Most health professionals would agree that not everyone in Australia with a mental health problem gets the help that they need. Anecdotal evidence in the media and from community members also supports this assertion. In 2014 the Australian Institute of Health and Welfare reported that only 70% of Australians who have a mental health problem receive any professional health at all. It remains unclear how many people who need help actually receive effective care.
The barriers to mental health care include stigma and self-stigmatisation. There are also problems of affordability and accessibility with gap fees, long waiting lists, long distances to appropriate professionals and the impossibility of taking time off work or organising child care to attend face to face therapy sessions.
In Australia research groups have been developing and testing online CBT programs since the mid-90s with the first (MoodGYM from Australian National University) being launched in 2001. Research has confirmed their efficacy in treating mild to moderate common mental health conditions (especially depression, anxiety and stress) as well as in helping build resilience in people who are vulnerable to mental health problems.
Evidence-based Australian e-mental health programs are almost all CBT-based but there are several which incorporate elements of Mindfulness Based Therapy (eg THIS WAY UP’s new Mindfulness Based Therapy modules) and Acceptance and Commitment Therapy (eg the new Diabetes related distress module in Black Dog Institute’s MyCompass program)
The biggest dilemma for health professionals is to understand which program to recommend. Some basic knowledge is required:
- Most programs are delivered in a linear fashion which requires working through the program from beginning to end but one program, the MyCompass program, allows users to choose modules in any order, thus tailoring the program to their own needs.
- Most programs fit into the self-help category but there are several which provide guidance either at extra cost (Swinburne University’s Mental Health Online) or with a GP referral (THIS WAY UP from St Vincent’s/UNSW). Macquarie University’s MindSpot Clinic functions as a “virtual clinic” providing personal support for each user either by phone or email at registration and after each lesson at no cost and without a referral.
- With the exception of THIS WAY UP all the evidence based Australian programs are available free of charge. THIS WAY UP is now available from the app store for use on mobile devices.
These programs fit very neatly into the stepped care model of mental health care which encourages patients and practitioners to match the intensity of the intervention to the severity of the illness. They also help overcome many of the barriers to care that many people currently experience with face-to-face care.