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“The Australian Government has made telehealth a key element of the fight against COVID-19 and has delivered 10 years of reform in 10 weeks,” – Federal Health Minister, Greg Hunt.
In March 2020, as the effects of the pandemic began to be felt in Australia, the Government expanded Medicare subsidies for telehealth services. This has allowed GPs, psychologists, psychiatrists and other health professionals to consult with patients via telephone and video using popular technologies like Facetime, WhatsApp, Zoom and Skype.
Pre-COVID-19, the uptake of telehealth by practitioners and patients had been slow. For example, in the field of psychiatry, only 66,000 appointments out of 2.4 million visits to psychiatrists in 2018-19 used telehealth. But by late November 2020, ten million telehealth services had been delivered to more than 3.2 million Australians in regional, rural and remote Australia. Between March 2020 and November 2020, more than 30 million Medicare eligible telehealth consultations were delivered across the country.
Current measures are in place until 31 March 2021 but may be available for longer if the Australian Health Protection Principal Committee (AHPPC) recommends an extension to the Medicare subsidies for telehealth.
Dr Richard Bonwick is a member of the Royal Australian and New Zealand College of Psychiatrists’ Telehealth Advocacy Steering Group, and a consultant psychiatrist to the DVA Practitioner Support Service run by Phoenix Australia. Like many health providers, he has seen telehealth gain rapid momentum.
Dr Bonwick works with aged Australians and about 30 per cent of his patients are veterans. He says most of them have engaged well with telehealth.
“Veterans in an older age group sometimes travel long distances to an appointment – they tend to have preferred psychiatrists and will travel to see someone they think is veteran-friendly or has expertise in dealing with veterans’ mental health. They are thankful they now don’t have to spend that time travelling,” says Dr Bonwick.
“Most veterans with mental health problems suffer with PTSD and avoidance is a key symptom – they avoid social interactions. For a lot of veterans, it has been easier to engage with someone on the telephone or audio-visually, rather than attending an appointment. The flipside of that is that telehealth as an option can almost feed into and exacerbate that isolated existence.
“But for the bulk of veterans, I think telehealth has allowed them to continue accessing services and engage with healthcare without the normal effort and challenges. Telehealth has given patients and practitioners more flexibility. If a patient of mine is struggling, they can call my office, leave a message and I can call them between appointments. That flexibility has helped maintain mental health and averted some crises.”
At the end of 2020, Dr Bonwick spoke to his patients to gauge their feelings about continuing with telehealth for future consultations.
“Of the veterans, 60 to 70 per cent said they’d like to continue with phone consultations but said it would be nice at some point, when necessary, to have a face-to-face consultation. About a third told me they wanted to make a full return to face-to-face appointments,” he says.
I think there has to be a balance between using telehealth technology and face-to-face consultations. I rely on what the veterans I am working with think is OK, but I explain that if I am concerned about how they are travelling, and if I don’t feel I am picking up the nuances of where they are at, then I would request a face-to-face consultation.”
Dr Bonwick believes telehealth is most likely to be effective for veterans who have an established and trusted relationship with a healthcare provider.
“If you are taking on a new veteran client, I think you should establish a relationship with them before shifting to any substantial telehealth work. There is a slight dislocation, even with good quality cameras and high-speed internet connection – there can be that lack of the human element,” he says.
“We are still learning about telehealth, finding a place for different types of consultations and how they fit together. We have to constantly think about the best way to conduct each consultation – is it better to meet on the phone, audio-visually or face-to-face? That needs to be part of decision-making each time. You can’t support clients solely with telehealth – but as an option or adjunct, it’s fantastic.”
Do you have a question or need advice related to veteran mental health?
The DVA Practitioner Support Service is a free, nation-wide service, funded by the Department of Veterans’ Affairs to provide expert multidisciplinary support and guidance to health practitioners, support organisations and others working with Australian veterans with mental health problems. If you would like a one-on-one consultation or multidisciplinary consultation, contact the advice line Monday to Friday, 9am to 5pm AEST on 1800 838 777, or submit an enquiry at www.phoenixaustralia.org/working-with-veterans/dva-practitioner-support-service.