Web and telecounselling in Australia

In reply: Borland and Segan are correct in assuming that we did not include substance disorder randomised controlled trials (RCTs) in the assessment of the efficacy of web and telecounselling services in our editorial.1 Our definition of web and telecounselling was also strict in that we included only contact that involved a person (a counsellor) online or by telephone. We specifically excluded interactive personalised web programs such as www.theQuitCoach.org.au or others specifically in mental health (narrowly defined), which have been found effective when delivered by the Internet. (Such programs include Panic Online,2 MoodGYM and BluePages.3) The use of RCTs in evaluating the areas of substance use, anxiety, depression and other mental health problems is to be applauded. Borland and Segan’s letter is also instructive in reminding us of the importance of coexistent substance-use disorders and mental health problems. Organisations such as SANE are committed to reducing the health costs of smoking in people with mental health problems and have developed specific programs for this purpose. Importantly, we are in agreement with Borland and Segan that telephone and web-based services “hold tremendous potential both as stand-alone services and as integrable components of comprehensive, coordinated care”. However, our editorial reported that web and telecounselling (not integrated web-based management systems) have yet to be evaluated through RCTs.

One point we contest is the view that smoking is invisible. Our systematic review of funding allocations to mental health research has found that the category of substance-use disorders, of which smoking was the third-largest component (below alcohol and opioids), received the most Australian research funding in 2000.4 The level of funding for substance use exceeded that for childhood disorders and dementia. Compared with substance-use research, depression research received less than half, and psychosis and anxiety less than a third, of funding. Affective disorders contribute the highest disease burden, and dementia has the highest health system costs. Although all our projects in these important areas require proportionately more funding, it is not helpful to claim that the omission of smoking outcome research is due to failure to recognise its importance.