Abstract
BackgroundThe MindSpot Clinic (MindSpot) provides remote screening assessments and therapist-guided treatment for anxiety and depression to adult Australians. Most patients are self-referred. The purpose of this study was to report on the procedures followed to maintain the safety of patients and to examine the circumstances of urgent referrals to local services made by this remote mental health service.MethodA description of the procedures used to manage risk, and an audit of case summaries of patients who were urgently referred for crisis intervention. The reported measures were scores on self-report scales of psychological distress (K-10) and depression (PHQ-9), the number reporting suicidal thoughts and plans, and the number of acute referrals.ResultsA total of 9061 people completed assessments and consented for analysis of their data in the year from 1 July, 2013 to 30 June, 2014. Of these, 2599 enrolled in online treatment at MindSpot, and the remainder were supported to access local mental health services. Suicidal thoughts were reported by 2366 (26.1 %) and suicidal plans were reported by 213 (2.4 %). There were 51 acute referrals, of whom 19 (37.3 %) lived in regional or remote locations. The main reason for referral was the patients’ self-report of imminent suicidal intent. The police were notified in three cases, and in another case an ambulance attended after the patient reported taking an overdose. For the remaining acute referrals, MindSpot therapists were able to identify a local mental health service or a general practitioner, confirm receipt of a written case summary, and confirm that the patient had been contacted, or that the local service intended to contact the patient.ConclusionsAround 0.6 % of the people seeking assessment or treatment by MindSpot were referred to local mental health services for urgent face to face care. The procedures for identifying and managing those patients were satisfactory, and in every case, either emergency services or local mental health services were able to take over the patient’s care. This review suggests that the uncertainty associated with taking responsibility for the remote treatment of patients who disclose active suicidal plans is not a major impediment to providing direct access online treatment for severe forms of anxiety and depression.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0676-6) contains supplementary material, which is available to authorized users.
Highlights
The MindSpot Clinic (MindSpot) provides remote screening assessments and therapist-guided treatment for anxiety and depression to adult Australians
Around 0.6 % of the people seeking assessment or treatment by MindSpot were referred to local mental health services for urgent face to face care
This review suggests that the uncertainty associated with taking responsibility for the remote treatment of patients who disclose active suicidal plans is not a major impediment to providing direct access online treatment for severe forms of anxiety and depression
Summary
The MindSpot Clinic (MindSpot) provides remote screening assessments and therapist-guided treatment for anxiety and depression to adult Australians. The MindSpot Clinic (MindSpot) was funded by the Australian Federal Government as part of the eMental Health Strategy for Australia [6] of which one key aim was to increase access to evidence-based mental health services for Australian adults with anxiety and depression. An important task of MindSpot is to identify patients who are at immediate risk of suicide and to refer them for appropriate treatment or support. MindSpot differs from many other remote or online treatment services because most referrals come directly from the public, rather than from a referring agency that knows the patient and can intervene and arrange emergency care for suicidal behaviour if required. A major priority in the service planning and the development of operational policies and procedures has been the safety of patients, how best to identify patients at risk of suicide and how the service should respond to those patients
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