Digital Mental Health Services Reached 282,000 Australians
Key Takeaways
- Three Australian government-funded online services, mainly serving adults with anxiety and depression, offered care to more than 282,000 consumers across their respective uptake windows.
- Clinician-supported treatment was associated with significant pre–post symptom improvement at Mental Health Online, MindSpot and THIS WAY UP.
- Self-directed Mental Health Online care was associated with a moderate reduction in anxiety-disorder severity.
- Supported symptom changes were close in magnitude to most selected comparison programs, although the comparison was indirect.
Investigators assembled aggregate use information for Mental Health Online from January 2015 through December 2021, MindSpot from January 2013 through December 2021, and THIS WAY UP from July 2015 through December 2021. For Bassilios and colleagues’ JMIR Formative Research study, they drew effectiveness inputs separately from purposively selected peer-reviewed and gray outcome publications, including Mental Health Online trials predating implementation, a discrete later Mental Health Online evaluation, and routinely collected MindSpot and THIS WAY UP outcomes. Investigators calculated standardized baseline-to-posttreatment changes in symptoms and, where available, quality of life, functioning or disability. They pooled estimates by service and support category using random-effects meta-analysis with restricted maximum likelihood. Support pathways differed: Mental Health Online used internal provisional psychologists, MindSpot internal allied health clinicians and THIS WAY UP consumers’ outside health professionals. Separately calculated effects from selected Australian low-intensity, primary and public mental health programs, United Kingdom stepped care, and Link-me treatment-as-usual groups served as indirect comparisons, not concurrently randomized treatment arms.
Among users in clinician-supported treatment pathways, pooled within-group symptom changes from baseline to posttreatment were Mental Health Online Cohen d=0.95, MindSpot d=1.42 and THIS WAY UP d=1.04. Each service showed significant improvement, but these estimates compare scores over time within groups; they are not treatment-versus-control effects and do not establish that clinician support caused the changes. Support also took different forms across services, so the pooled estimates do not isolate the contribution of clinician contact.
The self-directed Mental Health Online estimate (d=0.59) came from a preimplementation study of 225 adults with at least subclinical anxiety disorders, rather than routinely collected outcomes from the service. Corresponding pooled self-directed symptom estimates were not established for MindSpot or THIS WAY UP in this analysis. Changes in quality of life, functioning and disability were smaller than symptom changes. Service-use measures also captured different stages: Mental Health Online and MindSpot counted completed assessments, whereas THIS WAY UP recorded assessment starts and staged completions. Enrollment, treatment start and completion represented separate denominators; about two-thirds of those who started clinician-supported MindSpot treatment completed it; at THIS WAY UP, 46% (24,989/54,510) of all treatment starters completed treatment. Supported symptom changes were close in magnitude to most selected Australian and United Kingdom comparison programs, with Better Access at the higher end and Link-me usual-care groups at the lower end. These were descriptive, not head-to-head, contrasts.
Purposively selected outcome publications did not encompass every service study, and complete-case pre–post analyses excluded users without scores at both time points. Recorded support did not necessarily confirm actual clinician contact: MindSpot pathway records could diverge from contact received, while contact with outside professionals was not established for users in the pooled THIS WAY UP outcomes; in one separate study, more than half of patients reported no clinician contact during their course. Some pooled estimates were heterogeneous. Differences in clinical need, service populations, delivery, measures and uptake windows further complicate comparisons among these Australian services and other programs. Care offered does not establish coverage of community need, and changes observed before and after treatment alone cannot establish causation or comparative effectiveness.
The authors described considerable uptake of these Australian online services and symptom improvement during clinician-supported care; similarity to selected alternative programs remained descriptive.
Clinician Questions
How was online CBT treatment completion defined at Mental Health Online, MindSpot, and THIS WAY UP?
For adults enrolled in these Australian online CBT programs, Mental Health Online defined completion as participation for at least 6 of 12 weeks, MindSpot as completing at least 4 lessons, and THIS WAY UP as completing at least two-thirds of lessons. The services’ completion proportions therefore reflect different activities.
Do the Australian online anxiety and depression findings extend to adults with psychotic disorders or complex comorbidities?
The evaluated Mental Health Online, MindSpot and THIS WAY UP interventions primarily involved adults experiencing anxiety, depression or psychological distress. Their pooled outcomes do not establish effects for people with psychotic disorders or more complex comorbid presentations; the authors identify outcomes for these populations as a question for further research.