The Australian Commission on Safety and Quality in Health Care has developed a set of national standards to provide consumers, carers, referrers and providers with benchmarks for what constitutes safe and effective mental health services in the digital arena.
This article is published by Croakey Professional Services as sponsored content. It is funded by The Australian Commission on Safety and Quality in Health Care.
In a year of unprecedented isolation and anxiety, the novel coronavirus (COVID-19) pandemic has caused us to fundamentally rethink how we work, live and interact. During this time of rapid change, the demand for online and telehealth services has boomed, particularly in the sphere of mental health.
Professor Nick Titov is director of the virtual MindSpot clinic, which delivers online mental health services to more than 20,000 Australians every year. MindSpot has been running since 2012, and Professor Titov has seen a significant evolution in the digital mental health space in the intervening years, with a proliferation of services and platforms to meet burgeoning demand.
What we are seeing as a society is a shift in people’s comfort and appetite to use digital technology to reach out for health care, and not just digital mental health care but health care generally.”
And, he says, 2020 has been an exceptional year.
“There’s been a massive increase in demand – at one point we had more than 100% additional demand for our services.”
The surge started well before COVID hit Australian shores, with the summer of fire, floods and heavy smoke driving increased need for mental health services. Titov says this continued as the pandemic took hold, with a wave of fear and anxiety about the virus itself giving way to the psychological impacts of the isolation and restrictions, and ongoing concerns about the economy and financial security.
In any given year, one in five adults and one in seven adolescents will experience a common mental health disorder, and this year, more than three quarters of Australians report that their mental health has worsened since the outbreak of COVID-19.
As people’s worries evolved, so in addition, did the offerings of virtual providers, “probably much more quickly than I think traditional services would be able to,” says Titov.
But as the digital mental healthcare sector continues to grow, how can we be sure it is safe, effective, and has an evidence base?
Direction in a digital minefield
This is the focus of the Australian Commission on Safety and Quality in Health Care’s new National Safety and Quality Digital Mental Health Standards.
Due to be formally launched today , Monday November 30 2020, via webcast, the standards will set benchmarks for digital mental health service providers around three critical areas: clinical and technical governance, partnering with consumers and carers, and model of care.
“There are a lot of providers and services which are really good and quite reputable, but there are certainly some that warrant concern,” explains the Commission’s Senior Clinical Advisor Dr Peggy Brown, citing particular issues in the unregulated world of apps.
Some of the figures are frightening in terms of lack of privacy policies, lack of evidence-based approaches, lack of evidence of effectiveness, and to boot they will go and sell off or monetise your data. And you, as a vulnerable individual with mental health issues – which is why you sought the app in the first place – have no idea that your privacy has potentially been breached.”
Agreed standards and a voluntary framework
The numbers are staggering: according to Brown, there are more than 10,000 apps across mental health care. That does not account for the panoply of helplines, websites and video conferencing services that have gained a foothold in the space.
In a bid to marshal some of these resources into a one-stop shop for consumers and carers, the Australian Government established the Head to Health portal back in 2017, and it became apparent that there was a need for some form of safety and quality assurance in the sector.
We have regulation of health professions and we have accreditation of health services, whether that’s a GP practice or a hospital or a dental clinic; we just take it for granted that there’s a certain standard set and that services by and large meet them, and that there is a system in place for checking on them.
We just don’t have that for these digital services.”
A world-leading initiative, the new National Safety and Quality Digital Mental Health Standards are the culmination of extensive consultation and collaboration with service providers, clinicians, and consumers and carers in the sector.
Having been well received on pilot testing, they will offer a voluntary framework for operators to assess their business against, and will cover a diverse array of service types, ranging from telephone services and websites through to apps and more telehealth-style videoconferencing.
The Standards cover issues such as clinical governance, privacy and data security, accessibility, product information, evidence base, and incident management – including how a service will respond to a deteriorating client, and handle transfer of care. They also require services to demonstrate partnership with consumers and carers around design, development and evaluation.
The long game of quality and safety in service provision
Brown envisages that, over time, the Standards may inform a kind of ‘tick of approval’ system, where consumers and carers will be able to choose services that are branded as compliant.
Eileen McDonald, from the National Mental Health Consumer and Carer Forum, has been closely involved in the development of the Standards and says they are aimed not only at safeguarding service users, but empowering people with lived experience of mental health as developers of these services.
“Indeed, there are already quite a few being provided by persons with lived experience of mental health issues,” says McDonald.
For McDonald the proliferation of services is a reflection of broader trends in digital uptake, and also meets an important need for people whom “accessibility-wise it is the only choice that they have”. She says,
It’s not going to become, in my mind, the total replacement, nor should it become the replacement for face to face involvement where somebody wants or needs that, but it’s important for every individual to have choice.”
Evolving standards for an evolving sector
Although the Standards are voluntary, the project’s next phase will focus on development of an assessment framework for independent audit of services. For now, service providers can use the Commission’s self-assessment tool to see how they are tracking against the NSQDMH Standards and support their quality improvement without a formal accreditation.
“Technology is changing, the way people use technology is changing, software application is changing, and too much regulation too soon will restrict the development and, if you like, the growth and evolution of the sector,” Titov explains.
The voluntary nature of the Standards is really important from the perspective of uptake.”
Brown notes that experience and research overseas have shown that heavy handed or prescriptive approaches are neither practical nor effective, and says the Commission has been careful to strike the right balance, keeping the Standards at “quite high level: they say what’s required but they don’t tell you how you must do it”.
We are not assessing each individual app or each website. We are saying to service providers that if you have these systems and processes in place around governance, incident management, risk management, privacy and so on, then it is fairly likely that, across the range of digital services that you offer, you will meet the mark.”
A welcome opportunity for providers, consumers and carers
Titov’s MindSpot was one of the providers to pilot-test the draft Standards, and he says it provided a welcome opportunity to systematically examine “what we think we do well and how well we think we do it against a framework… to ensure that what we are doing is considered best practice.”
Our services are trying to provide care which is not only safe, but also of high quality. What I think is important about these Standards in terms of their unique contribution is that they provide our services with a tangible framework of expectations, as well as practical standards against which we can measure our services across the key domains.”
For consumers and carers, McDonald says the priorities are quite clear: an assurance of safety and quality in the level of care they can expect.
“When you walk into a medical clinic or a hospital you know that the providers have training and qualifications and registration, and that the place itself has mandated levels of accountability and credibility, and safety measures in place,” she explains.
“There is no reason not to expect that in the digital space.”
The Australian Commission on Safety and Quality in Health Care’s new National Safety and Quality Digital Mental Health Standards. will be launched via webcast today at 12:30pm AEST.
This article was written by Amy Coopes and edited by Ruth Armstrong, on behalf of Croakey Professional Services. It was sponsored by The Australian Commission on Safety and Quality in Health Care, which had final say over the content.
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