E-clinic integration into youth mental health services

Staff experiences and reported service quality improvements

Improving access to, and the quality of, mental health services through the use of health information technologies was highlighted as a key strategic recommendation in the 2014 report of the National Review of Mental Health Programmes and Services by the National Mental Health Commission

More specifically, the Commission called for an overhaul of the Australian mental health system, including an integration of e- mental health into face-to-face services.

While an enormous body of literature regarding digital mental health services exists, both nationally (eg, eheadspace, Mental Health Online, MindSpot Clinic) and internationally (eg, Babylon, PlusGuidance, BetterHelp, Talkspace), these services are almost all stand- alone clinics.

The successful implementation of health information technologies into face- to- face services, however, has the potential to vastly improve traditional service quality.

For example, the use of health information technologies before initial clinical assessment may reduce service entry wait times, especially for those with complex needs, and can go some way to addressing youth mental health service capacity constraints.

Although access to these services is rising, many young people enter care for the first time with significant functional disability and symptomatic distress, and those with higher needs at entry tend to have poorer outcomes at exit.

Health information technologies hold promise to improve clinical outcomes by enhancing access to more appropriate and timely care for those with chronic and enduring health conditions. While research regarding the engagement, efficacy and effectiveness of health information technologies is growing, there is currently little research into the implementation of technology enabled solutions into existing mental health care settings.

As with general health care settings, it is crucial that research aims to recognise and understand barriers to and facilitators of implementation. Research must also aim to devise strategies for improving widespread and effective uptake of health information technologies, and promoting their ongoing use. Broadly, implementation barriers can be split into clinician (or health professional) factors and service factors.

Clinician factors

Research has shown that almost all young Australians aged 16–24 years (99%) are online, with 60% using the internet to find information relating to mental health. In contrast, use of online services in mental health clinics has been acknowledged as a challenge to the professional attitudes and values of some health professionals.

For example, health professionals may feel unable to trust online service capability, they have questioned the effects of technology on establishing and maintaining therapeutic relationships, and they have raised concerns about being able to manage or allay consumer confidentiality and privacy concerns.

Recently, a review of the youth mental health workforce found that health professionals consider the assessment and management of risk and safety issues to be critically important and expressed concerns regarding the ability of technology to accurately assess, interpret or communicate such issues back to consumers.

In situations where doubts about the appropriateness of technology have been expressed by health professionals (eg, regarding the clinical applicability and utility
of technology), this influences their engagement with the technology. Consumer factors such as age, personal attitudes and prior use of technology also influence health professionals’ perceptions regarding use of technology in service.

Education and training of staff that addresses such concerns and perceptions, and emphasises the benefits and utility for consumers and clinicians, is therefore an important component of implementation.

To find out more, download our supplement ‘Implementation study of a prototypic e-clinic being integrated into youth mental health services‘ from the peer-reviewed Medical Journal of Australia.