e-Mental health - A guide for GPs

Management of patients who are using e-mental health

e-mental health: A guide for GPs
Download PDF
  2. Figures and tables
  4. Provided under licence

Last revised: 03 Sep 2018

While it is not a requirement that an e-mental health recommendation be documented in a GP Mental Health Treatment Plan, this can be a useful way to articulate the plan for the patient’s care. Such a document would include the plan for follow-up and alternative referral options in the event that e-mental health is not suitable or effective.

The General Practice Mental Health Standards Collaboration (GPMHSC) has developed a series of GP Mental Health Treatment Plan templates to support GPs in the management of patients with a mental health issue. These templates include prompts to consider e-mental health interventions and can be adapted to suit your needs and those of your patients and practice.

As with any individual who has a mental health issue, patients who have started an e-mental health treatment program should be followed up in a timely manner. Checking in with patients two weeks after recommending an e-mental health intervention, for example, allows you to determine whether they are engaged and responding to treatment. Decisions can then be made about patients’ ongoing management.54

Monitoring self-harm and suicidal ideation is crucial. If the patient appears to have an elevated risk at follow-up, take action in line with your existing practice protocols and revise the treatment plan.53

Practice tip

Many patients, particularly those experiencing depression, might have difficulties with motivation or concentration during their use of the recommended intervention. To counter these issues, set realistic goals for treatment and encourage patients to print material to use as a memory aide.

Figure 1. A model for follow-up of patients using e-mental health interventions

Figure 1

A model for follow-up of patients using e-mental health interventions54
Download View full size

Adapted with permission from Orman J, O’Dea B, Shand F, Berk M, Proudfoot J, Christensen H. e-Mental health for mood and anxiety disorders in general practice. Aust Fam Physician 2014;43(12):832–37. 

The exact reasons users drop out of e-mental health interventions remain unclear.

People may drop out of e-mental health for the same reasons they drop out of face-to-face therapy. They might lack time to engage in the treatment, experience a change in circumstances, or have problems in accessing the service. Some might make early treatment gains and decide they no longer need to use the program, while others might quit because they are not experiencing any benefit.55 However, the lack of face-to-face contact with a therapist might also present a barrier for some patients.55,56

Research shows that e-mental health treatment is most likely to be successful when the patient has some level of additional support from a clinician,11 although the optimal amount of therapist contact is uncertain.57

Simply reminding patients to use the service periodically might improve the individual’s chances of following the treatment through to completion.58–60 Reminders might take the form of a brief phone call, postcard, SMS or email. GPs might arrange for the practice nurse to make contact with the patient shortly after engagement to check progress and address any technical problems in accessing the service.

GPs considering the use of an automated reminder system should refer to the following RACGP resources:

 

Practice tip

In addition to reminding patients to log in, GPs might also provide prompts to complete ‘homework’ activities, make an appointment at the clinic to review progress, or print out material from the program to discuss at the next appointment.

  1. Eysenbach G. What is e-health? J Med Internet Res 2001;3(2):e20.
  2. Oh H, Rizo C, Enkin M, Jadad A. What is eHealth (3): A systematic review of published definitions. J Med Internet Res 2005;7(1):e1.
  3. Riper H, Andersson G, Christensen H, Cuijpers P, Lange A, Eysenbach G. Theme issue on e-mental health: A growing field in internet research. J Med Internet Res 2010;12(5):e74. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cogn Behav Ther 2009;38(4):196–205.
  4. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: Ameta-analysis. PLoS ONE 2010;5(10):e13196.
  5. Arnberg FK, Linton SJ, Hultcrantz M, Heintz E, Jonsson U. Internet-delivered psychological treatments for mood and anxiety disorders: A systematic review of their efficacy, safety, and cost-effectiveness. PLoS ONE 2014;9(5):e98118.
  6. Griffiths KM, Farrer L, Christensen H. The efficacy of internet interventions for depression and anxiety disorders: A review of randomised controlled trials. Med J Aust 2010;192(11 Suppl):S4–11.
  7. Hedman E, Ljotsson B, Lindefors N. Cognitive behavior therapy via the Internet: A systematic review of applications, clinical efficacy and costeffectiveness. Expert Rev Pharmacoecon Outcomes Res 2012;12(6):745–64.
  8. Johansson R, Andersson G. Internet-based psychological treatments for depression. Expert Rev Neurother 2012;12(7):861–69.
  9. Richards D, Richardson T. Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clin Psychol Rev 2012;32(4):329–42. Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis. Psychol Med 2007;37(3):319–28.
  10. Foroushani PS, Schneider J, Assareh N. Meta-review of the effectiveness of computerised CBT in treating depression. BMC Psychiatry 2011;11:131.
  11. Mayo-Wilson E, Montgomery P. Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults. Cochrane Database Syst Rev 2013;9:CD005330.
  12. Cuijpers P, Marks IM, van Straten A, Cavanagh K, Gega L, Andersson G. Computer‐aided psychotherapy for anxiety disorders: A meta‐analytic review. Cogn Behav Ther 2009;38(2):66–82.
  13. Andrews G, Williams AD. Up-scaling clinician assisted internet cognitive behavioural therapy (iCBT) for depression: A model for dissemination into primary care. Clin Psychol Rev 2014; DOI: 10.1016/j.cpr.2014.05.006.
  14. Andersson G, Hedman E. Effectiveness of guided internet-based cognitive behavior therapy in regular clinical settings. Verhaltenstherapie 2013;23(3):140–48.
  15. Reynolds J, Griffiths KM, Cunningham JA, Bennett K, Bennett A. Clinical practice models for the use of e-mental health resources in primary health care by health professionals and peer workers: A conceptual framework. JMIR Mental Health 2015;2(1):e6.
  16. Barak A, Klein B, Proudfoot JG. Defining internet-supported therapeutic interventions. Ann Behav Med 2009;38(1):4–17.
  17. Batterham PJ, Sunderland M, Calear AL, et al. Developing a roadmap for the translation of e-mental health services for depression. Aust N Z J Psychiatry 2015. PII:0004867415582054.
  18. Andrews G. We can manage depression better with technology. Aust Fam Physician 2014;43(12):838–41.
  19. The Royal Australian College of General Practitioners. Internet based or computerised CBT (iCBT or cCBT): depression and anxiety. The handbook of non-drug interventions (HANDI). Melbourne: RACGP, 2015.
  20. Taylor-Rodgers E, Batterham PJ. Evaluation of an online psychoeducation intervention to promote mental health help seeking attitudes and intentions among young adults: randomised controlled trial. J Affect Disord 2014;168:65–71.
  21. Andersson G, Cuijpers P. Pros and cons of online cognitive-behavioural therapy. Br J Psychiatry 2008;193(4):270–71.
  22. Andersson G, Titov N. Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry 2014;13(1):4–11.
  23. Proudfoot JG. Computer-based treatment for anxiety and depression: Is it feasible? Is it effective? Neurosci Biobehav Rev 2004;28(3):353–63.
  24. Griffiths KM, Christensen H. Internet-based mental health programs: A powerful tool in the rural medical kit. Aust J Rural Health 2007;15(2):81–7.
  25. Handley TE, Kay-Lambkin FJ, Inder KJ, Attia JR, Lewin TJ, Kelly BJ. Feasibility of internet-delivered mental health treatments for rural populations. Soc Psychiatry Psychiatr Epidemiol 2014;49(2):275–82.
  26. Meadows G, Enticott J, Inder B, Russell G, Gurr R. Better access to mental health care and the failure of the Medicare principle of universality. Med J Aust 2015;202(4):190–94.
  27. Dever Fitzgerald T, Hunter PV, Hadjistavropoulos T, Koocher GP. Ethical and legal considerations for internet-based psychotherapy. Cogn Behav Ther 2010;39(3):173–87.
  28. Klein B. e-Interventions and psychology: Time to log on. InPsych 2010;32(1):20–2.
  29. Handbook of Non Drug Interventions (HANDI) Project Team. Internet-based cognitive behaviour therapy for depression and anxiety. Aust Fam Physician 2013;42(11):803–04.
  30. Reynolds J, Griffiths K, Christensen H. Anxiety and depression : Online resources and management tools. Aust Fam Physician 2011;40(6):382–86
  31. Christensen H, Griffiths KM, Jorm AF. Delivering interventions for depression by using the internet: Randomised controlled trial. BMJ 2004;328(7434):265.
  32. O’Kearney R, Kang K, Christensen H, Griffiths K. A controlled trial of a school-based Internet program for reducing depressive symptoms in adolescent girls. Depress Anxiety 2009;26(1):65–72.
  33. Manicavasagar V, Horswood D, Burckhardt R, Lum A, Hadzi-Pavlovic D, Parker G. Feasibility and effectiveness of a web-based positive psychology program for youth mental health: A randomized controlled trial. J Med Internet Res 2014;16(6):e140.
  34. Lintvedt OK, Griffiths KM, Sørensen K, et al. Evaluating the effectiveness and efficacy of unguided internet-based self-help intervention for the prevention of depression: A randomized controlled trial. Clin Psychol Psychother 2013;20(1):10–27.
  35. O’Kearney R, Gibson M, Christensen H, Griffiths KM. Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: A school-based controlled trial. Cogn Behav Ther 2006;35(1):43–54.
  36. Powell J, Hamborg T, Stallard N, et al. Effectiveness of a web-based cognitive-behavioral tool to improve mental well-being in the general population: Randomized controlled trial. J Med Internet Res 2012;15(1):e2.
  37. Bower P, Gilbody S. Stepped care in psychological therapies: Access, effectiveness and efficiency. Br J Psychiatry 2005;186(1):11–7.
  38. National Institute for Health and Clinical Excellence. Depression in adults: the treatment and management of depression in adults. London: NICE, 2009.
  39. Clark DM. Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. Int Rev Psychiatry 2011;23(4):318–27.
  40. Scogin FR, Hanson A, Welsh D. Self-administered treatment in stepped-care models of depression treatment. J Clin Psychol 2003;59(3):341–49.
  41. Hollandare F, Johnsson S, Randestad M, et al. Randomized trial of Internet-based relapse prevention for partially remitted depression. Acta Psychiatr Scand 2011;124(4):285–94.
  42. Corey G. Theory and practice of counselling and psychotherapy. 9th ed. Belmont: Brooks/Cole, 2013.
  43. Moock J. Support from the internet for individuals with mental disorders: Advantages and disadvantages of e-mental health service delivery. Front Public Health 2014;2:65.
  44. Neal DM, Campbell AJ, Williams LY, Liu Y, Nussbaumer D. “I did not realize so many options are available”: Cognitive authority, emerging adults, and e-mental health. Library and Information Science Research 2011;33(1):25–33.
  45. Casey LM, Joy A, Clough BA. The impact of information on attitudes toward e-mental health services. Cyberpsychol Behav Soc Netw 2013;16(8):593–98.
  46. Cavanagh K. Turn on, tune in and (don’t) drop out: Engagement, adherence, attrition, and alliance with internet-based interventions. In: Bennett-Levy J, Richards D, Farrand P, et al., editors. Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press, 2010;227–33.
  47. Mohr CD, Cuijpers P, Lehman K. Supportive accountability: A model for providing human support to enhance adherence to eHealth interventions. J Med Internet Res 2011;13(1):e30.
  48. Lillevoll KR, Wilhelmsen M, Kolstrup N, et al. Patients’ experiences of helpfulness in guided internet-based treatment for depression: Qualitative study of integrated therapeutic dimensions. J Med Internet Res 2013;15(6):e126.
  49. Wilhelmsen M, Lillevoll K, Risor MB, et al. Motivation to persist with internet-based cognitive behavioural treatment using blended care: A qualitative study. BMC Psychiatry 2013;13:296.
  50. Ritterband LM, Thorndike FP, Vasquez D, Saylor D. Treatment credibility and satisfaction with internet interventions. In: Bennett-Levy J, Richards D, Farrand P, et al., editors. Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press, 2010;235–40.
  51. Proudfoot J, Klein B, Andersson G, et al. Guided CBT internet interventions: Specific issues in supporting clients with depression, anxiety and comorbid conditions. In: Bennett-Levy J, Richards D, Farrand P, et al., editors. Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press, 2010;247–52.
  52. Orman J, O’Dea B, Shand F, Berk M, Proudfoot J, Christensen H. e-Mental health for mood and anxiety disorders in general practice. Aust Fam Physician 2014;43(12):832–37.
  53. Christensen H, Griffiths KM, Farrer L. Adherence in internet interventions for anxiety and depression: systematic review. J Med Internet Res 2009;11(2):e13.
  54. Waller R, Gilbody S. Barriers to the uptake of computerized cognitive behavioural therapy: A systematic review of the quantitative and qualitative evidence. Psychol Med 2009;39(5):705–12.
  55. Palmqvist B, Carlbring P, Andersson G. Internet-delivered treatments with or without therapist input: Does the therapist factor have implications for efficacy and cost? Expert Rev of Pharmacoecon Outcomes Res 2007;7(3):291–97.
  56. Clarke G, Eubanks D, Reid E, et al. Overcoming depression on the internet (ODIN) (2): A randomized trial of a self-help depression skills program with reminders. J Med Internet Res 2005;7(2):e16.
  57. Titov N, Dear BF, Johnston L, et al. Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: Randomised controlled trial. PLoS ONE 2013;8(7):e62873.
  58. Musiat P, Tarrier N. Collateral outcomes in e-mental health: A systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health. Psychol Med 2014;44(15):3137–50.
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log

Related documents

Advertising