GPs stalling digital mental health: Hickie

Or do they just want better evidence that it actually works?

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Primary care doctors are hitting back at the idea that they’re working against digital mental health startups to protect their own interests, as alleged by one high-profile psychiatrist.

University of Sydney Brain and Mind Centre co-director Professor Ian Hickie, the driving force behind Australia’s Better Access scheme, has made comments to The Guardian intimating that concerns around a digital mental health platform he is involved with come from doctors who want to protect the current model of GP-led care from reform and disruption.

At present, he said, GPs have effectively monopolised access to mental health services; this echoes comments he made last year to TMR when he called for the end of general practice “gatekeeping”.

GP and mental health researcher Professor Louise Stone took issue with the implication that GPs were working as a group to slow the advance of digital healthcare – partly because it overestimated the homogeneity of GP opinion.

“[One of my colleagues said] if you have three GPs in a room, you’ll get five opinions,” she told TMR.

“And if you have more than three GPs, you’ll have a new college. As if we’re ever gonna work together.”

To see GPs championing digital mental health, Professor Stone said, you need look no further than the Black Dog Institute’s Dr Jan Orman, or prolific reform advocate Dr Steve Hambleton, who is currently with the Australian Digital Health Agency.

It’s also not necessarily a bad thing if there is reluctance to accept newer digital interventions and platforms, she said.

“It is our job to look at any intervention with a critical lens,” said Professor Stone.

“And what’s more, I think it’s good for us, it’s good for our patients and it’s good for Australia if there is a committee of different minds pulling apart the implications of any intervention.”

The direct-to-consumer digital mental health platform in question is InnoWell, which was developed under a $30m non-competitive federal grant given to PwC as first brought to light by the Medical Republic. Professor Hickie, former national mental health commissioner, co-founded the platform and was a 5% (now 3.2%) shareholder in the company.

Speaking to The Guardian for a story published today, Professor Hickie drew a connection between what he says is GP reluctance to embrace digital interventions and a letter to the Department of Health and Aged Care that detailed concerns with the methodology of several studies on the application of InnoWell.

He called the concerns “a campaign to protect the current primary mental health roles held by Australian general practitioners”.

“Clearly, by attacking me personally at this time, and seeking to discredit the rigour of our independently assessed and peer-reviewed academic outputs, their goal is to stall genuine reform of these key aspects of health care reform,” Professor Hickie said. “The much more interesting story is why digital transformation has been so slow, particularly post-Turnbull.”

The letter, which has been sighted by TMR but not made public, makes the case that these independently assessed and peer-reviewed academic outputs which seemingly justify the use of InnoWell are marred by over-generalisation and small sample sizes.

For instance, the trial looking at InnoWell as an intervention for defence force veterans only recruited 49 participants despite aiming for 100. Only six participants were currently serving personnel.

The trial involving older adults included a sample of just 16 people.

These people generally reported low levels of psychological distress and good mental wellbeing at baseline, making the need for an intervention questionable.

A third trial, which was a collaboration with The Butterfly Foundation, looked at the platform’s efficacy as an intervention in a population with eating disorders and body image issues.

Some participants in this trial noted that the app fuelled their eating disorder by using scores and requiring them to track certain habits.

Despite these question marks, along with a critical independent evaluation undertaken by UNSW, InnoWell went on to be declared a success by its multiple stakeholders.

The independent evaluation was only released publicly following a Freedom of Information request earlier this year.

Professor Hickie did not respond to TMR’s request for comment before deadline.