Clinical Practice Models for the Use of E-Mental Health Resources in Primary Health Care by Health Professionals and Peer Workers: A Conceptual Framework

Abstract

Background: Research into e-mental health technologies has developed rapidly in the last 15 years. Applications such asInternet-delivered cognitive behavioral therapy interventions have accumulated considerable evidence of efficacy and someevidence of effectiveness. These programs have achieved similar outcomes to face-to-face therapy, while requiring much lessclinician time. There is now burgeoning interest in integrating e-mental health resources with the broader mental health deliverysystem, particularly in primary care. The Australian government has supported the development and deployment of e-mentalhealth resources, including websites that provide information, peer-to-peer support, automated self-help, and guided interventions.An ambitious national project has been commissioned to promote key resources to clinicians, to provide training in their use, andto evaluate the impact of promotion and training upon clinical practice. Previous initiatives have trained clinicians to use a singlee-mental health program or a suite of related programs. In contrast, the current initiative will support community-based serviceproviders to access a diverse array of resources developed and provided by many different groups.Objective: The objective of this paper was to develop a conceptual framework to support the use of e-mental health resourcesin routine primary health care. In particular, models of clinical practice are required to guide the use of the resources by diverseservice providers and to inform professional training, promotional, and evaluation activities.Methods: Information about service providers’ use of e-mental health resources was synthesized from a nonsystematic overviewof published literature and the authors’ experience of training primary care service providers.Results: Five emerging clinical practice models are proposed: (1) promotion; (2) case management; (3) coaching; (4)symptom-focused treatment; and (5) comprehensive therapy. We also consider the service provider skills required for each modeland the ways that e-mental health resources might be used by general practice doctors and nurses, pharmacists, psychologists,social workers, occupational therapists, counselors, and peer workersConclusions: The models proposed in the current paper provide a conceptual framework for policy-makers, researchers andclinicians interested in integrating e-mental health resources into primary care. Research is needed to establish the safety andeffectiveness of the models in routine care and the best ways to support their implementation.