It Seems There A Quite A Few Wrinkles Involved In Remote Mental Health Care But It Seems To Be Valuable!

This appeared last week and I found it really interesting and reflective view of how technology and care mix.

Psychiatrists learn how to empathise, virtually

From mastering multiple technologies to reading body language via video, the pandemic has forced doctors to change how they help their patients.

Tanveer Ahmed Contributor

Jan 27, 2021 – 12.00am

For many of us, the coronavirus pandemic drove parts of our lives into the digital realm: from streaming entertainment, to buying groceries to Zoom meetings.

As a psychiatrist, my work also changed. Almost a quarter of my consultations are now conducted digitally, three times higher than before the pandemic.

Using a laptop or a smartphone, I have become familiar with Facetime, Skype, Zoom and the bespoke applications linked to some organisations I work for. I assess my clients in jail using Web Ex teams and they tell me about their crimes while sitting in cramped rooms staring at webcams in their green prison uniforms.

The statistics suggest that both doctors and patients are happy with the new options, with a 20 per cent increase in uptake on average across all Australian states. Unsurprisingly, Victoria had higher rates in the middle of 2020 during the state’s strict lockdown.

Medicare figures show the majority of these calls are for short appointments, of about 15 minutes, suggesting their use is primarily for prescription renewals, the delivering of test results or follow-up consultations.

Psychologists and psychiatrists prefer to avoid telehealth for first appointments fearing greater challenges in establishing rapport with their patients. The difficulties of interpreting the subtleties of body language and non-verbal behaviour in a video call can be an impediment, but are more easily overcome when there is an existing relationship that has been forged in real life.

In terms of trauma, one of the things many of us track is micro-expressions, these flickers of emotional tone.

— Dr Andres Sciolla, psychoanalyst

I was made aware of the potential pitfalls of telehealth in the early stages of lockdown. During a consultation I had with a young woman, she grimaced, partially closed her eyes and emitted a sound that I interpreted as laughing. After the call, I was reflecting at her ability to laugh in a challenging situation but then realised that she was in fact crying.

In spite of the limitations, a survey among Australian and New Zealand psychiatrists conducted in September 2020 found there was a tremendous acceptance of telehealth, with many who were previously sceptical converted.

The groups least likely to embrace teleheath are the psychotherapists who depend upon a process called transference, when patients respond to their therapist as they would to people of significance in their lives. These subtleties of the therapeutic relationship are pointers to patterns in past relationships with parents and partners.

A survey conducted by the American Psychological Association among its members discovered that 76 per cent found telehealth more difficult because of the challenges in interpreting non-verbal behaviour.

“In terms of trauma, one of the things many of us track is micro-expressions, these flickers of emotional tone, when people are talking,” California-based psychoanalyst Dr Andres Sciolla told The New York Times. “I cannot tell you how many times I have noticed a flicker of tears or fear in the gaze of a patient, perceived a shift in feeling, and explored that – and found a lot behind that change.”

Vastly more here:

https://www.afr.com/companies/healthcare-and-fitness/psychiatrists-learn-how-to-empathise-virtually-20210125-p56wm6

There are many tips and stories of traps for many here!

On the broader are it seems it can work well!

Digital mental health care is here to stay

February 3, 2021       Professor Nick Titov

While the concept is not a new one, Australia experienced a massive surge in interest and demand for these services due to the COVID-19 pandemic.

We all recall the intense feelings of isolation, despair, uncertainty, and fear as we watched COVID-19 unfold. It is unsurprising then that so many people went searching online to find information and support.

Here at MindSpot, our online mental health clinic based at Macquarie University, we saw an explosion in the uptake of our services. Any adult in Australia can access our clinically-proven treatments for free – delivered online and by telephone – to help overcome anxiety and depression. Normally, we have 400 people using our services each week. During the peak periods of the COVID-19 lockdowns, this number doubled to 800 people a week.

The spotlight is now firmly on Digital Mental Health Services (DMHS), the unique role they will play in contemporary health systems, and whether they are ready and capable of meeting the community’s needs.

Proving the value of digital mental health services

While demand and delivery of digital and telehealth mental health services has grown globally, information about actual clinical outcomes has been scarce. As one of the world’s first digital mental health services we regularly publish our clinical results and our learnings, to demonstrate accountability and save others from re-inventing the wheel.

As part of this commitment, last year our team at MindSpot set out to analyse the characteristics and treatment outcomes of the more than 120,000 patients who have used our services in our clinic’s first seven years.

Our research, published recently in the Lancet, found that the users of MindSpot represented a broad cross-section of the Australian population, despite the digital divide. People accessed the clinic for a variety of reasons, and most users sought a confidential assessment rather than treatment, often because they couldn’t access traditional services.

Much more here:

https://wildhealth.net.au/digital-mental-health-services-are-here-to-stay/

So while there can be wrinkles, undertaken thoughtfully considerable benefit is possible.

David.