The guide: An introduction

The term e-mental health refers to the use of the internet and related electronic communication technologies to deliver mental health information, services and care.^1–3

Various e-mental health applications have been developed, including:¹⁸

• instant messaging or video-based counselling services (also known as telehealth, telemedicine or telepsychiatry)
• consumer information portals
• online support groups, forums and social networks
• online assessment or diagnostic tools
• blogs and podcasts
• therapeutic gaming programs, robotic simulation and virtual reality systems.

The RACGP has developed the Guide to assist you in using e-mental health interventions with your patients when it is safe to do so.

e-Mental health is an emerging area of practice. The Guide is intended to provide advice of a general nature in the absence of a significant body of evidence on how to use e-mental health resources in the primary care setting. While exploring the efficacy of individual interventions is beyond the scope of this document, the Guide signposts important resources and places to find further information.

A growing body of evidence from controlled efficacy trials suggests that e-mental health interventions are effective for the management of mild to moderate depression and anxiety.^4–14 

There is now also evidence to demonstrate that e-mental health interventions for depression¹⁵ and anxiety¹⁶ can be effectively disseminated within the context of the primary care setting, and the RACGP has endorsed the use of e-mental health interventions for depression and anxiety in the Handbook of Non-Drug Interventions (HANDI).²¹ Further research is needed on the most effective ways to implement the use of e-mental health interventions in general practice.

Benefits

e-Mental health interventions:

• present a convenient and flexible option, granting patients the freedom to decide when and where treatment will take place⁵ and to review educational material as often as they like¹⁵
• can be provided at low or no service cost to patients (although related costs such as mobile data charges should be taken into account)⁵
• can provide an introduction to therapy for individuals who are experiencing mental health issues for the first time^22,23 or who have long-standing mental health issues but have never sought professional assistance²⁴
• can provide an alternative for patients who are averse to face-to-face treatment, such as those who have tried traditional approaches in the past without success, or who are reluctant to attend due to feelings of shame, embarrassment, stigma, or concerns about confidentiality⁵
• may allow mental health professionals to focus efforts on the face-to-face treatment of patients for whom e-mental health approaches are not appropriate,²⁵ thereby reducing wait lists
• provide a cost-effective solution to the health system when used with the appropriate target group in that they are inexpensive to deliver once established and can be disseminated to large populations⁸
• can resolve access issues in situations where specialist referral is difficult, such as in rural and remote areas^26,27 and some lower socioeconomic areas,²⁸ or where patients are prevented from attending for face-to-face therapy as a result of transport difficulties, lack of child care, pain, physical incapacity or anxiety.²⁹

Evidence has yet to identify ideal candidates for e-mental health.30 As a primary treatment pathway, e-mental health interventions are likely to be an appropriate option for people who have an increased risk of developing mental illness or mild to moderate symptoms of mental illness.^24,31

here is less evidence for the use of e-mental health for certain populations, in part because research protocols typically exclude higher-risk groups from clinical trials. Alternatives or adjunctive treatment pathways should be considered for people who have:^15,21,31,32

• complex and/or severe mental illness
• comorbid personality disorders and/or substance dependence
• an elevated risk of self-harm or suicide and require urgent clinical management.