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Web Doctoring: A Sad Comment on the State of Mental Health Services?
January 27, 2009 – 9:51 am, by
Some hundreds of patients with depression, anxiety and other disorders have received online treatment using a sophisticated computerised cognitive behaviour
therapy program from the St Vincent’s Clinical Research Unit for Anxiety Disorders in Sydney. The treatment is effective in the short and long term, according
to Gavin Andrews, professor of psychiatry at St Vincent’s Hospital. Writing recently in
Crikey, he said the approach had the potential to improve the community’s access to treatment.
What do others in the field think?
Sydney psychiatrist Dr Michael Robertson, a visiting lecturer at the Centre for Values, Ethics and the Law in Medicine at the University of Sydney, comments:
“The article by Andrews raises the possibility that computer assisted behaviour therapy for anxiety can provide the answer to what is, in the final analysis,
a problem of distributive justice. Yes, computers can provide the mechanics of behavioural treatments for anxiety and yes these are cost effective.
Whilst such innovation is laudable, it completely misses the critical point – that proper mental health treatment is either unavailable or too costly to
most people who are most in need of it.
Mental healthcare is not exclusively in the hands of psychiatrists. Indeed, it is well known that psychiatrists see perhaps only 5% of the most severely
ill (or well resourced) people with mental health problems. As such, most mental healthcare occurs in GP surgeries or in the offices of counsellors, psychologists
and other allied health professionals.
Some recent innovations with Medicare Benefits have provided some benefits in the more efficient and rationalized use of psychiatrists’ time, and the Better
Outcomes in Mental Health initiative (providing, inter alia, Medicare benefits for psychological treatment) has also aspired to broaden the reach of mental
healthcare to the most needy. Both of these initiatives are undermined when the psychiatric and allied health resources are not available near to the patient
or GPs are too oversubscribed to give such problems the time they need for proper care.
It is no secret that mental healthcare in Australia has proven to be a formidable challenge to successive state and federal governments. Despite the proclamations
of premiers and prime ministers of their passionate concerns for the mental health care of the community, the problem of inadequate or maldistribution
of mental health resources continues.
This is not to diminish the needs of those who are fortunate enough to be able to access such care (those who are referred to, straw man like, as the ‘worried
well’). Whether this is yet another symptom of the failure of Australia to train (or retain) an adequate health workforce, or whether there is a special
status of social disadvantage reserved for the mentally ill members of our community is a point of debate.
Successful treatment of mental illness and transient psychological distress is based upon a therapeutic relationship which provides an environment of unconditional
acceptance of the patient and his or her vulnerabilities. Computers can provide the mechanics of anxiety management but, in the absence of some form of
avatar therapist patient-psychotherapist relationship in a Second Life therapeutic encounter, not the human interaction that is critical to successful
That one of the country’s most eminent psychiatrists has seen the need to dedicate himself to develop computers to provide treatment for disabling anxiety
disorders, because of the failure of distributive justice in regards to mental health care, is a lamentable state of affairs in a prosperous society.”