Higher uptake of e-mental health services with GP referral

Morgan Liotta

11/08/2021 3:43:44 PM

Referrals to online screening and treatment lend ‘greater legitimacy’ and retention than if people self-refer, study results confirm.

Teenage girl looking at phone
Usage of e-mental health services is on the rise.

Since 2017, general practices and Primary Health Networks have collaborated with the Black Dog Institute to run the StepCare program, an online mental health screening and treatment recommendation tool.
In this time, more than 7000 patients from 85 practices across Australia have been screened as part of the program, which concludes at the end of 2021.
According to the program’s latest findings, the uptake of e-mental health interventions is 2−3 times higher among patients who were screened through StepCare and referred by their GP, than rates of uptake for people who self-refer.
From the cohort of screened patients, around 40% visiting their GP had symptoms of depression and 26% had symptoms of anxiety.
Black Dog Institute Research Fellow Dr Alexis Whitton told newsGP the findings highlight GPs’ place in linking patients to the right support services.
‘With the enormous number of mental health apps available online at the moment, it is understandable that people may struggle to know which ones are evidence-based,’ she said.
‘People trust their GP to provide them with treatments that are backed by science, so getting a prescription for an online mental health program from your GP removes a lot of the guess work.
‘We also think that the actual act of being “prescribed” an online intervention by a health professional, rather than accessing it online yourself, lends greater legitimacy to the program, making people more likely to use it.’
Dr David Lam, member of Black Dog Institute’s GP Advisory Council, agrees.
‘It’s great that we are seeing a huge uptake of digital health services in the form of online self-help and telehealth during the pandemic,’ he told newsGP.
‘But that can often be a double-edged sword, in terms of finding the information that helps to empower people with their health, given that there’s so much of it out there.
‘That’s where GPs can certainly help … to allow [patients] to make the best decisions and empower them to be as healthy as they can be.’
Dr Whitton said despite a ‘large proportion’ of people who screened positive for depression or anxiety having never spoken to their GP about their mental health, they were still suitable candidates for online mental health interventions.
‘[This] indicates that the screening tool was successful in identifying symptomatic people who may have otherwise gone undetected,’ she said.
‘Importantly, the majority [89.5%] of these people had symptoms in the mild-to-moderate severity range, which is where digital mental health interventions can be really useful.
‘The screening tool therefore gives GPs greater opportunity to prescribe lower-intensity digital interventions, rather than waiting for patients to present with mental health symptoms that are more severe.’
Considering the current climate, Dr Lam believes access to e-mental health tools that support best practice, patient-centred care is more important than ever.
‘Certainly, we have seen an increase in the rates of symptoms of depression, anxiety in the Australian population for obvious reasons given the current pandemic,’ he said.
‘And … it’s something that I see in my role as a GP that there is a lot of trust around patients’ relationship with their GP, not just to deal with their physical health but also with their emotional and mental health, which can often be quite a more personal health issue … and they find it all the better for having done so.
‘I just like to encourage people that it’s absolutely something that we can help with as GPs.’
Results from the StepCare study also showed that one in every 16 patients screened had untreated mental health symptoms. Almost a third of those who showed symptoms of depression or anxiety were prescribed online programs by their GP, with over two-thirds of patients following through and using the programs.
Dr Whitton said helping GPs detect and treat mental health issues in a timely manner is a ‘national priority’, particularly during the COVID-19 pandemic.
‘Although online therapy programs have been around for a while now and people can access them without a referral from their GP, we know that engagement with these programs can be low,’ Dr Whitton said.
‘Integration of digital mental health interventions into primary mental health care has also been slow. Our findings suggest that GPs can play a critical role in linking their patients with trusted digital mental health interventions, and that screening patients for common mental health conditions can help GPs identify suitable candidates for digital interventions earlier in the symptom trajectory.’
The StepCare digital tool is designed to integrate into general practice workflow and assist with providing timely, cost-efficient, early intervention and treatment. Results from the study indicated that although GPs prescribed online interventions less frequently than in-person psychotherapy or medication, the ‘promising’ rates of uptake by GP-referred patients suggests that GPs can ‘play a critical role in championing digital interventions and maximising the associated benefits’.
Dr Whitton anticipates screening tools such as StepCare will become a part of the ongoing expansion of telehealth.
‘The silver lining of the COVID-19 pandemic has been the rapid integration of telehealth into general practice and the introduction of MBS telehealth items,’ she said.
‘Introducing similar MBS items for digital interventions, including reimbursing the time needed to properly explain the interventions to patients and monitor their use, will be critical for ensuring their sustained use in primary mental health care.’
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