In this 12 months’s budget, the federal government announced one among the largest changes to the mental health system in nearly 20 years: a digital early intervention service to alleviate Australians’ early psychological distress before it builds into mental illness.
Starting in 2026, and based on the United Kingdom’s Talking Therapies modelthe service is expected to supply a mix of apps, web sites and free telehealth therapy sessions that deliver a variety of cognitive behavioural therapy called “low-intensity psychological interventions”.
The idea is that if we detect psychological distress early, we will prevent some people developing mental illness, and permit mental health experts more time to spend with complex patients.
It sounds good in theory, nevertheless it doesn’t all the time work in practice. Here’s what the evidence from the UK and elsewhere shows thus far – and what we will learn for Australia’s rollout.
What are the advantages of those programs?
In theory, low-intensity psychological interventions that mix digital tools and telehealth sessions offer patients the identical “dose” of treatment while needing less therapist time than conventional psychological treatments. These time savings mean more clinical hours for therapists to see more patients.
Research shows low-intensity interventions may also help people improve patients’ mental health, while addressing some big problems within the mental health system reminiscent of therapist shortages, long waitlists and the increasing cost of more in-depth therapies.
Looking at service data from UK Talking Therapies clinics, around 50% of UK patients said their mental health was higher after 4 to 6 sessions with a therapist, either in-person or online depending on availability.
Similar advantages have been shown in other large studies of comparable interventions, with most patients convalescing inside seven therapy sessions.
The Talking Therapies model has translated well to other European countries reminiscent of Norway and Spainand we now have good reason to think it would work in Australia. In Beyond Blue’s NewAccess service, which trialled the model at three sites from 2013-16, most patients saw real improvements of their anxiety and depression.
What are the downsides?
NHS data show 30-50% of people that use low-intensity psychological interventions don’t respond well resulting from a range of things like age, employment status, or disability.
The federal government estimates around 150,000 Australians will use the brand new service annually.
So if non-response rates are similar here, around 45,000-75,000 Australians will still need a better intensity level of care to get better, putting them back on already intolerable waitlists. The upcoming walk-in Medicare mental health services may not have capability to assist.
While services like UK’s Talking Therapies are meant to cut back these waiting times this isn’t all the time the caseparticularly in areas where it’s hard to access mental health care. And once in care, patients don’t all the time get the care they need or deserve.
Fernando Cferdophotography/Unsplash
A completely digital service risks alienating some consumers. Blending limited therapist support with apps and web sites could be highly effectivebut not everyone has high speed Internet access and a few Australians prefer no therapy to digital therapy.
The UK’s Talking Therapies doesn’t seem to handle the social determinants of mental illness, reminiscent of lack of social connection, unemployment and poverty. We have already seen these impacts in Australia, with single or unemployed people within the NewAccess trial benefiting lower than individuals with relationships or jobs.
Even more worrying, large-scale mental health services aren’t all the time culturally responsive. Data from the UK’s Talking Therapies shows cultural minorities not only get less profit than white people, they’re more prone to worsen after treatment. First Nations and culturally and linguistically diverse Australians deserve higher.
We’re going to wish an even bigger workforce
A protected, effective Australian Talking Therapies service will need expert therapists.
However, the mental health workforce is lagging well behind demand and the federal government has shown little appetite for investing in training.
Psychologists were excluded from the recently announced Commonwealth Prac Payment schemewhich pays students to undertake university placements.
And it’s unclear if any funding for the early intervention service will go to expanding the prevailing psychology workforce. It already delivers around half of all Medicare mental health services in Australia and is qualified to supply low-intensity psychological interventions.
Low-intensity psychological interventions can work in Australia, but they’ll’t replace the larger, more urgent reform our mental health system needs. More look after some people isn’t enough; we want higher mental health for everybody.
