 Hello and welcome to the MHPN All Together Better Virtual Conference. The great debate, it's the last session of the conference and I'm just sitting here imagining where all the many people are sitting watching this. So you're at your dinner table, are you in your car, are you sitting in bed, are you at your office, where are you, but you're part of our conference and we're great to see you and we've got a really good debate on today. Now before we begin, I'd like to reflect on the meaning of place and the traditional owners and the traditional owners in my place, it's the Bunarong people and I pay my respects to their elders past, present and emerging. I wanted to just, before we get started, thank our very professional MHPN team who put enormous amount of effort into the conference to make everything work and the excellent technological team as well, JT, who've been making it all happen seamlessly. So we do live in a very changing technological world, I don't know about you, but often I feel like I've got technology whiplash at the moment just when I catch up with one thing, something new comes on and I often think of that famous author, Thomas Friedman, who talked about us sort of living in this fast moving current, which is getting quicker and quicker and the only way to stay stable is to keep paddling your kayak. So I am certainly paddling and we all live in very technological worlds these days. The other thing to say is, although we'd like to have a magic pudding, our mental health budgets are a limited resource, you know, they're not bottom ones, they're not enough and the truth is that many people in Australia can't access the mental health care that they need and there's nothing abstract about that, it's very tough when you've got a teenager who's going through anxiety and can't get into the psychologist or depressed fella at his work and his life's spinning out of control and he can't get some proper mental health help and this is still an ongoing challenge that we have in Australia. Of course, there are many barriers, you know, stigma and affordability, but we do have the tyranny of distance in Australia. One of our presenters from today, who you'll meet drove a thousand kilometers today and we are a big country and so, you know, the potential there for digital technologies for mental health delivery is huge. The pandemic turbocharged things, you know, we were tinkering around with technology and suddenly overnight, everything was technological, we couldn't do anything without our phones, without telehealth and online. Now as a clinical GP, I'm a bit agnostic about the face-to-face versus online telehealth digital world of mental health and obviously the answers that we want both, so this is a slightly artificial debate because the real answer is we want both, but there are many pluses and many minuses for both face-to-face and digital mental health and that's what we're going to be debating today, the pros and cons of face-to-face versus digital mental health and we've got an absolutely brilliant team, couple of caveats and housekeeping to tell you about. First of all, these are pretty senior people that we're very lucky to have and we've allocated them to teams, but they're not necessarily, you know, taking a position for their organization or even necessarily the position that they've been asked to argue, so just keep that in mind a little bit before we take their arguments as quotes from them and this debate is really a device to get the conversation going. We're going to find out what are the views of the audience before our debaters with their great persuasiveness speak to you and after our debaters have spoken to you and to do that, we're going to do a little poll. So what's going to happen? We're going to have a poll. I'm going to get you to commit to if we had more funding, would you be pushing it towards the face-to-face mental health direction or the digital mental health direction? So try and land on one of those and we want to get your vote and so we can compare that before and after the debate. You'll be hearing from our six speakers, eight minutes talking for each person and a summary from their leader. So we're going to now open up our poll and we're going to get you to click. Are you a techno fan or a face-to-face fan? So I'll hand over to our digital friends to set that in motion. Thank you. It's great to see all these votes coming in and we've got some lovely background music, like a game show. It's really adding to the ambiance. So while we're just waiting for our pollsters to come back to us with some early results, I'm feeling a little bit like I'm Anthony Green. I secretly want to be Anthony Green, that fellow that they pull out during the voting every year. I don't know what happens to him when there's no elections, but they seem to just pull him out. So I'm going to be your Anthony Green person now and let's have a look at our pre-poll, Emily. Ooh, that's good. We've got a really good spread today. We've got about 42% going for digital mental health before the debate and about 58% want more face-to-face mental health services. All right. So our digital mental health people have got a little bit of a hill to climb, but that's good. At least it's a nice split. So that's excellent. So let's meet our wonderful debaters. And I'm going to start off first by introducing you to the lead debater from our face-to-face team. This is Associate Professor Matt Coleman. Now, we've got such fantastic people in our debate. We could spend the whole debate just reading their bios. I'll leave it to you to look at his bio. But I'll tell you what I do know about Matt. He's a rural general psychiatrist. He's just finished two terms with the National Mental Health Commission. And he's also a sheep farmer I discovered in his bio. So we're really looking forward to hearing from Matt. And Matt, just before we start, could you tell us one thing that you like to do when you're not working? Maybe a hobby or an interest of yours if you do have any spare time that is? I did enjoy riding horses until I got bucked off one and fractured my hip. So that's off the list. Okay. Well, hopefully you've recovered very well. And it was Matt who told me that he drove a thousand kilometers today. I think it was. So that was very interesting. So that was great commitment to the debate, to the face-to-face team. I like the way you've put that in there. So that's great, Matt. Let's hear from the head of our other team, the digital team. And we're going to hear we're going to meet now Ruth Vine, Deputy Chief Medical Officer for Mental Health, highly respected advisor on critical mental health issues that have been impacting the Australian community for many years. And we're really privileged to have her and appreciative and you can read all about her fantastic bio. Ruth, can you share with us something that you like doing, hobby, interest when you're not fulfilling your super busy work roles? Well, well, you know, I got to spend a bit of this afternoon digging up my ultra minute vegetable plot because it's the end of the summer, end of the summer veggie patch so the tomatoes came out and the beans came out and you know the leftover spuds got thrown out as well. So that's just a little thing but what a lovely thing to be able to do on a sunny afternoon like we got to have this afternoon. Well, that sounds absolutely lovely, beautiful. So our next presenter you're going to meet is Heather Nowak. And Heather is one of Australia's leading mental health consumer advisors. She's done some fantastic work. If you have a look at her bio, you'll be blown away. She's one of three mental health commissioners in South Australia and she really brings a unique perspective. So thank you, Heather. And perhaps you can tell us something a little bit interesting hobby or thing you like doing when you're not working just that you could share with our audience today. I really like catching up with friends face to face, not online. Wow. Look at this. Look at this commitment to the team. You see what you see like you see what she's done there, don't you? You've got that. You know, being at a hug, being at a hug someone actually. Yeah, it's just awesome. Nice move, smooth. Thank you. Lovely to meet you, Heather. Okay, back to our digital team. Not to be deterred. We're going to bring in up my lights gone. I'm just running around for one second because I'm at the Beyond Blue office and I need to move to make the lights work. Hold. No worries. I will have life. We're all good. iPhones are very good. Excuse me if I look at slightly ghostly from in it till we work it out. Okay, we're over now to our next speaker, Harry Lovelock and Harry is director of policy and research at Mental Health Australia. Welcome, Harry. And can you tell us something interesting about what you like doing when you're not working? Well, I'm acting CEO at the moment which I'm not enjoying but I do have a lovely boat sitting in the driveway that's looking a bit for lawn because I haven't been out in it but I know from being out in it previously I can run a webinar from my phone out on the water. How good is that? Technology boom, boom. Oh, very impressive. There we go. It's another strike from the technology team. They're getting they're getting more and more sneaky. I don't know what we're going to do but we're going to head across now to Professor Nicholas Proctor, director of Union of South Australia's Mental Health and Suicide Prevention Research and Education Group and he's the third member of the face-to-face team and can you tell us something interesting about you Nicholas? Hobby, interest, something you like to do when you're not working? It's got to be those face-to-face moments on the beach. Just walking the beach, hearing the sounds, seeing the waves, being with someone special. That has to be it for me, the beach walking and we're blessed in South Australia with such great beaches. Thank you Nicholas. And last but certainly not least we're going to hear from Associate Professor Morton Rawlin and Morton, many of you will know he's a well-known GP. He's the chair of the GP Mental Health Standards Collaboration, medical director of the Royal Flying Doctoral Service in Victoria and lots of roles. He's pretty much any GP organization that's got, you need a leadership sort of role. Morton seems to turn up there and does a great job. Have a look at his bio. So what a team that we've got. Morton, what's something interesting that you do when you're not working? I read Military History, would you believe, particularly World War II. Wow, fantastic. Do you watch Dock O's as well or it's mainly books? Yep, no, Dock O's as well. Yep, yep. And love to travel to battlefields and things like that if I get half a chance. Right, well nice segue then into our little battle here that we're going to have. Sorry about that, bit of a dad joke for the team. But we want to hear how we're going to enter into our fantastic debate today and we're going to start with our group. Now I'm working out which way to do my hands and I've got new respect for the weather people, the weather men and weather women on the news. So we're going to hear from Matt first speaker for the face-to-face team. He has eight minutes and we're very much looking forward to hear what are his arguments for the case for more support for face-to-face mental health care. Over to you, Matt. Thanks Grant. First of all I just want to say that I'm unashamedly a ruralist and that's the lens that I'm going to talk to from today. Interestingly my presence here today is largely because the predominance of this debate in rural and remote settings and context. So I make no apologies but simply this is an unfair debate. The world's biggest experiment with telehealth predominant recently with COVID as you all know and it even the playing field for all of us and there's been multiple studies study after study across all health fields asking and finding the evidence around preferences for face-to-face versus telehealth and the clear winner has always been in those studies face-to-face and Fred Moore at our recently in the JAMA said that clearly the preference from people in the mental health sector was around face-to-face and that really the question was understanding patient preference will help identify the role of telehealth in the future not the other way around the future is not telehealth we need to identify where it sits in patient preference or a consumer preference. So it seems that there is really no debate face-to-face wins but rather a desperate attempt to keep telehealth in the in the debate despite the hype and the promises over the last two decades because telehealth has not been our saviour outside of the global pandemic over the past two decades despite all the promises and the hype and Nicholas is going to talk to the shortfalls and the effectiveness of it and of telehealth and Heather will talk to the consumer preference and experience but I'm going to talk about the impact of telehealth on system configuration. I'm not going to dwell on the continued failings of the mental health system especially from a rural and remote perspective because I only have eight minutes not eight days and those failings are well described but rather I'm going to talk about why is the system in rural and remote Australia and perhaps urban fringes failing the mental health system that is and one of the key drivers for that has been workforce maldistribution. The place of telehealth has been front and centre of our failings as the high tech low cost solution to our metro centric systems of workforce training and development and distribution. Face to face is not the face face to face is not the failure within the system it's getting the face or more likely more accurately the bum in the right place at the right time in the right amounts that's been our failure in the mental health system despite hundreds of millions of dollars of investment in high tech allegedly low cost telehealth the system's really no better than it was 20 years ago particularly if you're in regional Australia so don't be fooled by the opposing team's likely arguments on the availability of telehealth because remember accessibility is more than availability and if we are so attuned to understanding the social determinants hopefully as we are these days of mental health and well-being and mental illness and well-being we know that the people that are most vulnerable those struggling in the lower socioeconomic groups in society the less educated perhaps the unemployed those with disability those not technologically literate like for instance the older population people in the older population or those people who have the audacity to live outside a capital city which by the way is only 30 percent of the Australian population who contribute more than 75 percent of the export earnings of Australia and over 30 percent so more than their fair share of our economic prosperity but also in particular those people in rural and remote Australia who are also indigenous their access to telehealth is demonstrably poorer for these high tech solutions so the irony is if it weren't such an irony it would be more obviously and blatantly immoral for such a rich nation to continue on this path that more telehealth is going to solve problems which it hasn't in the last two decades so once again our system of providing the preferred delivery of mental health care which we know following the pandemic is face-to-face our failings to adapt our systems of workforce development distribution are borne by those who who need it most yet have the least access to face-to-face and they you know pushed into telehealth despite not having access to it the irony is not lost on me and that our preparation for this debate when we met a couple of weeks ago because I live in a rural and remote location my internet dropped out and I missed half of the preparation and that's because I live in an mm5 area only 50 kilometres from a regional town but there we go even a rich white middle-aged building white guy is still disadvantaged because I live in rural Australia and so it is not our solution it is not the solution but we love to mythologize the bush in Australia there and Grant did that perfectly for me and we talk about resilience of people in the bush and we've heard about the tyranny of distance well for instance the back of Burke you're right there is a tyranny of distance because it's a hell of a long bloody way from Sydney or Melbourne but it's not terribly far from Burke fully supported fully staffed fully capable perhaps regional people would have a fighting chance if they went if they were supported to do face-to-face so let's drop the warm and fuzzies around telehealth the debate for telehealth is a sign of our failures it's a sign of the failures of the mental health system across Australia and arguing that it is well tolerated or widely available and effective compared to say nothing it's just another reminder of where our efforts in the system are not but being an unashamed regionalist I'd like to end on a positive note because we have because we do have technology which will be argued by the opposing team we need to bring workforce development training and opportunities to regional people to enable them to provide the preferred face-to-face that mental health care that people in the community want rather than funding metropolitan populations to provide a charitable uncontextualized telehealth service to regional and remote people who struggle to get the accessibility because of connectivity problems and the like and currently what I would describe as the digital divide opportunity cost because we're spending hundreds of millions of dollars perhaps we should be using technology to break down the existing two-tiered system that we have in Australia and mental health care system where metropolitan people are afforded choice choice of face-to-face or telehealth but regional people generally are not perhaps in doing so we could also reverse some of the social determinants of mental health by providing opportunity training employment and better mental health care in regional Australia our team's not anti-technology but we want to provide a clear and honest and open debate from a lens that is not entranced by the pixelated high-tech low-cost excuses for our failing systems over to you Ruth. Okay thank you very much Matt for very thoughtful presenter number one and I'm looking forward to hearing from our digital team their first speaker their leader and I will hand over to Dr Ruth Fine and look forward to hearing your presentation thank you so much it is a little surprising isn't it that despite all of the effort that we've had over the last decade it is only recently that there's been this explosion in in in take-up of the technological stuff and one has to ask a little why but let's just get there firstly I'm look I just have to take a couple of seconds to acknowledge the traditional custodians of the lands on which we meet we're all over the country for me it's the Wurundjeri people of the cool nation anyway I and my colleagues will make the case not notwithstanding what Matt has just outlined that indeed digital mental health services and virtual means of accessing treatment and support are cost-effective they are evidence-based and they are trusted by consumers and clinicians and they operate across a much broader continuum of care than just clinical care they operate operate across from prevention self-help clinical crisis care they provide high-quality supports that increase the availability and reach I'm not arguing with Matt that we shouldn't have available face-to-face but this is a really important adjunct and and and I also address common barriers now Matt's talked a bit about geography but there are other barriers there's cost there's stigma language cultural barriers wait times and technology helps us with some of those so I'm going to start by presenting some facts in turn my colleagues Harry and Morton will argue and support the above by considering perspectives from consumer and clinician respectively and and of course this debate is happening in in our COVID era and I think it is important to recognize that pre-COVID there was some technology where there was Medicare items in relation to rural loadings from 2017 but from 2020 the new items that were released in response to COVID were really embraced and so in 2021 about one-third of better access treatment services were accounted for by telehealth and phone and it was it was Matt that that increasing uptake was actually seeing among people in remote areas as well as Metro and out of Metro so I'm going to go through a few areas I'm going to start with digital mental health these include things like crisis support helplines web chat clinician supported online therapy self-directed education programs and tools moderated peer support programs they're mostly free or low cost they cover a whole range of things people do not need a referral and as we saw in COVID they can be scaled up fantastically so they can they can be used to complement they can be used as an alternative and just coming back to the Productivity Commission in 2020 they estimated that around about two million people being treated with medication and or individual face-to-face therapy were probably using treatments that were more costly than may have been necessary and that the treatment needs could have been met through services that offered a lower treatment burden in terms of cost or adverse side effects or whatever and another about half a million people would were not getting any care and would have benefited from some low intensity care so they recommended additional funding sorry Matt additional funding to expand some of those online supported treatments noting that they were convenient clinically effective and and helped people to manage their mental illness so there is this real potential still a growing potential for digital mental health supports to help make the gaps in the availability of lower intensity services as well as complementing usual care options like face-to-face or nbs funded services and to help some of that redistribution of demand and reducing pressure on the border mental health system so we shouldn't we shouldn't I think fail to to grasp the metal of what we can achieve and some of these expansions so in addition to digital mental health services is also clinicians supported online treatments and again these have been independently evaluated the University of Melbourne recently evaluated three funded services Mindspot this way up mental health online and those evaluations found that those digital mental health services can produce superior outcomes to treatment as usual which was discussing issues with general practitioner superior outcomes in many instances to pharmacological treatment in primary care which overall have small to moderate effects that they were cost-effective in compared with usual care particularly this was in relation to individuals with both depression or depression and or anxiety and when productivity impacts were taken into consideration they costed less and produced greater benefits and and by the way many practitioners found that to be a more satisfactory way of delivering services so things like 38 percent of Mindspot users had never previously spoken to a mental health professional another similar figure 38 percent that were accessing it from outside a major city and up to about a third of the enrollments in this way upward from regional and remote so clinicians supported works and then there's digital peer support I'm sure Heather's going to talk about peer support but but the ability to deliver recovery focused services including mental health peer support can increase access to services it can increase prevention and help in early diagnosis it can de-escalate and and help people with their help seeking behaviours and preferences so again Sain has been a very active player in this they've provided um digital forum communities that have worked as an adjunct to the mental health system providing support again to those who gaps and and and supporting to people who might be on a waitlist who might need something before that face-to-face services um operating uh Sain Australia's consumer and care reforms get to about almost 22 000 participants a month about 400 new members on average over a month and they get nearly um nearly quarter of a million visits in a year so that's sort of the opportunity for moderated forums is pretty important and just before I finish um Matt mentioned support for health workers that the essential network is a commonwealth funded service provided through the Black Dog Institute it was established because of the recognition that health workers would be under particular and increase pressures in the context of COVID and that that the 10 services been able to um reach almost 80 000 health professionals using their resources it's almost 13 000 have received an assessment and support to access further services and a large number have received one on one so I could go on and on and on about yet the reach the convenience of digital mental health programs and support and avenues for treatment I also wish to um emphasize that we do not see this as a panacea I'm not you know suggesting that there is not still a need but we so we do acknowledge that face-to-face has some virtues but the opportunities for digital technology and that it provides in terms of scope scale choice availability too important to dismiss and probably too important even relegate to second place thank you very much well thank you very much Ruth and I don't know what people at home are thinking but how's the caliber of this debate we are watching a fantastic tennis match I'm on the edge of my seat and I'm looking forward to speaker number two Nicholas Proctor and I'll hand over to you for the second speaker on the face-to-face team and Nicholas just click your um mute button um mute button thanks yeah thank thank you very much Grant I'm coming to you from Ghana country I'd like to acknowledge the traditional custodians of the LA Plains and the LA region and certainly Ghana elders past prison and emerging I you know you've just got to go with face-to-face I mean face-to-face just has so many advantages you know there's something about being in the room um in the same room as a person that allows them to get a better read of the moment the mood the vibe and it works both ways the better read for the person seeking assistance and of course the better read for the person there to help and true connection is everything in a person's recovery journey and it's not the kind of thing that you can plug in now here's a quote from a psychologist who really highlights this disconnect in online and I quote I find it hard to build rapport I can't control the environment it's harder to pick up on cues phone consultations are the worst and it's not healthy for me to be in front of a screen all day then there's the extra effort of sending links dealing with broken links educating around online therapy following up on people who don't attend or couldn't get a connection and then these are just my frustrations I wonder what the client's experience is like so there is something to be said about being there and being in the moment and sometimes being there and being in the moment might mean you can get a sneaky read of your therapist's notes and then there's a trip to and from the therapist venue now this is a really interesting space this is a space that's in conscious play before and after the session there's a time that someone can use on the way to prepare for the session and then on the return journey to process and reflect on the session afterwards maybe it's on public transport maybe it's walking through some park lands maybe it's just quietly driving in the car whatever it is on the return journey it allows you to reflect on what has happened and process it and rather than going to more screen time going into another virtual conversation or a virtual engagement it might also mean that you get some extra time away from woodwork but being there means that you can judge the outfits the therapist is wearing you have the full picture for example are they wearing funky novelty socks some say it's important in helping to get to know your therapist as a person there is no risk of technical difficulties delays mute microphones blows in or sluggish screens power cuts disconnection things that happen every day when you're in the online world once you're in the room together you're confident the session will happen it will unfold there'll be a seamless connection the opportunity for seamless connection to be made but on the other hand living in a technological world the world of virtual mental health supports that you're not in the room or in the moment you can easily get distracted you can get distracted by your phone your computer email notifications and so there are some boundaries here that the online world propels us towards boundaries that need careful consideration thoughtful navigation that not navigation is around personhood where feelings can be received and lives revealed that needs to be preserved it's preserved through face-to-face engagement it's face-to-face that serves as the antidote to a technology saturated in personal and runaway world and let me give you an example just recently 2023 the washington post newspaper ran a really powerful story on how people share their deepest fears and darkest secrets within the safe confines of a therapeutic relationship and increasingly across north america therapists in the world are sharing versions of those stories with millions of followers on tiktok so as the online and virtual means play out even more central role in society therapists have crossed over to more extreme places in the online world they have taken online spaces to discuss mental health issues that they see in their clients and many of them are now sharing video vignettes that reveal conversations they're having with their clients so as a result of these fast-moving runaway world developments more clients are being asked to sign social media consent forms that allow therapists to use revelations to inspire their online contact and content so the online therapists might pledge to avoid including identifying information it's true to say that people in therapy may find their painful life experiences or troubled relationships with their parents on therapy talk but why is all this important because these actions undermine true connection and true connection is about being together being in the present moment true connection is not something that you can plug in and let's face it the fast-paced of technology if you put that to one side it's not healthy either we heard that from our school being yet a moment ago there's way way too much of it in our lives so my point my argument and i think it's compelling for all of us just pause for a moment and think about what we need and what our clients are really seeking they're seeking true fit connection so let's go for it face to face means you are there with the person and if they become distressed you can share a cup of tea together you can share that moment that critical moment of lived experience together a place to learn and to lean in and listen in together true connection comes when feelings are received and lives are revealed together true connection is in the same room a place where the therapist works towards a situation where the client feels felt by them and it's also a place of less distraction so there are compelling arguments here really compelling arguments we need to think about the fast-moving developments clients in the north american context are now being asked to sign online consent forms we need to think about the technical difficulties the disruptions the mute microphones power cuts we need to think about and privilege seamless connection we also need to think about the pre and post therapy session time and bring that into conscious play use that time when we are preparing but use that time when we are processing and reflecting on the session afterwards so there is something to be said about being in the moment and it's not about being on screen it's about being truly present and having true connection so thank you very much everyone well another terrific speaker i don't know about you but i feel like i'm being pushed and pulled from either side of this debate with very persuasive arguments and and nice move there nicholas to get the mute button off and the connection to play up a little bit could work on pushing your point i assume that was all completely by chance anyway on to our next speaker and we're looking forward to hearing from harry lovelock from a digital team over to you harry thank you grant great to be with you today congratulations to the mental health professionals network in pulling off this online stravaganza so many thousands of clinicians who are all online at some point during the past couple of days for this pd event something that wasn't considered possible only a few years ago but here we are and it's advancing technology and increasing level of user comfort for the reasons why having worked myself in professional organizations for psychiatry and psychology while also working closely with many gps and other allied health providers i know how close to your heart face-to-face serves delivery is but in this modern age we can now effectively connect with people all around the world in ways that just weren't thought possible a short time ago these advanced in technology have given us new tools to help people struggling with mental health issues while some may argue that face-to-face services are the only way to effectively treat mental health problems i believe the digital mental health service offer a unique and valuable approach that can provide equally effective and in some cases as riz has pointed out superior results the recent national mental health and well-being survey found that there were 4.2 million people with a 12-month mental disorder in 2020-2021 almost half 47 of these saw a health professional for their mental health which means that over half of people didn't see a health professional and this is higher than previous survey results back in 2007 so we're getting backwards on the face-to-face metrics and if you think we can provide enough face-to-face services to meet this need well as Daryl Kerrigan said in the castle i think you're dreaming well we don't have specific data on why people didn't see a health professional we know from other studies that there are a range of issues that technology can help address accessibility is a major one the recent review of the Better Access Initiative showed how waiting lists are growing and access to mental health professionals deteriorating this is worse in rural and remote areas where the review showed the disparity in utilization by geographic divide this unfortunately is mirrored by other health services funded under the NBS scheme one of the biggest advantages of digital mental health services is that they can be accessed from anywhere in the world at any time this is especially important for people who live in rural or remote areas where access to traditional mental health services may be limited or not existent these sort of services digital mental health services that are people to receive the support and care they need without having to travel long distances or take time off work this can be especially critical for people who require ongoing treatment as they may need to attend regular therapy or counseling sessions to arrange to manage the mental health affordability is another issue traditional mental health services can be expensive especially for person requires ongoing treatment digital mental health services can be more cost-effective as they add lower overhead costs that can be accessed remotely this can make services more accessible to people who may not have the financial means to pay for traditional face-to-face services the Guardian recently reported a person with lived experiences saying finding a good psychologist or psychiatrist who belt bills and has appointments available like hunting for unicorns while blindfolded then there is a convenience of these services digital mental health services can be far more convenient for people with busy schedules or mobility issues as traditional mental health services often require people to take time off work or school to attend appointments digital mental health services can be accessed from anywhere with an internet connection which can make it easier for people to fit mental health care into the busy schedules this convenience can be especially important for people who may not have access to reliable transport or illig in areas with limited public transportation costs and then there is the increasing evidence of the effectiveness of these services Ruth has already referred to a number of research articles but there are multiple studies now too long to listen to this presentation they've shown digital mental health services can be just as effective as face-to-face services for treating a range of mental health concerns and the evidence is growing not just for online therapy but for the value and range of other online digital supports including things like meditation and mindfulness apps that offer guided meditations and mindfulness exercises to help managing stress and anxiety mood tracking apps that can help you track your mood and identify patterns and triggers social connection apps that can help you stay connected with loved ones even if you can't be together in person cognitive behavioral therapy apps that offer CBT based exercise activities and physical training apps that can help track your physical activity which we know can help in supporting good mental health and then of course this is the scary part is the increase in use of artificial intelligence the recent CSIRO megatranspaper showed an exponential increase in research across all major sciences on the utilization of AI that will provide enormous opportunities to further increase and improve availability and effectiveness of digital mental health services in the future plus there's also the added bonus of anonymity digital mental health services can offer a level of anonymity that face-to-face services cannot and for many people seeking help for mental health can be intimidating and uncomfortable making it hard for people to seek the care and support they need this can be especially important for people who may may be hesitant to seek mental health care due to stigma fear and fear of judgment but a good example is men they can be particularly poor help seekers and find it challenging to engage in face-to-face therapy but online sessions can be conducted from privacy of a person's own home in a range of modalities that allows their trust and engagement to grow as they progress through sessions in contrast face-to-face sessions involve long wait times travel cost lack of choice and the discomfort for some of discussing highly personal issues with comparative stranger so in conclusion while face-to-face mental services have been the traditional form of care for many years digital mental health services offer a unique and valuable approach to provide equally effective in some cases superior results they can be more accessible affordable convenient for busy people with busy schedules have mobility issues or living in rural areas furthermore the research is showing increasingly that they can be just as effective as traditional face-to-face services and finally these services provide a level of anonymity the traditional mental health services cannot make it easy for people to seek care and support they need of course it's important to note the digital mental health services may not be suitable for everyone and some people may still prefer face-to-face services it's essential to have a range of options available to ensure people can access the support they need however digital mental health services provide a valuable and effective alternative to the traditional mental health services to meet the future needs of the Australian community so thank you thank you very much Harry and another terrific speaker and we've got a real game on our hands here and I'm looking forward to hearing from our next speaker the final speaker from the face-to-face scene Heather Nowak over to you and Heather just unmute yourself there so we've got to oh sorry that was all over the shop aren't they we've got we've got you we've got you back and um and you're ready to go we can hear you yeah but I've just lost my um can you bring me the paper donnie yep I'm sorry take your time take your time we're we're running we're running we're running ahead oh good good when you're when you're ready okay so I'm coming to you from Paramount Country this evening and thank you for talking about peer work Ruth um I probably won't be talking about it tonight um mainly because peer work really can't be done in an online environment it's very much a face-to-face um walking with a person and we can't really do that online so what I wanted to talk to you about really was you know in the world of mental health consumers we often refer to the saying we may not always remember what you said we may not always remember what you did but we will always remember how you made us feel and from my own recovery journey and the and the views of the many other people I've worked with and walked alongside it's not the what but very much the how clinicians and others engaged with us and made us feel that was most therapeutically beneficial or not so how people make us feel requires true connection this means that we need to be with and able to see a whole person and according to bird whistle about 65 percent of social meaning is derived from non-verbal cues so even with video options non-verbal cues can be distorted or concealed altogether so the online option will never allow us to have full presence to gauge a person's reaction or emotions we also can't see if the person has on other physical health issues that might be going on for them you know such as hand tremors etc um we can make an effort to look good from the waist up and say you know i'm doing really well when concealed beneath the table are our pyjamas and bed socks because the person's only actually just managed to get out of bed for the appointment trust is also needed in therapeutic relationships so let's imagine a consumer online with their clinician and the connection is just suddenly lost the person who may already be experiencing feelings of um self stigma is faced with thoughts of was it my fault did i actually say something wrong the busy clinician may or may not have time to call you back and you can almost guarantee that that can that consumer isn't going to call back to make another appointment for fear of rejection and it can be read as i don't matter and they don't care so mental health issues are also highly prevalent amongst people with low income only a computer and having access to the internet can be a luxury and not always possible so who is technology actually convenient for certainly not the person accessing services when they actually can't access it we can't assume that using internet modalities are possible for everyone even attending at a library doesn't provide privacy or adequate confidentiality for conversation nor can we assume that everyone knows how to use these devices or even has the literacy levels to even understand the instructions i've never used digital mental health programs as when i needed them i was never in a headspace to be able to use them having poor concentration and limited motivation it didn't help so the other day i decided i might actually go and have a look so the first screen was a huge big paragraph about the confidentiality and service agreement so once i actually read through that i got to the next section i then started to take through all of the sorts of issues that i was facing and guess what i was informed that i needed to go and see a GP or a other medical professional and that the online tools may not be very helpful for me at this point in time and that i couldn't actually proceed any further well i thought i was in a good headspace but not anymore so thinking about confidentiality who wants to talk about their most private issues with family members or housemates in airshot of the conversation in an area of illness where people can be highly anxious or skeptical we're relying on a system that assumes privacy i don't know who's listening on the other end or how my information is going to be recorded or who actually even has access to my data we see headlines in the news like more than six million Australian adults had personal data stolen in past year medibank admits personal data stolen in cyber attack latitude financials had 14 million clients information hacked it doesn't serve to be very reassuring when we're at a point of feeling very negative and doubtful so oh sorry just sorry about that i have to be like a railway station so um let's look at the breadth and reach we have the wonderful issue of no internet access at all due to living in a rural area or some rural areas and you don't actually need to be very far away to have interrupted or no access here in the Adelaide Hills i'm constantly receiving these little pop-up screens with you have low bandwidth turn off your camera and in fact i had no internet access at all yesterday for reasons i was unable to actually determine so for people using mobile devices accessing a signal can also be really difficult i have family members less than 20 kids in the city who can't even consistently rely on a signal so there's also that annoying delay in transmission that happens for telehealth appointments so i remember when i was unwell um and i had one of these appointments feeling like i was even more mad because the sound in the visual image were delayed and distorted my concentration was poor and i had no abs no idea of what i was agreeing to or not agreeing to so having a high level of anxiety then being faced with sitting in front of a computer stressing over what time to click on the link and will the link work and what do i do if it doesn't can be really nerve-racking we've all experienced the time when we click on the link and we get oops something went wrong for someone who's not traveling well this can cause really high levels of distress and self-blaming then we also have the issue of having low self-esteem and having to look at yourself on the screen or the person viewing your messy house in the background because you've had no motivation to clean it up you want to be able to change the background but you actually don't have any idea how to go about it or you do manage to put something up and completely hide the truth around how you actually do so i'm concerned with how i look and i'm confused because the person at the other end is out of focus or crooked on the screen is it them or me how do i fix this it's hard to concentrate on what i'm talking about with all these distractions technical or physical and oh how i wish i was in the room and not on a screen scripts sound simple i'll send you an electronic script we're told not to open links within text or email messages from sources not well known to us oh well you get to the pharmacy and you can't find the message with the script because it's about 50 messages down on your phone you hold the phone up to the scanner to be told no you have to open the link or the link doesn't seem to be working oh well back to square one so everything just seems so hard and i already feel that i'm hopeless and useless and yes stuffed up again so post-covid we're often hearing people comment how good it is to get back in the meeting room after being online we're social creatures we like to know we're not isolated and alone if it's good enough for the bureaucrats why should it be different for people accessing services to see others face to face with their illness actually keeps them isolated from other people technology options are here because they're considered to be cost and time effective but they are but are they effective emotionally and practically for the consumer that is struggling we need to ask ourselves though who really pays the price for these i believe it's the consumer it can create stress fear worry inequity and sometimes no access at all and where's it going to end artificial intelligence is rapidly encroaching our world we could end up having a robot an appointment with a robot and i don't know about you but i'm not leaving my social emotional wellbeing to be assessed by a thing with no feelings at all so true connection is everything in a person's recovery journey and it's not the kind that you plug in thank you very much Heather giving us some really in-depth experiences of the of consumers in using technologies so our final speaker on our digital team Morten Rowland we're looking forward to hearing from you and i'll over to you now thank you very much Grant and i'd like to acknowledge the Wurundtary people of the Kulin Nation and their oldest past president emerging on the lands that i mount on today we've heard from a erudite and wonderful crew but on both sides of the argument i think and if people hear some snoring in the background it's because it's my french bulldogs who had their dinner early so that they wouldn't disturb us the main issue i think is that it's horses for courses by that i mean if you know the patient very well as i often do digital mental health can be really helpful you can see somebody who is a grey nomad who's in north Queensland whereas where i'm in Victoria a particular a particular thing that i always remember is i had one patient of mine who's a long-term patient who went to a funeral in England had some really terrible post-traumatic stress brought up he rang me and we dealt with it over the phone but that was because i knew him very very well it is difficult if you don't know somebody well to find that nuance in the consultation and as we all all the clinicians around this table have been trained in the time of face-to-face that's not to say that face-to-face is the only modality we need to work out when to use digital when to use face-to-face it is great when people can't get to the doctor you know they've got fires raging around i mean we at the rfds we did a lot of work around Malakuta in the big bushfires there and we had one clinician on the ground but 10 clinicians who were able to come in over satellite phones and satellite imagery and that was really well accepted by the by the population so it has its place it was then followed up by some face-to-face and quite a bit of after that face-to-face has gone back to you know digital means of counseling and so forth it also depends a little on the experience of the clinician sometimes as has been said particularly by Nicholas you know it does take and also Heather it does take you time to notice the extra bits and pieces that are in their background i mean people probably are looking at the background of mine and are saying what's that in the in the bookshelf well it's it's a it's a statue of legalists okay so that gives you an idea that i like science fiction um and that's an important thing to notice um in terms of where to from here i think that there needs to be and there is becoming more standardization around the mental health digital uh offerings and i particularly need to know when i'm talking to somebody that that particular thing will actually suit them and it's not going to do harm these uh you know apps and so forth they're not diagnostic tools as Heather said you know some of them are quite black and white and they've got um algorithms in them that say you must go do not pass go you know it's terrible you've got to see a doctor now um that may or may not be the case um but we we are learning and that's the point that i think we'd like to make on our side clinicians need to use the tools that they have available for some people face to face will be the other only option for others it will be blended for others it may well be digital because that's the only thing that they can do um and we have to recognize that and try and make the experience for them as good as possible in the process that they have generally speaking um we have a lot of time spent with patients and it takes time to develop a rapport if you use the right tools those digital apps and so forth can be really effective at giving people homework for instance giving them the ability to assess themselves and see how they're actually progressing give them ideas of what to ask you next time that they see you um whether that's face to face or not i use those digital tools to help in that way as well they are not diagnostic tools in my opinion they're to help us in making sure that our patients get the best possible care as we've moved to further developments in AI i know that um there are some programs which are said to be CBT is better on AI um i i don't really believe that myself but we need to keep an open mind we actually need to do the research and find out when these things are appropriate to use and when they're not appropriate to use we've used lifeline for 30 40 years it is effective at helping people in true crisis but that then needs to be followed up with face to face and i think it's a duality that we need to be aware of and embrace because it's not going to go away i'll give you 20 seconds there Grant so thank you very much thank you very much Morton for your reflections on on our debate tonight and um if we were in a big auditorium i think at this point i'd be asking everyone to be clapping so they're probably doing it at home i'm sure but if you listen very carefully you may just hear them in there they're living rooms just sort of quietly clapping away but that just the caliber of the discussion the commitment to patients to good mental health care um you know to have the quality of these people thinking about these things in our our countries are really a great privilege and and just a fantastic discussion i think as Morton said and a number of our speakers said we know it's not all or nothing and a lot more work is needed to look at where it all lands um there were so many interesting points that came up for me and i'm sure listening at home a lot of new ideas have come up for you i was very interested in this idea of of what happens to people on the face-to-face side with sort of anticipation of their appointment and you know what they do beforehand when they go in afterwards and and there was some very interesting evidence that i found Ruth presented which you know ultimately we're scientific as well and if the science is telling us that people can have improvements in their lives through digital approaches i'm very persuaded by that too so i tell you what as the moderator very appropriately i sit beautifully on the fence wouldn't it be interesting to see what happens with our post poll and if you can i believe we're going to see what the first poll results were again too so we can sort of compare and see if we've had any any shift any movement from this terrific debate and before we do that we're just going to have a summit from Matt and first of all Matt and then Ruth about their summarizing their team's argument so over to you first Matt for a little bit of a summary and discussion for five minutes thank you so first of all thank thank you very much to Nicholas and Heather for giving us really good information advice about the the complexities of providing mental health care and the experience of providing mental the experience of receiving mental health care and the importance of having face-to-face as the primary and predominant way in which that care is provided and thank you also to Morton for summarizing our discussion and and somehow jumping the fence and being on the face-to-face side i really appreciate it but i'm coming to you from southern Yamagy country but am i and i'd like to acknowledge the people here but really am i coming from southern Yamagy country you don't know that i could be in a call centre as part of the commodification of telehealth services that inevitably we're going to see and probably one day there may even be a Matt Coleman who's an AI bot and probably according to our colleagues on the opposing side will suggest provides better and effective care than in person so i could be anywhere and are providing any sort of care and not understand the context and i think Morton's point about the experiences of providing crisis care particularly in a changing world with climate change and rural adversity like the floods one year drought the next fires in the summer biosecurity risks at other times context in mental health is everything and if i'm sitting here in my call centre in some far-flung place maybe not even in Australia and i'm trying to provide care that's context specific and have no idea what it's like to be in the fires that are just down the road and the fact that your internet playing up because because of the fires and i don't understand that then really am i providing mental health care or am i making it convenient to provide the sorts of things that Ruth was talking about we've become obsessed with our drive towards episodes of care and we'll hear it we heard about the amazing amount of episodes of care and occasions of service that that have occurred and the the head-to-head trials which suggest that that telehealth is tolerable and as effective but often some of these when do we hear about the enormous amount of face-to-face care that's provided and the effectiveness of face-to-face care it's almost like and please audience don't be taken by the shiny new toy and as i was listening to the debate it it reminded me that telehealth is like the monorail of the transport system it's the shiny new toy that will tell you and i'm thinking about the simpson's episode that will tell you how effective people are transferred from one part of spring town to the to the next and how safe it is and how wonderful it is and it's effective as a car well here it is today and perhaps here it won't be tomorrow unless we give it more oxygen and more room to move and that and that commodification and that obsessionality around essentially overcoming our failures that particularly in in my sector in the rural regional and remote setting our failures of being able to adequately provide face-to-face healthcare and the compensation that telehealth will provide for our failings my question and it's the iron is not lost on me that we're talking in a mental health professional network my question is how much of this system how much of telehealth is for practitioners preferences and that the failings of us being able to adequately distribute well trained and capable mental health clinicians throughout Australia and i i'm as a psychiatrist i'm going to think i'm going to talk about my own colleagues and that 85 percent of them live in capital cities you could probably throw a blanket over them in a single postcode in in those capital cities yet 30 percent of the Australian population lives in rural and remote regions and largely that's because of the way in which our systems have organised around practitioners and around the services themselves so rather than coming up with a shiny new toy and look over here and let's let's compensate for our failings and and overcoming the tyranny of distance and the the thousand kilometers that i drove today to be able to see consumers that don't have access to the internet that do need to be seen desperately who will only come out to the front of their house to sit down and have a yarn with a mental health professional who's real who's not pixelated who is on their country who does acknowledge where they live in the context in which they find themselves and who lives and breathes the same air as them and the same struggles sometimes and is part of their community so forget the shiny new toy don't don't be fooled by the limited resourcing question there's opportunity costs at every turn stick with face to face and and we'll use the digital world to our advantage to provide face to face rather than the other way around thank you very much thank you thank you very much matt and and i'll now hand over to dr ruth bine to summarize for the digital team uh ruth just flick on your microphone please thanks it wasn't me someone else did it but where to start i mean i think i don't think anyone and i think you know all of the speakers all of the people who participate in this would not say face to face is is a crucial and continuing and you know an important part where to start but it is not a shiny new toy in fact digital and and and uh Morton mentioned lifeline that i think celebrated a very important milestone just recently those means have been around for a long time what's changed i think and maybe covid was the was the sort of accelerator it what's changed is the scope the the the the the range and and who uses it and how and matt mentioned that is this a is this a clinician choice or or a user choice i have to say it's both i i i accept that many practitioners have found it much easier to sit at home and provide virtual treatment than you know go to the inpatient unit and provide um inpatient care to those who have significantly suffering but equally the consumer has also exerted choice and and what's interesting i think is that the face to face side talked a lot about the problems of technology and i'm not going to suggest that i don't have days when my why internet knocks out but they didn't mention that for some people accessing public transport to get to appointments arranging for childcare taking time off work all of the things that actually for those places that it suits make actually consumer choice much better and and i think one of the things we've seen and again particularly in the last few years has been this escalation in people choosing to use different means and and avoiding you know minimizing wait lists and getting support while they're on a wait list the the face to face people i'm as optimistic as the next person but let's not live in la la land and and and it is difficult to get enough practitioners in the right places without wait times who provide their services at low cost so that there's easily accessible services we need to have blended services as as more than highlighted we need to have choice we need to accept that technology is part of our lives and use it wisely we don't need to be of course we need protections Heather Heather mentioned concern about privacy and confidentiality and who else was in the room that's why we've got standards in digital digital mental health care it's why it's why we we we need to continue to have quality and safety and oversight it's why we need to continue to have professionalism we need to continue to make sure people are upholding their professional standards but boy oh boy let's not let's not um have that blanket that map just threw over the eastern suburbs of melbourne thrown over our heads to think that we shouldn't be looking out looking at what's available looking at what's effective and letting people um have choice and and i will i will absolutely say and agree of course mental health needs more funding of course mental health workforce needs more support and of course we need to keep the availability of that intense therapeutic engagement or Heather peer support i'm going to disagree with you because i think that sayin's got some pretty good evidence about some online peer support but but i also accept intentional peer support is something that often needs a relationship and and that intense engagement but oh no don't throw don't throw digital away don't throw virtual away don't throw this sort of technology away let's let us have this conference and maybe feel a little bit like we're in each other's living rooms even though we're not so great great discussion but um i think we can have it all thank you thanks for wonderful sum ups uh from matt colman and ruth bine and um it's really been an extraordinary discussion and i'm very interested if we our tech team could now uh re uh re-survey our our attendees and let's see where they're all at um and um but while they're doing that that will be just going to you now um i think um what strikes me is just an extraordinary uh opportunity we've got to have have it all as ruth said we obviously need to keep reforming our mental health system in increasing our access to services and at the same time uh you know keeping track and keeping up with the technological developments that are there it's really extraordinary to see where it's all going to land and um at the moment uh our poll is up and um we should have our results shortly while we're waiting for that to occur i just wanted to particularly take this moment as this is the last session in the conference to thank jt production who've been managing the technology for the conference because you as you can imagine there's many many moving parts particularly in this uh particular uh this session where we've had uh little screens whizzing over all over the place and switching speakers but throughout the conference and making people feel very comfortable and uh feeling like they've been at a conference and also for the presenters to make them feel part of it all um also a particular shout out and thank you uh to the mhpn team who've been incredibly committed and enthusiastic and very supportive of all their speakers and great attention to detail many of us who've been involved or involved in a lot of conferences and and you'd have to say the um the work that's been put in and the preparation has been absolutely wonderful and they've been all in so i'm expecting our results to be in now and um let's get up and have a look if there's been any shift in our our brilliant audience out there and um i might do a little drum roll here on my laptop as we wait for well there's great suspense building here oh something has come up but it's a bit small can we make it a bit bigger perhaps because i can't see what it is oh and and it looks like it looks like our face-to-face team of that's a surprise that's great now now hang on a minute i've been the good researcher could there be any confounding variables here i mean is it that digital type people have jumped off the conference a bit earlier because they've got some distractions and they've jumped on no we're getting shaking heads or is it that the face-to-face team has has has made a quite a convincing case there or is it like what Matt said that that Morton was a bit bit too supportive of his other team there look like he might almost cross the bench at one one point there i'm not not too sure about that i'd just like to compliment the face-to-face team on all those bogus technological mess ups i thought that thought that was a terrific strategy you know oh sorry my microphone and oh my connection it's gone you know really really a bit sneaky but very effective but um you know it's been such a good collegial conversation and it's nice to see us all back on the same screen um we will congratulate the face-to-face mob because i think they had a significant shift there and um it's certainly given me a lot of food for thought um and i'm i am a digital tech enthusiast but also very much like being back doing face-to-face care with my patient so i think it's something that we're all going to be continuing to grapple with um so a really fantastic conversation um this is in fact the last um well just before i closed the conference i just wanted to thank um our incredible team um who participated today i could see a lot of work and actually gone into those presentations very thoughtful for those of you who want to publish anymore sounds like you've got some beautiful ready made op-eds all set to go um i think any one of you a very good opinion piece either in the lay press or in this mja insight there's some very well articulated arguments for both both ways there and i think the debate will continue to occur thank you again to Matt Coleman Nicholas Proctor Heather Nowak Ruth Byne Harry Lovelock and Morton Rowland applause from your living rooms and i'd like to officially um close the conference again with a very big thank you to the MHPN team who have put their heart and soul into making this a great conference and also to the very supportive JT production tech support crew very professional really made sure they left nothing to chance to try and reduce any chance of technological tech stress made it very easy for all the presenters so thank you so that's all from us tonight we're as a good GP i'm four minutes early and i'll give those four minutes back to you and thank you very much for your involvement and um have a good night