low or no service cost to patients – many interventions are free, although related costs such as mobile data or internet download limits should be taken into account.
  • Fills service gaps – can provide an introduction to therapy, or an alternative for people averse to face-to-face treatment.
  • Saves practitioners’ time – allows mental health professionals to focus on patients for whom e-mental health approaches are not appropriate, thereby reducing wait lists.
  • Cost-effective to the health system – inexpensive to deliver and can be disseminated to large populations.
  • Easily accessible – can provide support to patients who are unable to attend face-to-face treatment.

While evidence has yet to identify ideal candidates for e-mental health, it is likely that these interventions are an appropriate option for people who have an increased risk of developing mental illness, or who are already experiencing mild to moderate symptoms of mental illness.

There is less evidence for the use of e-mental health interventions with people who have complex or severe mental illness, comorbid personality disorders, substance dependence, or people who have an elevated risk of self-harm or suicide and require urgent clinical management.

eMHPrac

A project funded by the Australian Government to provide free e-mental health training support for health practitioners, including GPs.

Use for

  • Watching introductory videos
  • Reading introductory fact sheets
  • Reading a guide to resources with content arranged by diagnosis, target audience and mode of delivery

Black Dog Institute

Under the eMHPrac project, e-mental health promotion, training and support for GPs are led by Black Dog Institute.

Use for

  • Viewing webinars
  • Joining an online community with GP discussion forums, blog posts and useful links
  • Completing e-learning modules
  • Downloading resources
  • Following links to particular interventions and supporting evidence

Head to Health

Head to Health is an online portal to digital mental health care funded by the Federal Government. It provides reliable information about mental health and a range of mental health conditions. It also provides an interactive chatbot and a set of filters that allow users to find evidence-based online resources and treatment programs to meet their specific needs.

There is a range of applications for e-mental health interventions. Programs can be used for prevention or early intervention, first-line treatment, adjunctive treatment and as a tool for relapse prevention. GPs can choose the level at which they would like to use e-mental health.17

Level of engagement/knowledge in e-mental health

Figure 1

Level of engagement/knowledge in e-mental health


 

The type of support GPs provide to patients who are using e-mental health might be related to whether they recommend self-help interventions or human-supported interventions.18,19

Self-help interventions:

  • are accessed through a publically-available website
  • are usually offered at no cost to users
  • offer users only automated feedback. Human-supported interventions:
  • are generally accessed through a password-protected website
  • occasionally require the user to register and complete a screening questionnaire and/or request referral from a health practitioner
  • occasionally require payment from users
  • offer feedback or support from a health professional or another person as part of the program.

Talking to patients about e-mental health

  • You can introduce your patients to e-mental health by promoting resources in the waiting area of the clinic or on the clinic’s website, training other staff in the use of e-mental health, providing fact sheets and logging in to particular programs with patients during the consultation.
  • In recommending e-mental health to your patients, consider discussing:
    • the benefits and limitations  
    • potential financial costs, including mobile or internet data charges
    • the need to refer to the terms and conditions of service before agreeing to treatment
    • the extent to which you will be involved in the delivery of treatment and support you will provide
    • the schedule for follow-up – processes for arranging alternative treatment and crisis support 
    • how you will handle information you receive from the service as a referring provider.
  • Patients are more likely to use e-mental health if they have positive expectations about the treatment, belief in the credibility of the program and a feeling that the benefits of the treatment outweigh the costs.

Managing patients who are using e-mental health

  • A GP Mental Health Treatment Plan can be used to document an e-mental health recommendation, outline the schedule for follow-up and present the plan for alternative or additional referral in the event that the recommendation is not suitable or effective.
  • After recommending that a patient use an e-mental health intervention, you should ensure the patient is followed up in a timely manner and the treatment plan is adjusted in the event the patient is unwilling to engage, still unwell, or deteriorating.
  • Patients might drop out of e-mental health interventions for the same reasons they drop out of face-to-face therapy. However, some people dislike the lack of therapist contact inherent to e-mental health interventions.
  • Providing additional support might help people to stay in e-mental health treatment. This might be as simple as providing regular reminders to continue use of the program.
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