e-Therapy may revolutionize mental health care in Australia

From The Age in Australia:

Mentally ill Australians are increasingly being diagnosed and treated online in virtual psychiatric clinics, without ever seeing a doctor.

Patients suffering from depression, anxiety and post-traumatic stress disorder are being assessed by computer and given ''e-prescriptions'' for online counselling courses instead of medication or treatment sessions with a psychologist or psychiatrist. Doctors who provide e-therapy say it produces better results than face-to-face treatment but at a fraction of the cost.

Private appointments with mental health specialists cost an average of $100 an hour.

With e-therapy, patients are clinically diagnosed after completing psychiatric reviews by answering online questions. They then have the option to enrol in a free electronic self-help treatment program or receive assistance from an online therapist at limited cost.

Advocates predict it will revolutionise the way mental illness is treated, particularly in remote areas where access to services is limited.

The Sunday Age believes the federal government is so supportive of e-therapy it will this year offer GPs in every rural Australian community free training in an online treatment program developed by a leading Sydney mental health clinic.

In Melbourne, David Austin, the co-director of the National eTherapy Centre's Anxiety Online program, which is run from Swinburne University of Technology, said the service did not attempt to treat people with more serious conditions such as schizophrenia or bipolar disorder but there was scope for that in the future.

''Within five to 20 years we will have a proven e-therapy for most of the psychological conditions. Once you do that, you have 24-hours-a-day, seven-days-a-week low-cost access for everyone,'' said Professor Austin. Since the launch in October, more than 5000 patients with a range of anxiety disorders have been diagnosed by the service, which offers free self-help programs or internet-based therapy sessions with postgraduate psychology students, costing $120 for a three-month course.

Patients log on anonymously to complete modules on cognitive behavioural therapy and breathing and relaxation techniques through videos, podcasts, online forums and interactive questionnaires.

Next month, courses will begin for people with eating disorders and gambling addiction.

''It's a radical departure from the mental health system we have now where even though less than 10 per cent of people with a psychiatric problem seek professional help there's still waiting lists, there's still problems with access; people in regional and rural areas haven't even got an option to go on a waiting list because there is no service. E-therapy just completely wipes away all those issues,'' Professor Austin said.

The Royal Australian and New Zealand College of Psychiatrists and the Australian Psychological Society are largely supportive of e-therapy but remain concerned that seriously ill patients could miss out on appropriate care if they rely solely on online programs.

Bob Montgomery, the society's president, said underlying emotional issues or substance abuse often caused mental health problems and e-therapy could fail to detect them.

''I have grave doubts about whether it [e-therapy] will be the panacea some people tout it as being so it's important that people have access to full-blown therapy,'' he said.

More than 360 doctors across Australia are also using a program developed by the University of New South Wales and St Vincent's Hospital's Clinical Research Unit for Anxiety and Depression in Sydney, which allows GPs and psychologists to refer patients with mental health issues for online treatment by buying a $100 pad of 20 e-prescriptions for 20 patients, each providing a six-week counselling course.

The federal government has trialled the program in New South Wales and, with funding extended until June next year, it is expected to be introduced in rural communities nationally.

The program allows people to record their emotions with electronic mood monitors that are tracked by their doctor, who can intervene if they feel extra support is needed.

It has become the hospital's treatment of choice for people with anxiety disorders, and those behind the program are now in discussion with the United States and New Zealand governments which want to replicate it. Gavin Andrews, who heads the online research unit clinic, said more than 2000 patients had been treated and the program had been found to be 13 times more cost effective than face-to-face treatment.

''For every two people you treat, you get one fully better and they stay better for six months. When you're treating depression with antidepressants you get one better for every five patients you treat and for cognitive behavioural therapy you treat four and you get one fully better … The results are quite staggering.''