Digital mental health services (DMHS) are a routine part of the contemporary mental health ecosystem in Australia and internationally. DMHS deliver treatment, assessment and psychoeducation via mobile
phones and other internet-connected devices, and address many of the barriers to accessing traditional face-to-face treatment, including financial cost, long waitlists, stigma, and geographical and
time constraints.
In Australia, the COVID-19 pandemic has exacerbated many access barriers, with 88 per cent of psychologists reporting an increased demand for their services, 3 in 4 having a waitlist in metropolitan areas alone and 1 in 3 not accepting new patients (vs ~1 in 100 pre-pandemic) (Australian Psychological Society, 2022). This said, DMHS are not for everyone, and previous research has shown people vary in how they use these services, which service offerings they take up, and how fully they engage with treatment.
Our study aimed to better understand user decisions to access supported DMHS to take up online assessment and therapist-guided treatment for high prevalence conditions, such as anxiety and/or depression. We interviewed 20 therapists from two supported DMHS, one national and one state-based service. Qualitative analyses of interview transcripts yielded three overarching themes.
The first theme highlighted an interplay between individual users, DMHS and the broader mental healthcare system. According to therapists, DMHS are not a standalone entity separate from the mainstream mental health system. Instead, DMHS offerings are used flexibly by a diverse range of people, for example, as a monotherapy, as psychoeducational or therapeutic adjunct to face-to-face sessions with a GP or psychologist, or as an interim solution while on a waitlist.
The second theme showed that despite being digitalised, therapists working within DMHS play an integral role in supporting user decision-making around online assessment and treatment uptake. Therapists viewed their role as dynamic and multidimensional; they explored users’ treatment readiness and motivation, tailored information, and managed user expectations based on their existing knowledge levels and preferences, while encouraging person-centred and informed choices.
Finally, the third theme shed light on the unmet informational and decision-support needs of some DMHS users. Therapists felt that DMHS users vary in how informed and realistic their treatment preferences and expectations are, which reportedly then impacts on their treatment uptake and engagement. Therapists spoke of the importance of providing pre-consultation information about treatment options, using text and other multimedia formats, such as embedded videos. Therapists also reported that some users experience decisional conflict, resulting in indecision, and so need extra time with a scheduled follow-up call to ensure they make the right decision for them at that time.
Our study suggests that DMHS are crucially supported by mental health professionals; both those working internally, but also third-party clinicians such as GPs and psychologists, who use DMHS as a referral pathway. In this way, our findings support one of the key objectives of the National Digital Mental Health Framework (Australian Government Department of Health, 2021) to develop a “digital mental health ecosystem that... integrates digital mental health services across the broader mental health and health systems”.
To do this, greater investment is needed to build health professional and general community awareness about the role of DMHS, as an alternative, complementary or supplementary option to face-to-face assessment and treatment. Investment in technology-enhanced tools and platforms is also needed to better connect and integrate DMHS with other parts of the mental healthcare system, especially at points of patient referral, entry, exits and ongoing monitoring.
On the back of recent cuts to Medicare-rebated sessions with a psychologist from 20 to 10 sessions as part of the Better Access program, DMHS represent an important, scalable avenue for sustaining high-quality continuity of care for patients.