Editorials
Mental health Health services administration Information science
Volume 211 - Issue 7

The “uberisation” of mental health care: a welcome global phenomenon?

Author:  Ian B Hickie

Med J Aust 2019; 211 (7): 315-316. || doi: 10.5694/mja2.50342
Published online: 7 October 2019

New health information technologies have the potential to transform the delivery of mental health care

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New health information technologies have the potential to transform the delivery of mental health care

The World Economic Forum has highlighted the capacity for health information technologies to transform health care.1 Four key care themes emerge: smart care (emphasising precision medicine); care anywhere (promoting access closer to home); empowered care (engaging people in their own care); and intelligent health enterprises (using data to drive new solutions).1 More recently, the World Economic Forum has focused on the digital transformation of mental health care,2 highlighting the need to address ethical issues such as privacy, trust and clinical governance.

Given the rapid spread of health information technologies and the unmet demand for mental health services, extensive deployment of digitally enhanced care is now inevitable. This will be driven by economic imperatives and more educated users. People expect access to digital tools that support greater choice, convenience, lower cost and higher quality care. However, given the broader socio‐political concerns about the impacts of health information technologies, those engaged in this deployment will need to answer substantive ethical, legal and funding questions (Box).

Health care involves aspects of service delivery which are common to other industries, such as high infrastructure costs, a highly trained workforce, quality assurance and risk management, but also has unique features such as medico‐legal responsibilities, a high level of consumer trust in traditional providers, and the fact that it does not operate within an open market. This has led to assumptions that it will not be disrupted by the technology‐empowered forces that have transformed other services such as personal transport, accommodation, travel and food delivery.3,4 Such technological transformation can be described as “uberisation” — the utilisation of “a business model in which services are offered on demand through direct contact between a customer and a supplier, usually via mobile technology” (Collins Online English Dictionary). Typically, these uberised services have succeeded because they respond to consumer priorities such as easy access, choice, competitive pricing and user‐facing quality control. The world's largest technology‐based companies (including Apple, Alphabet–Google, Amazon) are now investing heavily in health care such as a health records feature on iPhones and more sophisticated health information technologies to provide cheaper care than conventional service providers in the United States.5

Worldwide, as demand for more personalised mental health services far outstrips supply,6,7,8 mental health presents a rich opportunity to provide care in an alternative way.3,9 Although the risks for consumers of mental health services in accessing online health care are similar to those for general health care (ie, accessing inappropriate care or failing to access appropriate case in a timely fashion), the potential additional vulnerability of some groups (ie, young people or those with impaired cognition, affect or reasoning) requires that this domain be subject to additional scrutiny. New clinical service initiatives in mental health include a wider range of preventive, early intervention and secondary prevention services.8 These are designed not only to achieve better outcomes10 but also to reduce demand on acute care services (eg, emergency departments).11 To go to scale, however, these new initiatives will also require substantive digital capability.

Mental health care is not constrained by the need to be geographically close to consumers. Digital tools, combined with new personal sensors and monitoring technologies, can underpin clinical assessment, objective testing, initiation of treatments or collection of additional information from family or supportive others.12 Specifically, mental states can be observed by voice monitoring or video links; psychological treatments can be delivered online; psychotropic medications can be recommended and usage tracked; social support can be readily enhanced; and crisis management plans can be shared with families and other health care agencies.9,10,12

The only real constraint to high quality digitally enhanced mental health care is the availability of affordable technologies. This hands‐off approach is very confronting to health professionals who believe that the large non‐specific benefits of treatment are dependent on empathic personal interactions (ie, the therapeutic relationship).13 However, a number of studies have now shown that the therapeutic relationship is maintained when comparing face‐to‐face with digitally enhanced treatments such as immediate online assessment and dashboard of results.14,15,16 Digitally enhanced care may also be unacceptable to some users of services, particularly where other demographic, disability, clinical or cultural factors present specific barriers.14,16

So, how likely are we to see an uberisation of services? Internationally, there are new service and research developments in digital mental health care9 and suicide prevention.17 The World Economic Forum highlighted case studies, including those operating in low and middle income countries, which had the capacity to be low cost and go to scale (eg, Crisis Text Line, iCALL, 7 Cups, Ieso Digital Health and Inuka).1 In reality, however, the shift from simple digital add‐ons to fundamental system level reform is rare.

Internationally, major information technology‐based companies and many smaller venture‐style entities are now moving to create more complete health care solutions; for example, Homecare Medical, which is contracted by the New Zealand Government to provide a national telehealth service (https://www.homecaremedical.co.nz). Based largely on the delivery of psychological therapies, these solutions are being marketed to individuals directly as well as to third party payers (eg, private health insurers, or government agencies that purchase services). Consequently, the most likely outcome is that large private and technology‐capable investors will drive digital mental health care.18

For Australia, what are the likely next steps? Fortunately, we have a rich tradition of innovation in this domain (Supporting Information). As described in the Supplement accompanying this issue of the MJA,19 the Australian Government has invested in Project Synergy, which is now conducting research studies with mental health service partners (including urban and regional headspace centres, Open Arms – Veterans and Families Counselling, and the Butterfly National Helpline).20,21 These studies, four of which are described in the Supplement, highlight both the potential for real change but also the challenges that emerge (eg, ethical, legal, funding, telecommunications infrastructure) in moving to contemporary technology‐enhanced service environments.

Box – Ethical, legal and funding questions to be addressed urgently by new digitally enhanced mental health services

Will services be:
  • largely government‐funded or provided mostly by for‐profit entities?
  • nationally based or operating internationally?
  • highly regulated (as with other medical devices) or subject to minimal regulation (as with telecommunication devices)?
  • complementary to place‐based mental health services or largely independent?
  • more accessible to those who are already disadvantaged economically, socially or geographically?
  • acceptable to those who have a preference for in‐person, culturally appropriate or place‐based health care?
  • relevant to people with more complex and ongoing mental health care needs (eg, more severe mood or psychotic disorders)?
  • appropriate for people requiring medical therapies (eg, medicines, brain stimulation or other physical therapies)?
  • effective in reducing demand for other acute care, crisis or hospital‐based services?
  • integrated with concurrent physical health care?
  • ethical in their practice, respecting equity, clinical governance, privacy, duty of care and family and social support?

Author

  • Ian B Hickie1
  • 1. Brain and Mind Centre, University of Sydney, Sydney, NSW

Correspondence: ian.hickie@sydney.edu.au

Competing interests

Professor Ian Hickie is the Scientific Advisor to, and an equity shareholder in, InnoWell Pty Ltd. InnoWell has been formed by the University of Sydney and PwC [Australia] to deliver the $30 million Australian Government‐funded Project Synergy. Project Synergy is a 3‐year program for the transformation of Australian mental health services through the use of new and innovative technologies.

Acknowledgements

Project Synergy is an Australian Government Department of Health‐funded initiative that is administered by InnoWell Pty Ltd (a joint venture between the University of Sydney and PwC [Australia]).

References

Linked content

  • MJA Supplement: Project Synergy: co-designing technology-enabled solutions for Australian mental health services reform

  • MJA Podcast: Professor Ian Hickie

  • InSight+: Digital tech: making mental health care fit for purpose

Provenance: Commissioned; externally peer reviewed.

View this article on Wiley Online Library

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