NZHIT guest column by Professor (Adj) Anil Thapliyal, eMental health lead, Centre for eHealth, Auckland University of Technology
Digital mental health or eMental health has to play an integral part in the response to the mental health and suicide crisis in this country.
New Zealand’s suicide statistics released last week provide sobering and alarming reading. I cannot stop thinking about the 668 individuals in New Zealand who took their own lives in the past year and the families, friends and communities so deeply affected. Of the total number, 71 per cent were male, 20 per cent were young people aged 10–24 and 21 per cent were Māori.
If this does not serve as a wake-up call for us as a nation, then what will? Prime Minister Jacinda Ardern rightly summed it up as a “tragedy” and emphasised the need to improve access to care.
I agree with Ardern that “we need to do more”. Going by successful international trends, digital mental health or eMental health has to play an integral part in the holistic response to this crisis, post the mental health enquiry report.
A paradigm shift
Time and time again we continue to fix the same broken system by tweaking around the edges. We need a whole paradigm shift in our thinking, by embracing newer ways and means of engaging with the mental health service users and ensuring they are genuinely at the centre of service design.
I believe it is important for New Zealand to consider establishing an eMental health strategy and an eMental health programme of work at the Ministry of Health. We also need a Ministerial advisory group on eMental health to look at the role of digital technologies in providing mental health services.
Defining the problem
The absence of an eMental health strategy in New Zealand has resulted in incoherent provision of mental health services. This is further exacerbated by the ineffective and cumbersome procurement processes strewn across the Ministry of Health, district health board and primary health landscape, often duplicating services.
There is a lack of integration and interoperability between disparate services and IT vendor systems, which means that as a system we do not know what the left hand and right hand are doing and have been unable to develop a mental health service that consumers can easily navigate on their own.
Many individuals with mental distress are not able to access the kinds of professional support or treatment they need at the time and when they precisely need it. Due to regional, professional or resource limitations, access to care can be difficult.
In both rural and remote areas, as well as inner city neighbourhoods, the time between the onset of symptoms and getting professional help is taking far too long.
No silver bullets
Enhanced integration and co-ordination between primary and secondary care needs to be addressed with the understanding that eMental health services are not silver bullets capable of replacing face-to-face clinical services.
They can, however, play a much more effective role within the mental health ecosystem. While we are deliberating on these issues, somebody out there is wanting to access better quality services right now. We need a sense of urgency to expedite the next steps.
It is about time primary and secondary mental health have an embedded eMental health component (e.g., build on the Ministry of Health’s existing investment in the National Telehealth Service). Adequate investment in this area is long overdue.
Mental health service users across New Zealand receive and consume information differently from the way we used to in the past. We take small things for granted, such as internet banking, Google, texting and social media tools like Facebook and WhatsApp that connect us to services, information, friends and families.
But our current mental health services continue to stagnate in the absence of an overarching cohesive innovation framework for New Zealand. We have failed to deliver effective and efficient mental health services commensurate with the changing times.
There are some examples of brilliant developments happening internationally in the eMental health domain, such as the eMental Health Strategy for Australia and the Canadian report eMental Health in Canada: Transforming the mental health system using technology.
Also, the National Mental Health Commission of Australia commissioned the pan-Australia eMental Health Review and the World Psychiatric Association published a position statement on eMental health in August 2017.
In New Zealand, we pride ourselves on our number eight wire approach, representing the best of Kiwi ingenuity and resourcefulness, a can-do attitude and ability to think laterally to solve a problem.
The time is right to implement this attitude and thinking. This is not so much about the fiscal envelope alone, it demands strong leadership and most importantly political support to get it right.
Professor (Adj) Anil Thapliyal is the eMental health lead, Centre for eHealth, Auckland University of Technology. He is also the president of the eMental Health International Collaborative and a member of the eMental health section of the World Psychiatric Association.