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Deciding how to use e-mental health

​e-Mental health interventions

e-Mental health interventions can be used in a variety of different ways across the care continuum.

Prevention and early intervention

To teach psychological concepts and build resilience33–38

Primary treatment

As a first-line strategy for mild to moderate mental illness. Under this stepped care model, patients who do not make clinically significant and reliable treatment gains after receiving e-mental health would be referred to another form of treatment (eg face-to-face therapy or pharmacotherapy)39–41

Adjunctive treatment

Complementary to another treatment for patients with more severe or chronic mental illness42

Maintenance

To prevent relapse of mental illness43

Prevention and early intervention

To teach psychological concepts and build resilience33–38

Primary treatment

As a first-line strategy for mild to moderate mental illness. Under this stepped care model, patients who do not make clinically significant and reliable treatment gains after receiving e-mental health would be referred to another form of treatment (eg face-to-face therapy or pharmacotherapy)39–41

Adjunctive treatment

Complementary to another treatment for patients with more severe or chronic mental illness42

Maintenance

To prevent relapse of mental illness43

There are various ways in which GPs might integrate e-mental health into their day-to-day practice. You can choose to use these services in a way that suits your skills, interests and working environment.32

A group of Australian researchers has proposed a framework for using e-mental health services in the primary care setting.17 Five models are outlined in Table 1, each requiring a different level of engagement and knowledge on the part of the GP.

The first three approaches involve recommending e-mental health to patients. This may simply involve providing information about e-mental health resources (the ‘promotion’ model), or suggesting a particular intervention and providing some level of support to the patient while they are receiving the intervention (the ‘case management’ and ‘coaching’ models).

GPs who are already delivering focused psychological strategies or other brief psychological interventions might use either the ‘symptom-focused’ or ‘comprehensive therapy’ model. These models are informed by an integrative approach in which the practice of therapy is informed by a range of different theories and techniques.44 Under these models, GPs would use e-mental health tools and resources to supplement their delivery of face-to-face therapy.

Table 1. A framework for the use of e-mental health in the primary care setting

Table 1

 A framework for the use of e-mental health in the primary care setting17

You will next need to decide on the type of support you will provide your patients using e-mental health:17

  • Promotion model – you may guide patients to where they can find useful information about e-mental health, or provide brief information about particular high-quality interventions.
  • Case management model – your role might involve pre-assessment or post-assessment, referring patients to an e-mental health intervention based on an assessment of their needs, following up with patients and arranging for alternative referrals if the treatment is ineffective.
  • Coaching model – your role will involve assessment and follow-up, but you might also check in with patients more frequently, show them how to use the intervention, provide emotional and technical support while they are using the intervention, remind them to continue treatment between appointments, and address any barriers to use of the intervention that arise along the way.
  • Symptom-focused model or comprehensive therapy model – your role would be that of a primary therapist, designing and delivering an intervention that includes both e-mental health and traditional therapeutic techniques. You may meet with the patient on a regular basis for therapy sessions and follow up on the patient’s progress against particular assignments completed outside of sessions.

The type of support you provide to your patient might also be related to whether you recommend a self-help intervention or a human-supported intervention.

As the primary treating clinician, you will need to make arrangements for regular follow-up to assess the patient’s response to treatment, as you would with a patient for whom you have prescribed medication. e-Mental health programs are not designed to respond to crisis situations,45 so there must be other systems in place to manage an escalation of symptoms. Refer to Following up with patients for more information.

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