IntroductionThe Australian Government has invested $70.4 million to date in developing and funding telephone crisis and e-mental health services over the last 6 years from 2006-07 to 30 June 2012. This investment has given rise to several online automated therapies and phone services, supported by research, and has proven to be effective therapy for those with low to mild severity, high prevalence disorders and those experiencing psychosocial distress.
The Government will invest a further $110.4 million over the next 4 years 2012-13 to 2015-16, to build a mature online mental health care environment. This investment is in addition to that already being provided for the youth specific online mental health service through eheadspace. This service is already operational and is popular with young people who are comfortable with using new technology.
This investment, inline with the objectives of the Strategy, will introduce new features to the online mental health care sector from 2012-13. These activities will improve consumer access to evidence based services and support, provide a greater range of service options in the online environment, and provide further guidance to the future development of the online e-mental health environment.
Youth-focused telephone and online counselling service - summaryThe youth-focused telephone and online counselling service is intended to enable young people aged 12-25 to access e-mental health services that are specifically designed for their needs and ways of communicating. This service will be linked to the national e-mental health portal. The headspace National Youth Mental Health Foundation was selected by tender to set up and run this service and operations commenced in 2011. The Government has provided $12.3 million from 2010-11 to 2013-14 for this youth specific on line service. The youth-focused telephone and online counselling service, called eheadspace, can be contacted at: Headspace website (www.headspace.org.au) or on: 1800 650 890.
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Improving access and services
The e-mental health portalThe first of these new features will be the establishment of an e-mental health portal – an Australian first in the field of online health services. The portal will provide accessible pathways for consumers and carers to navigate and use the online services they need.
The portal is central to the success of this Strategy as it will bring together, in one site, reliable information and access to a range of evidence based mental health support and therapy services.
The Australian Government will invest $12 million in funds already provided to the National Health Call Centre Network for mental health activities, to build and operate the e-mental health portal. The Government has also allocated $14.4 million to an online mental health portal in the 2011 Budget. This funding will be allocated to improve the range of services available through the portal and the promotion of linkages between the portal services with more traditional mental health services.
The portal is currently under development, with design specifications informed by the E-Mental Health Expert Advisory Committee, and it is anticipated that the first stage will be operational in July 2012, with further functionality and additional services being added over the next year.
E-mental health portal - summaryThe national e-mental health portal will be established to provide a visible, signposted, online gateway to a suite of self-directed support, mental health information, and low-intensity services. The portal will be a point of referral for the use of general practitioners, carers, service providers and organisations such as Lifeline, as well as for self-referring individuals. The portal will:
- provide information and resource material concerning mental health;
- provide a guided search tool to assess a person's mental health needs and provide information and referral to further on-line assistance;
- provide links to a variety of self help online programs;
- provide an additional avenue to traditional face-to-face services should individuals making inquiries through the portal require or prefer this approach; and
- allow for ongoing consumer feedback.
User accessThe establishment of the e-mental health portal will provide Australian consumers and health professionals with an authoritative source of trusted information and access to evidence based, automated, online and crisis support services.
While the portal will assist consumers by providing a gateway to evidence based services, consumers and carers will also be able to access these services through self referral directly to one of the e-mental health services or by referral from another health provider, such as a general practitioner or psychologist, to either the e-mental health portal or directly to a specific e-mental health service.
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Information for consumers and carersInformation about mental health and e-mental health services will be available on the e-mental health portal. There will be four key components of the portal information services
- Information which promotes a greater understanding of mental health, its dimensions and the value of early intervention.
- An overview of mental illness, including information about diagnoses and treatment.
- An e-mental health overview including: how it works, the evidence of the success of cognitive behavioural therapy (and other therapies which are shown to be effective) , the advantage of e-mental health in empowering consumers, and the nature of stepped services.
- Overview of services in the portal and how to access them.
Individual users will find their way to the portal and then to services linked to the portal as demonstrated in the diagram below.
Diagram: e-mental health digital eco-system
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Text version of DiagramThe diagram shows the components of the e-mental health digital eco-system. One component is the eMental Health Portal, which includes information, a dictionary, a guided search tool, narratives, a mood monitor, and a directory of services.
The diagram shows users can choose the access path that works for them:
- going directly to the Portal
- via existing consumer facing services and sites, such as Headspace, Beyondblue, Black Dog, Lifeline, and others
- via a range of consumer digital access points (non mental health), including social media, traditional media, NHCCN, referral from HCP, and search
- via Commonwealth funded services under the Telephone counselling, self help and web-based support programme: Kids Helpline, Lifeline, Anxiety Online, Black Dog Institute, CMHR@ANU, CRUfAD, Reachout, and Virtual Clinic. These services require authorisation for collection of personal data.
More e-mental health services – the virtual clinicThe Government has allocated approximately $20 million from 2011-12 to 2013-14 to the establishment of a Virtual Clinic. This Clinic will provide another therapy option for people looking for online or phone counselling. At present the Government's investment in mental health has provided several services which provide automated cognitive behavioural therapy (CBT). The Virtual Clinic will provide real-time online counselling or phone counselling with a trained CBT counsellor.
The Virtual Clinic will provide a stepped care approach which allows an individual to begin therapy with the Virtual Clinic and be referred to other mental health care services if needed. The Virtual Clinic will provide free counselling, at an arranged time and it will allow consumers to work with the same counsellor if they wish.
The Clinic is designed for those with mild to moderate anxiety, depression or related disorders. It is anticipated that people using the service will require 3-5 sessions to be effectively assisted. The Clinic will assess consumers' needs on their first visit and gauge what level of care they might need.
This new Clinic will provide Australians with access to counselling services without the need to travel, reducing the time and costs for care.
Virtual clinic - summaryThe national online counselling service (Virtual Clinic) will assist people with mild to moderate symptoms of mental illness. The Virtual Clinic will be linked to the national e-mental health portal and will have the capacity to respond to up to 50,000 people over five years with its current level of funding. As a 'stepped service' it will provide access to services that match the level of need so a consumer can step up from low intensity (self directed) services to one on one clinician support if required. The Virtual Clinic will be delivered by a provider through a select open tender process and will commence in the second half of 2012.
More online mental health support servicesThe Australian Government has allocated $38.6 million through the Telephone Counselling, Self Help and Web-based Support Programme from 2012-13 to 2014-15 for the provision of online mental health and crisis support programs. Through this program, the Government will continue with the projects already providing crisis support and online e-mental health therapy (see Appendix A) and will expand and diversify the range of services funded through this program with a new grant funding round to be finalised in mid 2012-13.
Services currently funded under the Telephone Counselling, Self-help and web-based support Programme will form the first services available through the new e-mental health portal when it goes live in mid 2012.
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E-mental health support serviceThe Australian Government will establish an E-Mental Health Support Service to work with traditional primary health care providers to promote online services and develop strong linkages between the two sectors. The service will also provide practical support in building the e-mental health environment, through advice on effective programs and on operating secure and effective mental health support in an online environment. The service will also have a role in supporting health professionals using these online services and provide training where appropriate.
The E-Mental Health Support Service will play a key role in the development and expansion of the e-mental health sector. It will have a range of responsibilities, including but not limited to:
- clinician support, including promotion of e-mental health services to health professionals, and workforce training including support for Indigenous mental health workers;
- establishment of referral pathways from traditional primary health care services to the e-mental health service environment and vice versa; and
- advice on quality assurance standards in the online environment.
E-mental health support service - summaryThe E-Mental Health Support Service will provide a range of support services in areas that cover the following: engagement of general practitioners and allied health professionals; the use of relevant technologies; workforce training; advice on quality assurance and new innovations in this field. It will also be expected to establish close links with a wide range of other relevant e-health organisations. The E-Mental Health Support Service will be managed by a provider to be selected by an open tender process and will commence in late 2012.
Enlisting the support of health professionalsCrucial to the success of e-mental health services will be the participation of medical and allied health professionals working in primary care services. Their participation in making appropriate referrals and in providing follow-up services to those who have come through e-mental health services will affect both level of take-up and the effectiveness of these services. A key to their participation will be the way e-mental health services are integrated with mainstream health services, particularly general practice, and this is more than simply educating health professionals about the value of e-mental health.
General practitioners and allied mental health workers already have an important role to play in responding to mental health issues through the Better Access initiative and the Access to Allied Psychological Services program. In this context, there will need to be clear processes that integrate e-mental health services with general practice and other health services designed for people with mental illness. The E-Mental Health Support Service will lead this work.
Workforce trainingThe service will develop and provide online mental health training for health professionals working with Aboriginal and Torres Strait Islander peoples as one of its first priorities.
In the longer term, the service will provide advice on what basic training is required for all mental health professionals in their undergraduate training. It will also examine what specialist skills in cognitive behavioural therapy are required for workers who provide clinical support to online counselling services. Advice will also be provided on supply of appropriately qualified clinicians and if specialised training needs to be put in place to meet demand for these services as they grow.
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Improving quality assuranceQuality assurance will be an important aspect of support for clinicians and consumers engaged with e-mental health services. An e-mental health quality assurance framework will need to reference other quality assurance arrangements in the health system but there are a number of issues that relate specifically to the electronic environment, including privacy and security of personal information. Standards of practice will need to be developed in these areas and others crucial to the effectiveness of e-mental health services, such as the way stepped services are provided, safety net arrangements for people who need immediate intervention and referral protocols. The E-Mental Health Support Service will provide advice on mechanisms for quality assurance across services delivered online and work with other government agencies which have responsibilities in this area.
The Australian Government will allocate funds for the Support Service from the 2011-12 Budget measure that involves the establishment of the Single Online Mental Health Portal.
Promotion of the e-mental health service environmentA marketing strategy will be developed to ensure entry points and pathways through the e-mental health system are known to consumers and carers, and key health professionals in the primary health system. Targeted and consistent messages about the effectiveness of e-mental health will also be developed and broadcast.
The existing online mental health services are generally not well signposted. Engaging with consumers, carers and the wider community of potential users will therefore involve a focus on publicising e-mental health services and ensuring there are a range of places where people can find information on e-mental health and gain access to services. This will require a national approach and development of a range of strategies, including consistent badging, support of e-mental health 'champions', promotion of positive media stories and creation of information material that consumers will be able to find at key mental health gateways. The Government will invest in a marketing strategy for this new online environment.
The futureA particular strength of the e-mental health system, as it has grown in Australia, is that it is largely research-based. A number of the existing services are associated with Australian universities and have been established with a research focus in mind. With the maturing of the e-mental health system as foreshadowed in this Strategy, there will be a need to take a whole system view about its effectiveness. The development of a system wide evaluation framework through advice from the E-Mental Health Support Service will be an important component of the evaluation of the Strategy.
There is still much to learn about how e-mental health services can be developed and promoted to assist as many people as possible. For example, it is not clear whether the balance of existing services is optimal in terms of their target groups and target disorders. It is difficult to assess whether there are gaps in current service provision. Similarly, there is a lack of sufficient evidence to indicate whether existing services are meeting a full spectrum of need from the provision of information to voice and video interaction with a health worker/professional.
Further new systems such as the National Broadband Network are going to give rise to new functionality which will make other interventions for mental health care possible. New technologies will need to be explored and developed as we move into the next decade.
The challenges engaging with some hard-to-reach population groups with new technology will also be an area that will need future attention and investment.
The Australian Government has made a record commitment to improving our mental health care services and this Strategy is one example of the innovative ways that we can work together to improve access to effective mental health care.
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