Digital mental health: Not just extra resources, but a revolution in practice!

David Kavanagh

November 2016001111100100100101110011001010

0001001010111101001001000100101010010

Australia is now e-connected• 92% accessed the Internet over the previous 6 months in 2015 1

– (Never accessed 10% in 2010 6% in 2015)

– (Daily use 74% 2012 83% 2016)

• 15.8m (86%) had Internet at home

• 13.4m adults (74%) accessed the web on a smartphone 1

– 79% of online access was by phone1

• Average of 6 devices used by families to access the web at home

1. Australian Communications & Media Authority (ACMA) Communications Report 2014-152. http://www.abs.gov.au/ausstats/abs@.nsf/mf/8146.0.

Barriers disappearing

• Rurality– Wider web access, though not universal or fast

• 60% in very remote areas Handley et al 2014

• Satellite increasingly available• Apps help to address blindspots, narrow bandwidth

• SES– smartphones becoming universal

• (72% in a US sample with serious mental disorder—Ben-Zeev et al 2014)

– Download cost still limits use • But can address using wifi

Devices are rapidly changing our lives

• In 2016, 19.8m Australians actively surfing the web1

– spent an average of 60.7hrs/month online

– in an average of around 218 sessions

• Most popular online activities (2014-15)2

– Banking (72%)

– Social networking (72%)

– Entertainment, education (each 73%)

1. Nielson Digital Landscape September 2016, from Digital Ratings (Monthly)2. http://www.abs.gov.au/ausstats/abs@.nsf/mf/8146.0

…including health information seeking

• In a 2013 Aus survey (2944 patients of 100 GPs)1

– 28% had sought health information on the web

– 17% got information about the issue of that visit

• But may not mention to their doctor2

– In a 2008 survey of 689, only 26% who had looked online talked about it

1. Wong C et al (2014) Aus Family Physician 43, 875-772. Dart et al. Aus Health Review 32 559-69

Other aspects of practice are changing, too

• SMSs for appointment reminders

• Digitised practice records, e-health records

• Practice software with decision support tools

• Links to specialists by email, digital reports, images

What’s on the digital horizon?

• Universal e-connection– Full geographical coverage– Falling cost of hardware, data

• (although data requirements will also rise)

• Highly digitally sophisticated community– But increases in digital/virtual reality addiction

• Ongoing improvement in data security, but also additional risks

• Potential for warfare /terrorism to destroy infrastructure, cause networks & services to crash

Digital mental health has already had an impact

• (Widespread use of web-based information)

• Access to support by more Australians– Especially relevant to the bush

• 5.5x fewer psychiatrists, 3.1x fewer psychologists /100k

• Some use of consumer-grade automated monitoring

…but use is not uniform

• Predicted by

– higher education

– gender (women more likely)

Recent federal policy framework—Digital Mental Health Strategy

E-Mental Health Portal (mindhealthconnect)

Virtual Clinic (MindSpot)

Training of use in primary care (eMHPrac)

Menzies Indigenous

QUT—Lead & Indigenous

U SydneyIndigenous

UNSW/Black Dog GPs

ANU Allied Health

What we are doing

Raising awareness

Training use

Providing peer support

Collating national data on digital mental health

Advising the government on policy

Why?

• Digital services have operated in parallel– Some increased access, but an add-on, not integrated

• Medicare mental health costs are high and rising– More access requires > service efficiency

• Coaching increases completion, perhaps effects

• It’s what people currently want

Government’s response to the2015 Review of Mental Health Programs & Services

• A new digital mental health gateway– Screen, help find right service

• Refocus primary services to stepped care– with e-mental health a key focus in low-severity conditions

pennymiller.com.au

Current dMH issues in 2016

• Short-term, uncertain funding

• Still mainly universities offering service

• Few services can safely be taken to scale

• Programs, services do not yet routinely have – Same measures, routinely readministered– Regular reports to referring practitioners– Close monitoring, reports of deterioration

Current dMH issues in 2016

• Bewildering, rapidly growing menu– Varying in quality

• Evidence-based strategies• Stability• Perceived attractiveness, usability, utility• Data protection; numbers of small players• Varying degrees of co-design

– Limited advice available• First model of gateway will not include quality information

Current dMH issues in 2016

• Limited coverage, especially for– Aboriginal & Torres Strait Islanders– Culturally & linguistically diverse communities– Severe mental disorder – Comorbidities—especially physical health, substance use

• Patchy investment in resources by states

• Lack of marketing, minority community acceptance

• Current practitioner education severely limits dMH training

What’s on the dMH horizon?

• A practitioner digital gateway

• Near universal awareness, wider acceptance of dMH– Supported by marketing?– Medicare coverage of remotely delivered MH services?

• dMH tools, services for all MH problems

• Acceptance of pay-per use digital services – by community, insurers, govt?

• Vibrant dMH industry with a wide range of products?

What’s on the dMH horizon?

• Accreditation, consumer advice routinely available – but continued exponential increase in # of dMH tools

• Accredited dMH therapist-assisted services have routine • individual monitoring• reporting to practitioners, warning of crises• public reporting of group outcomes

• e-health records are linked to dMH

• Automated digital monitoring of functioning, mood, & physical/environment correlates routine

What about practitioners?

• Initial & continuing education have dMH use & support as a required component

– Specialist courses on dMH development

• Practices seamlessly integrate dMH

• Individualised decision tools are routine

Stepped MH care with dMH becomes routine?

We are part of a revolution

?

Find out abut digital mental health