Flexibility in service design needed for effective telehealth provision to remote areas
While the prevalence of mental health disorders in regional Australia is comparative with the prevalence in metropolitan parts of the country, as remoteness increases, rates of suicide also increase. At the same time, access to mental health services decrease.
The Australian Government’s announcement of greater funding for telehealth in April this year is a potentially important step towards alleviating poor accessibility of mental health services in regional Australia. However, the need for flexibility around the actual requirements for telehealth service provision must be addressed if there is any hope of truly eliminating obstacles to accessible mental health care for people who live outside metropolitan areas, especially the more rural and remote places.
The 19 April announcement from Greg Hunt and Fiona Nash aimed to knock down ‘a major barrier to rural residents accessing vital mental health treatment … with the introduction of a new Medicare rebate for online videoconferencing consultations with psychologists’ and ‘no longer will [residents] have the inconvenience, time and expense of having to travel to larger regional centres or major cities for sessions with their psychologist.’
The subsidisation of telehealth services is certainly welcome, and has the potential to enable regional residents to overcome the tyranny of distance for access to services not provided locally. However, the requirements for remote access under this proposed scheme mean that, in practice, it will not fully overcome the local provision issue and may actually reinforce barriers to access.
Under the scheme, up to seven of ten Medicare rebateable mental health consultations are claimable as video consultations. In other words, at least three rebateable consultations must occur face-to-face. This puts up an obstacle for people who live in remote and very remote areas that are far away from a GP, let alone a psychologist or psychiatrist. Essentially, almost a third of subsidised mental health consultations may be inaccessible for those unable to physically attend consultations.
While there may be sound clinical guidelines for imposing face-to-face requirements on mental health service provision, they nonetheless hinder the ability of people who live at great distance from any kind of health service provider to get access to the same kind of tailored mental health care plans available to people who live in more urban areas with a range of localised practitioners.
Moreover, to be eligible under the Medicare Benefits Scheme, all telehealth specialist encounters must meet the definition of a video consultation, ‘where a patient and eligible specialist, consultant physician or psychiatrist undertakes a referred consultation via video conferencing (i.e. visual and audio link)’.
The requirement of both an audio and video link for a remote consultation to be covered by Medicare increases the burden on patients to have a reliable and high-quality internet connection. Without first addressing telecommunications issues, any aspirations for telehealth to solve the mental health service accessibility issues in regional Australia will not be solved (a point echoed by the National Farmers Federation).
The RAI has written to Minister Hunt to suggest he provide flexibility in some of these rigid rules around both physical presence and type of remote connection for areas where they will prevent services being provided. This is one clear example of the unintended consequences of centrally designed programs and where greater flexibility in policy and program delivery is necessary to meet the needs of rural regions.
Are you experiencing other issues like this that are undermining local services and also leading to poor outcomes from government programs? To share your experience please contact [email protected].