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H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, November 25, 2015

Is The Health Minister Following The Evidence With Respect To E-Health In Mental Health?

This appeared last week:

E-health key to mental health reform: Ley

Serkan Ozturk | 17 November, 2015 |
The Federal Government wants digital programs to play a central role in reforming mental health care, despite growing concerns over the efficacy of treatments such as online CBT.
Speaking in Federal Parliament late last week, Health Minister Sussan Ley signalled that the eagerly awaited report into the country's mental health system by her appointed expert reference group would be released before the end of the year.
Foreshadowing the report's contents, Ms Ley told parliament the recommended reforms contained within it would be "significant, far-reaching and very important".  
A key part of that would be the far greater use of online mental health programs, she said.
"The opportunity for digital engagement, the great advances that have been made in communicating via a self-help app, a digital gateway and counselling online — a lot of young people put their hands up and said that is a preferred method for them," Ms Ley said.  
"If we know we can intervene early and get the right assistance for that cohort, we can save our resources for the people who need complex care later on in the cycle."
Her comments come at the same time as concerns were raised over the effectiveness of e-mental health treatments following the publishing of a randomised controlled trial bringing their widespread use into question.
The study by UK researchers concluded that online CBT programs provide "modest or no benefit over usual GP care and suggests that the routine promotion and commissioning of computerised CBT be reconsidered in light of our findings".
However Kate Carnell, who is leading the Mental Health Expert Reference Group, refused to comment on questions about the findings when contacted by Australian Doctor on Tuesday.
"Our job with an expert panel was to look at what implementation would look like that, which bits should be implemented and how they would be implemented," said Ms Carnell who was formerly CEO of beyondblue.
"I'm not going to make a comment on a report that hasn't been released yet and I'm not the expert on digital mental health services."
Associate Professor Nick Titov, project director of online mental health program MindSpot based at Macquarie University, said e-mental health should not be seen as a "panacea" for mental health care.
More here:
Interestingly we had this appear in the same week.

Doubt cast on value of computerised CBT

Thomas Meek
17 November 2015
Computer courses to treat depression are likely to be ineffective, according to research by the University of York.
A study published in the British Medical Journal says that participants offered computerised cognitive behaviour therapy experienced “no additional improvement in depression” when compared with patients who received their usual care from a GP after four months of treatment.
The two-year REEACT trial included 691 patients with depression selected from 83 general practices across England.
Patients were randomised to receive 'usual GP care for depression' or 'usual GP care plus' one of two computerised CBT programme recommended by the National Institute for Health and Care Excellence.
These were the commercially produced Beating the Blues or the free to use MoodGYM developed at the Australian National University Centre for Mental Health Research.
Previous, developer-led trials for both systems have demonstrated the products have been able to reduce symptoms of depression. However, the York research suggests their impact is less clear in a real world setting.
The study’s authors noted: “Patients generally did not engage with computer programmes on a sustained basis, and they highlighted the difficulties of repeatedly logging on to computer systems when clinically depressed.”
However, there have been recent studies suggesting that electronic CBT tools can have some benefit, at least when combined with other services.
This month, the Canadian Medical Association Journal published an evidence review that shows internet-delivered CBT combined with clinical care can support people with depression, anxiety and emotional distress from illness.
More here:
I find it interesting that there were different findings reported from different countries and this compares with most of the evidence from Australia that suggests a positive effect with e-Mental Health.
It seems to me what we need here is to try and understand just what has led to difference in findings before making any decisions as to where the Government should make its Mental Health investment.
There is no doubt that Prof. Titov is right and that e-Mental health should be seen as a part of but by no means the whole story.

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