One positive outcome of the COVID-19 pandemic has been the addition of telehealth to Australia's healthcare system, particularly for the disadvantaged in our community.
Historically, there have been significant barriers to accessing face-to-face services for people with physical and mental disability, and those in situational crisis (e.g. domestic violence, residential instability) and in regional, rural and remote areas, most notably our Aboriginal communities.
On March 13, 2020 temporary Medicare Benefits Schedule telehealth items were introduced to help reduce the risk of community transmission of COVID-19, providing protection for patients and healthcare providers. Positively, government has now made telehealth permanent for medical and psychology items.
Realisation of the benefits of telehealth in psychological treatment are timely.
Never before has there been so much pressure on Australia's mental health system. The consequences of extreme bushfires, floods and the COVID-19 pandemic have played havoc with the mental health of Australians, and those in rural regions arguably face the greatest challenges in accessing treatment.
Telehealth has been widely embraced by Australians. In the first quarter of 2022, 33 per cent of Medicare mental health consultations were via telehealth.
While this rapid shift was one of necessity, it also proved beneficial in improving accessibility to mental health services for many people.
But is the delivery of psychology treatment via telehealth effective? And how does it compare with in-person treatment? Pretty well: research demonstrates that telehealth can produce comparable outcomes to face to face therapy for a range of client groups.
A large-scale review of video-delivered psychotherapy found significant improvements pre to post treatment, significantly better outcomes than wait-list, and no significant difference to in-person psychotherapy.
The effects were particularly noticeable with cognitive behavioural therapy, and for people who presented with anxiety, depression, and post-traumatic stress disorder.
A review of studies using video and telephone to provide therapy for less common mental health conditions (e.g. eating disorders, substance dependence) also found little difference in outcomes compared to face to face therapy in terms of symptom severity, functioning, working alliance, satisfaction, and cost.
There are caveats however. While most of the research indicates that telehealth is not inferior to in-person therapy, it is not yet possible to confirm whether they are equivalent and we don't yet know how well patients remain over time following cessation of treatment.
Some reviews note there might be some gender differences in videoconferencing, with more favourable outcomes for women. While more research is needed to clarify the nuances of what will work best for whom and when, in general, we can have confidence in offering telehealth, particularly using video, as an alternative mode of service delivery of psychology treatment across a range of conditions.
Telehealth is a particularly helpful medium for people in rural and remote areas, providing greater access to psychology services. This is because health workforce statistics show most psychologists work in metropolitan areas whilst one third of Australians live outside major cities.
For this reason, people in rural areas have the most to gain from telehealth where the psychology workforce is inadequate to meet community needs.
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Despite the demonstrated benefits of telehealth, there are barriers of access for people who are older, live rurally, less formal education, lower socioeconomic status, from culturally and linguistically diverse backgrounds, have multiple chronic conditions, and/or have less access to online resources. In particular, there are significant barriers in regional areas where internet coverage can be patchy, connectivity unreliable, with two-thirds of NBN users experiencing internet speed limitations.
Additionally, the 2021 Regional Telecommunications Review found internet connectivity and investment in additional network capacity are not keeping pace with increasing demand in regional areas.
The government has committed $1.3 billion to address these telecommunication issues. Is this enough given the complexity and scope of the issues?
To maximise the potential of telehealth, further investment is needed in telecommunications infrastructure, education on connectivity and telehealth options particularly to disadvantaged groups and the elderly, resourcing primary health care services particularly in regional areas, supporting vulnerable Australians to access telehealth, and providing sufficient Medicare sessions to treat mental health needs.
- Dr Marjorie Collins is a clinical psychologist and president of the Institute of Clinical Psychologists.
