Macquarie University’s MindSpot is a boon to (digital) mental health

Macquarie University’s MindSpot delivers mental health services remotely, and helped thousands during Covid’s enforced isolation.

Macquarie University's Nick Titov, director of digital mental health service MindSpot, conducts outreach to stakeholders in regional and remote Australia.

When a pandemic-related lockdown hits, clients of a digital health service don’t miss a beat: they are already hooked into a system custom built for effective remote counselling.

The rub, says MindSpot director Nick Titov from Macquarie University, is that the psychologists and other staff who have been operating from a clinic suddenly have to work from home as well as deal with the inevitable influx of new clients as enforced isolation takes its toll on the general population.

“Our staff were also trying to provide care and empathy and remain professional every day,” Professor Titov says.

“Just before the pandemic, we had about 1600 people per month and our figures for September (2021) show more than 2600.”

He and colleagues set up MindSpot at Macquarie University in 2013, with $16.4m from the federal Department of Health, and have received regular funding since.

Telehealth and mental telehealth are not new but the Macquarie-based national service’s first point of difference, he says, is that clients can gain access to the service online and via telephone, rather than one or the other.

“The second is that we employ experienced mental health professionals who deliver the services. An increasing number of digital services are fully automated and our experience is that they don’t provide the same outcomes or experience to consumers.”

At MindSpot, clients register, fill out a questionnaire, speak to a therapist and are prescribed eight weeks of treatment, with regular phone and messaging check-ins.

There is an option to work through treatment with minimal therapist involvement. However, if what the client reveals in the questionnaire or subsequently is concerning, a therapist will contact them immediately and suggest they call a crisis line or avail themselves of other services.

During the pandemic, Professor Titov and the team have defined five areas to work on for maximal wellbeing: clear thinking; doing the things you love; having plans and goals; maintaining healthy routines; and social connections.

“The impacts of events are often made worse by the changes we make in our thinking and our actions,” he says. “We tend to stop doing things we usually do and which help to keep us well.” While negative thinking patterns can be reversed, it can take weeks of practice to start feeling better.

The 30,000 people who have used MindSpot programs so far have reported their symptoms were halved as a result and remained that way at the three-month follow-up. About 40 per cent of clients are based in rural and remote areas, including offshore, in places such as Christmas Island.

Covid-19 clients have ranged from those who were fearful at the start, when no one knew what was going to happen, to those who lost their jobs (although JobKeeper and other measures ameliorated that), to those returning from overseas to hotel quarantine for the first time. The first lockdowns also precipitated referrals from psychologists and therapists who could no longer see their clients face-to-face.

“Many psychologists and therapists weren’t prepared for the virtual model of care,” Professor Titov says. “And as lockdowns continued, we saw more people visit us because of pre-existing psychological vulnerabilities, including anxiety and depression, which were being triggered.

“Then we had people with, for example, severe social anxiety, or obsessive compulsive disorder, many of whom had actually been coping very well with lockdown. But they were triggered by the idea of having to resume a normal life.”

MindSpot recruited more therapists and brought forward plans to upgrade the clinical software, increasing its capacity to handle clients by 20 per cent.

There have been some counterintuitive outcomes. “The volume of people seeking services has increased dramatically, but the average severity of symptoms of anxiety, depression or stress haven’t increased,” Professor Titov says. “In parallel, concerns that people had about suicidal thoughts and plans reduced.

“What we’ve seen in the community is that all of us have been stressed and some people for very good reasons, but it is actually normal human stress. It’s not actually a mental health problem.”

MindSpot 1800 614 434, www.mindspot.org.au;
Lifeline 13 11 14.