e-Mental health - A guide for GPs

Appendix 2

Last revised: 03 Sep 2018

Case studies

The following case studies demonstrate how e-mental health resources can be used with patients under each clinical practice model outlined in the framework developed by Reynolds et al in the Journal of Medical Internet Research Mental Health.17

 


Corey is an 18-year-old Year 12 student. She presents with persistent upper respiratory tract infection (URTI) symptoms, saying her mother is wondering if she needs antibiotics. After discussing that issue, her GP asks her how her studies are progressing. Corey admits that she is quite anxious but tells her GP that she has been feeling better since her teacher told her about an online program called myCompass. She has spent some time completing the modules about stress management and problem solving and has found that tracking her mood on her phone has helped her work out a study timetable that suits her better and keeps her feeling well.


Judy, 53, has been living with anxiety and mood fluctuation since a motor vehicle accident five years ago, which resulted in ongoing pain from the injuries she sustained. She has tried face-to-face therapy, but has not felt comfortable talking to the people she has seen so far. Judy’s GP recommended that she try an online program and, after looking at Head to Health as her GP suggested, she opted to try the MindSpot virtual clinic’s wellbeing program. After two weeks Judy returned to her GP as planned to say that she felt much more comfortable with the therapist at arm’s length. She had been placed in the post-traumatic stress disorder (PTSD) program and was happy to continue. Judy returned to her GP two months later with a printout of her end-of-program assessment, which showed marked improvement in her levels of distress and Judy agreed that she was feeling better and, although not ‘cured’, she felt more in control of her symptoms.


Bill is a 68-year-old retired school teacher who has had an interesting and varied career, including volunteer teaching in Africa. He was an elite athlete in his youth and a keen mountaineer in his middle years. Bill recently required knee replacements, which he chose to have bilaterally and, unfortunately, postoperative bleeding into one of his knees has made his recovery unpleasant and prolonged. Usually a buoyant and gregarious person, Bill has begun to feel low about recovering his normal functioning and his wife reports that he is reluctant to go to physiotherapy or do his exercises.

His GP recognises that Bill’s low mood is now interfering with his recovery and convinces Bill that a trial of antidepressant medications may be helpful for both his mood and his pain. In conjunction with these medications, Bill’s GP recommends that he look at an online program (eg e-couch or This Way Up clinic’s depression program) that may help him develop some new strategies while he waits for the medications to take effect. The GP arranges for Bill to return in a week’s time to monitor medication side effects and check in on his progress with the online help.

On review, Bill admits he has not looked at the e-mental health information yet. His GP logs on to the program on his desktop to show Bill what it looks like and arranges with Bill for him to complete the first module and come back to discuss his progress. Bill thereafter agrees to see the GP fortnightly for review. With his GP’s support, Bill makes good progress through the program, his mood improves and he never gets around to taking the antidepressants.


Kate is a 35-year-old mother of two. She has experienced a number of episodes of depression in the past, including an episode after the birth of her second child, who is now six years old. Kate has presented on this occasion with low mood and anxiety that has escalated since financial pressures demanded that she return to full-time work. Medications don’t seem to be helping as they have in the past.

Kate has begun to see a psychologist and has realised that she needs to talk more about her childhood issues, something touched upon but never fully explored in previous treatments. Unfortunately, Kate does not have the means or the time to have enough sessions to address these issues, as well as to review the cognitive behavioural strategies that she previously learned to use to manage her depression. In collaboration with her psychologist, Kate has agreed to enrol in an online CBT-based depression management program and focus on deeper issues in her face-to-face sessions with the psychologist. She is finding this quite useful.

 


Tom is a 38-year-old car salesman with a long history of depression and substance misuse. He is currently at risk of losing his licence after a drink driving offence. Tom has so far avoided the physical and mental problems experienced by his father and two of his brothers as a result of their alcohol use. Tom’s father, a Vietnam veteran with a history of violence in the home, left the family by the time Tom was seven years old, but his older brothers grew up under their father’s influence.

Tom’s second marriage is currently in jeopardy as his wife is not able to cope with his erratic behaviour and constant drinking. She is very concerned for the wellbeing of their six-year-old son, who has been tearful and anxious because of Tom’s constant criticism. Tom is still moderately depressed despite antidepressant medications, but no longer suicidal. He has seen a psychiatrist and agreed to undertake drug and alcohol counselling. He and his wife have been referred for relationship counselling.

Tom’s therapist chooses to refer him to an online support and treatment program for people suffering from alcohol misuse and depression. She uses her face-to-face sessions with him to reinforce what he has learned and discuss how his own experience and the things he is learning resonate with his past experience of his father and older brothers. Tom’s wife also looks at the program, which provides a starting point for discussion in their sessions together with the therapist.

At their therapist’s suggestion, Tom’s wife seeks some support from a moderated forum for carers and together they undertake an online parenting skills program. Issues arising from these online contacts are discussed within the therapy sessions. Meanwhile, with Tom managing to curtail his alcohol consumption, more conventional face-to-face relationship counselling is undertaken.

 

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