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This financial year, 58 percent of the mental health services commissioned by COORDINARE – South Eastern NSW PHN have been delivered via telehealth, up from 53 percent in the last financial year.
While the uptake is encouraging, the move towards greater telehealth adoption has not always been smooth, according to Mental Health Project Coordinator, Alanna Sherry.
She says several factors make it challenging for telehealth-based services to reach disadvantaged groups, and reflects on a few, ahead of the National Telehealth Conference.
It isn’t always affordable
Given that telehealth removes the costs associated with travel, it is often touted as a saviour in terms of equity of healthcare access.
However, for some of the most disadvantaged mental health consumers, the internet data costs involved in a telehealth session are prohibitive.
During the early days of the pandemic, the South Eastern NSW PHN took strides to address this, with the provision of funding to cover such expenses.
“Some areas are so disadvantaged in terms of their socioeconomic status, that affording a laptop isn’t an option, nor is forking out extra phone data for a 45 minute mental health appointment.
However, some people just cannot attend face-to-face appointments. “In rural areas, public transport options are extremely limited – which means we see the greatest demand for telehealth coming from these areas.
“That’s why offering a range of modalities is so important,” Alanna says.
The smallest communities are often the most disadvantaged, but the least serviced
Like many PHN regions, South Eastern NSW grapples with a high degree of rurality, and resources are naturally funnelled into more densely populated areas.
However, Alanna points out that some of the highest per capita demand for telehealth-based mental health services comes from smaller areas.
“The more rural you are, the more likely it is that you will need to consider telehealth. For example, we have small communities in our region that are deeply impacted by bushfires and their associated mental health challenges.
“The trouble is, these areas are often too small to justify the provision of a mental health service. It can be a bit fraught deciding where to place physical services when we are dealing with these paradoxes.”
A lack of specialist services
Like all PHNs, the South Eastern NSW PHN uses a needs analysis to make decisions about resource allocation, but the resources are often too finite to cater for all hard-to-reach groups.
For example, not all psychiatrists offering telehealth services to rural areas are prepared to bulk bill, further disadvantaging consumers from rural and low socioeconomic areas.
“Telepsychiatry should be available to anyone with a sufficiently rural postcode, but in practice, not all psychiatrists will bulk bill.
“So, despite our very best efforts to extend telehealth, we may still be falling short of consumer needs in these areas.”
Younger children are also hard to cater for, given a national shortage of clinicians catering to the under 12 demographic.
Thankfully, the Commonwealth is rolling out a kids’ mental health hub in the Illawarra Shoalhaven that will cover this age group.
However, with just one service for the entire region, Alanna is concerned access issues will remain.
“Under 12s are a small demographic in terms of mental health, but their needs are growing. It will be increasingly challenging to help GPs find appropriate services for children, regardless of one’s access to telehealth,” she said.
Getting the balance right
To ensure telehealth-based mental health resources are allocated appropriately, Alanna says flexibility is key.
“You have to be flexible and take into account the full breadth of access issues. Mental health consumers can be hard to reach for a number of reasons – geography, age, socioeconomic status – so it’s about getting the balance right.
“For example, Wollongong, which is serviced more generously than rural areas in terms of mental health support, has a large migrant population, including people from refugee backgrounds whose needs can’t be met by mainstream services.
“Then we have areas where other needs, like homelessness and substance misuse, take priority. Someone who needs a roof over their head or who has just been released from gaol might not prioritise their mental health.
“So we have to tailor our services to suit consumer needs.”
Further discussion
Alanna Sherry is Project Coordinator for Mental Health, COORDINARE – South Eastern NSW PHN.
Join her for a deeper dive into this topic at the upcoming National Telehealth Conference.
The event will be held 7-8 March 2024 at the Hilton Sydney.
Learn more and register your place here.
About Alanna Sherry
Alanna has worked in the mental health team at the PHN for the past six years. She relocated from Sydney where was the suicide prevention lead at the Mental Health Commission of NSW. Prior to that she worked at the NSW Ministry of Health in MH-Kids and NSW Kids and Families. Her background is in children’s human rights law.
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