eheadspace

Challenges and Directions

Dr. Steve Leicester

Setting the scene

• Youth Mental Health, early intervention

• Enhanced access to care

• headspace

• Significant part of reform agenda

• Australian of the year 2010

• Largest increase investment across mental health

• Now seen as a ‘sector’

• Key focus within the Mental Health Commission Review

Strategically

• Fundamentally:• Policy and funding is encouraging more people to access online

supports (e.g., Aust. Govt. E-Mental Health Strategy, 2014)

• Cost reduction

• Service demand

• During more stages of illness/ distress

• We need to think beyond entry into MH system

• Closer alignment with face to face

Embedded in daily lives …

Embedded in daily lives …

Digital Health Agenda

Setting the scene

• Mental Health Digital Agenda

• MHR

• Digital gateway

• 2 year extension contracts

Setting the scene

• What is the sector:

• Teleweb sector

• Major part of MH framework

• Unknown – what else are people using; non linear

• A way to go re: outcome measures

• We still receive majority of GP interaction via fax!!!

How is Digital MH delivered?

• Telephone:• Crisis lines**• 1 off support**• Information & referral• Structured therapeutic interventions**

• Text Based:• Webchat**• Email**• Forum – threads; discussion groups; group chat• Closed communities• Social media• SMS

However …

• Separate contracts; EMR; governance, etc.

• A way to go re: outcome measures

• Client pathways … who knows???

• Separation from primary, secondary & tertiary health … integration??

We still receive majority of GP interaction via fax!!!

This shit works!!

• iCBT• Mild- moderate depression & anxiety (Meurk, et.al. 2016)

• NICE guidelines

• Self guided

• Information based options

• Telepsychiatry & telehealth• Well established

• Embedded within health frameworks (Hilty, et al. 2013)

Streamseheadspace.org.au

Our Place in the Sector

• Youth

• Primarily 1:1

• Highly skilled & robust governance

• Open to all presentations

• Clinical in conceptualisation

• Diverse client spectrum - growing

• Part of headspace network (hSS, centres, DWSS)

eheadspace

• Providing skilled mental health support and interventions

• Webchat (dominant) – Phone – Email - recently SMS

• Stand alone DoH contract, operates independently from centres

• 9am – 1am AEST

• Credentialed mental health clinicians (approx. 80)

• Psychologists, social workers, mental health nurses, OTs

• Treatment focused• Extensive client follow up• Regularly works with high complexity• Nation wide coverage

Service Delivery

- Webchat dominant for young people- Phone preference for family

peak age of presentation

15 to 17

Who is using eheadspace?

Just over half of eheadspace clients report that they have sought mental health support in the past (prior to their first use of eheadspace)

Prior help-seeking

eheadspace registrations

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

2012 2013 2014 2015 2016

33,000 registrations, 90,000+ interactions in 2016

Service demand by hour of the day

- 3 shifts per day- Acuity increases later in day- Head of service & CSM on call

Turned Away (not enough clinicians, July 2015 – Nov 2016)

Challenges …

• Great appeal, however, meeting service demand is an increasing concern

• Never actively marketed

• Not yet capitalising on the breadth of digital options available

• Increasing demand

• Staffing (shift work, high credentialing)

“Decrease investments in first generation e-mental health type systems … e.g., eheadspace”.

Challenges

• Expectations of online• Immediate

• Flexible

• Confidential

• Quick

• Anonymous

• Accessible

Next Steps ….

Dilemma

• Great appeal, however, meeting service demand is an increasing concern

• Never actively marketed

• Not yet capitalising on the breadth of digital options available

National Mental Health Commission’s Review of Mental Health Programmes and Services ‘first generation’ online services providing one to one interventions were outdated, potentially contributed to service

duplication and failed to capitalize on new technologies.

“Decrease investments in first generation e-mental health type systems … e.g., eheadspace”.

Forward …More than the virtual headspace centre – support & treatment hub

Easy access “… dip in, dip out …”

Impermanence. Build the platform - content, resources, etc. must be agile

Principles of stepped care can be embeddedIn

form

Facts

Guides

Myths

Static options Dyn

amic Apps

Self Guided

Interactive

Co

nn

ect Peer

Forums

Group Chat

Facilitated GroupsClinical

Interface1:1

However …• Community still expects an interaction …

“ approach your GP”

“see a mental health professional”

“contact a headspace centre or eheadspace”

• Instead … • We have growing evidence that a range of options are effective

• Support comes in many forms & stop referring to information, apps, etc. as an adjunct or separate from support

• Inform what works instead of keeping our work secret• Connections

• Purpose & future

Road Mapping …

• Options for account creation outside of 1:1 “… we want a space… ”

• Login & dem. in line with IDS

• User pathway, rating & analytics – guide resources, links, endorsements, etc.

• Integration with DH2

• Expand interactivity

• No wait space – always within the environment

• Links remain within eheadspace environment

• Outward facing recommendations

• YP & family led areas – forums, group chat, Qheadspace, increasing peer experts, etc.

• Best options for those that come to eheadspace

Hopefully we are getting better at …

• Digital health is no longer an adjunct • Preference for many – stop comparing with face to face• Still seeking human interaction

• The old ways of designing health services are out• Concepts of EOC need rethinking• Outcome, distress & satisfaction measurement

• Agile organisations • Respond quickly• Measure smartly• Transparent

• Partnerships and collaborations are more critical than ever• No agency or product can do it alone• No shortage of demand – there is plenty of space for more than one

• Stronger R&D• Analytics & traditional measures• Research is redundant quickly• Translation from academic to practice – currently too slow to be relevant

Development &translational research

Absolutes

o Improve accesso Effectiveo Measurable o Contribute to knowledge baseo Enhanced user design and feedback

o Partnerships

Workforce Options

Concerning …

• No specialist (or other) focus within post grad training

• Clinical placements

• Growing – but minimal PGrad research

• Minimal private, PD or other skilled based courses to deliver teleweb

• No standardised EMR or data sharing across teleweb

Workforce Realities

Overall – major concerns across clinician sample (Orlowski, et al., 2016)

1. Prevailing sentiment that online activity was detrimental to well being & social engagement (i.e.,

“real relationships”).

Response: Move on … it’s a viable and critical option. Here to stay – now adapt.

2. Filters clinical practise. Lose essential non-verbal nuances – adverse impact on therapy. Despite

using SMS, email out of session.

Response: New skill set. Distinct nuances including disclosure.

Workforce Realities

3. Challenges clinician’s power dynamic. Language, digital skill set ease of access.

Response: Don’t pretend what we don’t know. Autonomy and counter-transference key

supervision themes.

4. Professional identity – ‘in person’ is the foundation. Clinical risk, familiarity with tech, data

governance. Tech options perceived as adjunct - rather than primary mode.

Response: User perspectives are driving the ehealth push. Anonymity and associated risk

are accepted components of practise. Data security is likely better than your current EMR.

Workforce Realities

5. Personal use and acceptance for the clinician

Response: Acknowledge it is a shift. Training in ehealth essential

6. Organisational legitimacy. Priorities and strategy across the organisation.

Response: A comprehensive digital strategy is essential for organisational legitimacy .

Recommendations

What should a teleweb –digital service be?

• Not developers!!

• Accessible

• Effective

• Responsive

• Stable – i.e., not reactive to latest bling

• Please no more apps!!

What should a teleweb –digital service be?

• Create a framework / space - architecture

• Don’t worry if someone else is doing it – clients are coming to you

• If you’re not collaborating, you won’t survive

• Stop assuming that you are the only service being accessed

What should a teleweb –digital service be?

• More focus on long term – end of MBS, rather than front end only

• Key area – high complexity, high need client groups

• Fluency, rather than EOC.

What should a teleweb –digital service be?

• Brands must last

• Interaction & community

• Connection is the key factor• Doesn’t always align with concept of self guided digital solutions as the way

forward

Where are the greatest offers ….

• Interop ability “ this will allow multiple platforms to speak”• However, be wary of people providing gold

• “I have a solution” … develops working in a lab or bubble.• Whether you like or not, must build on what is already achieved and known

• Co-design with users

• Don’t confuse innovation with bling

Risk

“… the structure and delivery of the MH system is primarily shaped by risk and

the imperative to manage it …” (Rose, 1998)

Redefine ‘risk’

Anonymity

Informed client

Limits of online also create freedoms

Clearly treatment focused