Another call for increased mental health support, and how we can help.
I work as a GP and feel powerless to treat patients with mental illness.
During medical school I was made aware, in an abstract sense, of the scale of the problem that mental health disorders pose to our healthcare system. Systematically I learned how each one was treated, readying myself to regurgitate management plans in a viva. With my hurried response to the examiners’ question, the hypothetical situation would be resolved, my patient healed.
Years later I am working as a junior doctor in general practice. The receptionists have left a note on the electronic record: “needs to talk about mental health.” My opening gambit is always to listen. I listen to the stories of childhood abuse suffered. I listen to the scores of people who feel that they just cannot go on anymore: work, home, there is no escape for them. I hear about the multiple visits to the emergency department after suicide attempts. I was not prepared for this. I was not prepared for the 25% of adults in the UK who have experienced a mental illness.
Take depression as an example. It is typically expected to affect one in 10 people throughout their lives. It is the single largest cause of disability worldwide. Depression costs the UK £7.5bn per year due to cost of healthcare and loss of employment. The staggering prevalence of depression means that GPs will see many people each week, if not each day, with the condition.
Patients ask what we can do to help. They need this sorted out. My mind is cast back to the exams. I know this one. I default to the script. I tell you about cognitive behavioural therapy, a talking therapy which can be effective in depression. Then I tell you about the waiting list; for some, it can exceed a year. I tell you about the medications, some of which there is good evidence to suggest will help in certain cases. Then I tell you about the side effects: weight gain, nausea, constipation. Some of them might even make you more anxious at first. The risk-benefit ratio can be precarious. Patients may have to wait months for specialist psychiatric input if it is required.
This is why, when patients describe non-specific symptoms that could theoretically be attributed to physical or psychiatric illnesses, it is easy to desperately think of alternative diagnoses. If you have told me your mood is low, you are tired and have put on weight, we could check your thyroid hormones. Maybe they are low – we can treat that. Something is deficient and I can replace it. I can give you a pill and ask for you to book some follow-up blood tests. With a knowing smile I have diagnosed you and sent you away with effective medication.
This is not the case with mental illness. I have to work outside of the comfortable diagrams. It is more unknown. Patients ask what depression is. They ask if it is genetic. They ask if it is their fault. I do my best to explain. I give our current best guess: there is an imbalance or dysfunction in the brain’s chemical messengers, neurotransmitters. But ultimately, our understanding of mental illness is relatively poor.
The 10 minutes available to a GP for each appointment is barely enough to listen, let alone understand and provide holistic care. Mental health disorders pull doctors out of the comfortable and traditional doctor-patient paradigm, often rendering us inert.
Changes are already being put in place, though. The Five Year Forward View For Mental Health from NHS England identified parity of esteem between physical and mental health as an essential goal. This reflects broader institutional acknowledgement of the challenge.
In recognition of gargantuan waiting times, in 2008 NHS England rolled out the Improving Access to Psychological Therapies programme, which aims to provide effective talking therapies to those with anxiety and depression. Since inception the programme has grown steadily but currently 960,000 patients per year have been able to access the service, only approximately 16% of those with depression and anxiety in the UK.
Despite these efforts the magnitude of this problem is yet unmatched by institutional and scientific progress. The reality of helping those with mental illness in primary care is a monumental challenge. I wish we could do more and I wish the system served these patients better.
Key takeaways from our team's experience at the 2019 annual psychiatry conference held in Cairns
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Call to Mind can now offer all Australians telemental health support – an important step in the right direction as uncertainty and anxiety around Covid-19 continues to grow.
CALL TO MIND PTY LTD
TERMS OF ACCESS FOR THE CALL TO MIND ONLINE PLATFORM
These terms apply to all Call to Mind Services you access through Call to Mind Pty Ltd ACN 623 520 598 / ABN 93 254 104 171 (“Call to Mind”).
In these terms:
“Call to Mind Services” means the technology, communication and administration services provided by Call to Mind when you access the Call to Mind online platform.
“Psychiatry Services” means the health and psychiatry services provided to you directly by the psychiatrist you are connected to using the Call to Mind online platform.
1. DESCRIPTION OF CALL TO MIND SERVICES
If you create an account with us, we will provide Call to Mind Services to you. These are technology, communication and administration services to enable you to use the online platform to connect with your psychiatrist. We will facilitate a connection and communication with a psychiatrist by providing personal contact details.
You will also have a separate relationship with your psychiatrist who is responsible for providing the Psychiatry Services to you directly. You acknowledge that your psychiatrist may require you to agree to other terms and conditions relating to the Psychiatry Services.
Call to Mind does not provide Psychiatry Services or employ or engage psychiatrists. All psychiatrists who use the Call to Mind platform practise independently.
Call to Mind Services include but are not limited to:
(a) A website (calltomind.com.au) which provides a platform that performs functions such as:
(b) administration services including reception, triaging of referrals, billing, managing any confidential health or personal information Call to Mind receives from your referring general practitioner or psychiatrist with your consent (see “Confidentiality and Privacy” and “Records” below) and answering any questions you may have. Administration services are provided via email, or in certain situations by phone; and
(c) technical support services.
Call to Mind Services do not include:
(a) crisis management (see “No Crisis Management” below);
(b) mental health advice independent of Psychiatry Services; and
(c) clarification or interpretation of the diagnosis, formulation, or management advice provided by individual psychiatrists.
We do not charge for Call to Mind Services. The only charge is your psychiatrist’s charge for the Psychiatry Services. Call to Mind does charge psychiatrists a fee to use the platform.
In agreeing to these conditions, you also consent to being added to the Call to Mind mailing list for communication after your appointment.
2. NO CRISIS MANAGEMENT
Call to Mind and psychiatrists appearing on the online platform do not admit patients to hospital. Call to Mind is also not a crisis service and therefore if you are in crisis or feel your health is an emergency requiring immediate attention, you will need to contact your local mental health service or attend an emergency department.
Lifeline may also be of assistance in a crisis and can be contacted by telephoning 13 11 14.
If there is an immediate risk of harm to yourself or someone else, it is more appropriate to telephone emergency services on 000.
3. OUR RESPONSIBILITIES
3.1 Connecting you to your psychiatrist
We receive referrals from general practitioners. The psychiatrists that provide Psychiatry Services have indicated their areas of interest and particular expertise. Based on the referral from your general practitioner, we will offer the referral to one or more psychiatrists. The psychiatrist who accepts the referral will directly provide the Psychiatry Services to you.
All psychiatrists appearing on the online platform must be Fellows of the Royal Australian and New Zealand College of Psychiatrists (FRANZCP) and must have Specialist Registration as a Psychiatrist with the Australian Health Practitioner Regulation Agency (“AHPRA”). We will provide you with all the relevant details of your psychiatrist, including their name, qualification and AHPRA registration number. You can check the registration of your practitioner at https://www.ahpra.gov.au/ and your practitioner’s fellowship status by contacting The Royal Australian and New Zealand College of Psychiatrists.
3.2 Providing you access to the online Call to Mind platform
We will provide you with the details of your appointment including login and other details to access the online Call to Mind platform. You must keep your login details confidential.
The platform will enable you to manage your access to the Psychiatry Services and connect you with your psychiatrist using either video or teleconferencing facilities. If your psychiatrist is unable to attend an appointment, we will assist you to reschedule the booking.
4. VIDEO CONSULTATIONS
If your consultation will take place via videoconference, you acknowledge that:
(a) you understand how the videoconferencing technology will be used to provide such a consultation;
(b) you understand that the consultation will not be the same as a direct patient/psychiatrist visit because you will not be in the same room as your psychiatrist;
(c) you understand there are potential risks to this technology, including but not limited to interruptions and technical difficulties;
(d) you understand that this video consultation is done over a secure encrypted communication system, but you accept the risk that security issues could affect confidentiality;
(e) you understand that you or the psychiatrist can discontinue the video consultation if it is felt that the videoconferencing connections are not adequate for the situation. If this is the case your psychiatrist may endeavour to continue the consultation over the telephone. In that case, the lack of visual data may limit your psychiatrist’s capacity to fully assess your mental state;
(f) you understand that depending on the referral information the psychiatrist may request that a health care person sit in the room with you during the consultation to assist in the consultation and to help provide for continuity of care;
(g) in very rare situations, technical support may be required and this may involve a technical support officer. We will discuss with you in advance how to maintain your privacy in this situation, and technical support officers are bound by the same principles of confidentiality. You may also elect to cease the consultation until the technical issue is resolved or reschedule to another time;
(h) you have had the alternatives to a video consultation explained to you and you understand that aspects of investigation and treatment such as prescription of medications and physical investigations may need to be undertaken by your general practitioner under the guidance of the psychiatrist; and
(i) you understand that the consultation will not be recorded or photographed.
5. YOUR USE OF CALL TO MIND SERVICES
You agree to use the online Call to Mind platform and the Call to Mind Services to access any and all Psychiatry Services which you are eligible for as part of your program. Your agreement with us relates only to the use of Call to Mind Services, but does not extend to any medical consent between you and your psychiatrist. Your psychiatrist will speak to you directly about any required psychiatry consents.
6. YOUR RESPONSIBILITIES
You must attend all scheduled appointments, and tell us in advance if you can no longer attend. If you do not give us 2 business days’ notice in cancelling an appointment, you may be charged a fee of $150.00 for the consultation which will not be eligible for a Medicare rebate. You must also talk to us if you have any concerns regarding the online Call to Mind platform.
Your psychiatrist’s fees will depend on the Services requested. We will provide you with details of the fees prior to you having your first consultation with your psychiatrist. You acknowledge that fees for the Services may change. Any discussion regarding fees is a matter between you and your psychiatrist.
You acknowledge that we collect fees as your psychiatrist’s agent. You acknowledge that we are remunerated by psychiatrists for providing the online platform. General information on fees may be provided via Call to Mind Services (i.e administration staff) but the Psychiatry Service and its fee is between you and the individual psychiatrist.
If you live in an ASGS-RA 2-5 area, your first appointment may be bulk-billed if the psychiatrist completes a one-off assessment. If your psychiatrist feels that they can do an assessment in up to three sessions and then you can be managed by your GP on an ongoing basis without further input from the psychiatrist, they may conduct a further 1-2 sessions to complete the assessment and recommendations to your GP. If you want ongoing treatment from the psychiatrist and the psychiatrist is able to offer this, then there is an out of pocket expense for ongoing treatment. The Call to Mind admin staff will provide you with the details of these fees prior to the appointment.
If you live in an ASGS-RA 1 area, your appointments will be privately billed and may attract a Medicare reimbursement, depending on the service provided. The Call to Mind admin staff will provide you with the details of these fees prior to the appointment.
If you cancel your appointment with less than 2 business days’ notice or do not attend the appointment, a $150 cancellation fee is payable.
We use the company Pin Payments to process fees from your credit or debit card. Pin Payments has the highest level of security possible with the “Payment Card Industry Data Security Standard 2018”, all your payment data is securely encrypted and not transmissible to a third party. We do not have access to your card details. We take your credit card details over the phone and enter them directly into the Pin Payments system. We do not write down your credit card details and are unable to retrieve your credit card details after storing them. They are stored securely in industry standard encrypted format. You can remove or change your payment details at any time.
We will debit your card in the week prior to your appointment. If you are eligible for Medicare reimbursement, this will be processed after your appointment has taken place. If there are insufficient funds in your account, we will contact you to clarify and it is possible your appointment could be cancelled. If the appointment is cancelled by Call to Mind or if there is a change in the billing amount, we will arrange for appropriate reimbursement.
If you cancel your appointment within less than 2 business days’ notice or do not attend the appointment, you authorise us to charge your credit card a cancellation fee of $150.00.
We will submit your claim for the Medicare rebate on your behalf and your rebate will automatically be credited to the bank account you have stored with Medicare. Alternatively we can provide the invoice so that you can submit the Medicare rebate yourself.
8. CONFIDENTIALITY AND PRIVACY
Any information you disclose to us or our contractors as part of the Services will be kept confidential by us, our contractors, employees and agents. We will not disclose such information without your prior written consent or if required to disclose the information by law, for example, to a court in response to a subpoena.
If any of your personal or health information is disclosed to us, we will treat that information in accordance with the Privacy Act 1988 (Cth) and any applicable health records legislation.
Your psychiatrist is also required to store, record and treat your personal and health information in accordance with any applicable legislation.
All records created by us or our staff as part of the Call to Mind Services belong to us and remain our property. Our records will only relate to administrative matters such as personal contact details, appointment details and payment.
Your psychiatrist is responsible for keeping all medical and health records created in connection with the Psychiatry Services.
If you have any concerns and wish to make a complaint regarding the Psychiatry Services you must make the complaint directly to your psychiatrist or AHPRA. Call to Mind is not responsible for handling any complaints you may have regarding the provision of the Psychiatry Services.
If you have any concerns regarding the Call to Mind Services, please direct them to Call to Mind at firstname.lastname@example.org.
11.1 Limitation of Liability
(a) To the extent permitted by law, we exclude all warranties, conditions or terms, other than those expressly set out in these terms. Nothing in this clause has the effect of excluding, restricting or modifying the application of any legislation (including the Competition and Consumer Act 2010 (Cth)).
(b) To the extent we are not entitled to exclude a warranty, condition or term then our liability for breach is limited to either the resupply of the Services or payment of the reasonable cost of having the Services resupplied.
(c) Our total liability to you for any loss or damage (including indirect and consequential loss or damage), caused by, resulting from, or in relation to the Services, including whether arising from breach of contract, negligence or any other tort, in equity or otherwise, and whether we were advised of the possibility of such loss or damage, is limited (to the extent permitted by law) to the fees paid for the relevant Services.
(d) To the extent permitted by law, our liability to you is limited to that part of the loss or damage (excluding interest and costs) suffered by you, which is ascribed to us under proportionate liability legislation.
Either you or we may terminate this engagement at any time with at least two business days’ notice. If we terminate the agreement our administration staff will attempt to give you alternatives. Otherwise we recommend you contact your general practitioner, local mental health service, or emergency services.
13. CHANGES TO THESE TERMS AND CONDITIONS
As we operate an online platform, it is reasonable for Call to Mind to require all persons accessing the online platform to abide by the same terms and conditions.
We may update these terms and conditions at any time. We will provide you with 14 days’ notice of any change to these conditions. If you have any concerns or do not agree to the changes to the terms, please notify us as soon as possible.
14. APPLICABLE LAW
These terms are governed and must be interpreted in accordance with Victorian law.
1. ABOUT THIS POLICY
This section explains how to read this policy and describes its purpose.
1.1 Interpretation of this document and general overview
Defining specific terms:
1.1.1 “APPs” refer to the Australian Privacy Principles in the Privacy Act 1988 (Cth).
1.1.2 “Call to Mind”, “we”, “us”, “our” means Call to Mind Pty Ltd ABN .
1.1.3 “Call to Mind Services” means the technology, communication and administration services provided by Call to Mind when you access the Call to Mind online platform.
1.1.4 “Health Information” means information about the physical, mental or psychological health or disability of an individual or an individual’s wishes about the provision of health services.
1.1.5 “Personal Information” means information that is capable of identifying an individual such as name, address and date of birth.
1.1.6 “Privacy Information” means Personal Information and Sensitive Information.
1.1.7 “Psychiatry Services” means the health and psychiatry services provided using the Call to Mind online platform and other related services provided now or in the future by us.
1.1.8 “Sensitive Information” includes information relating to religion, racial or ethnic origin.
1.1.9 “You”, “your” means any person who accesses the Call to Mind Services or Psychiatry Services.
Call to Mind is subject to the Australian Privacy Principles as laid out in the Privacy Act 1988.
1.2 Purpose of this policy
2. TYPE OF INFORMATION WE COLLECT AND HOLD
Call to Mind collects information about you in order to provide Call to Mind Services and facilitate the Psychiatry Services.
Types of Personal Information we collect:
2.1 Health providers
We may collect Personal Information regarding health providers (for example, general practices, independent psychiatrists), and their employees to facilitate the provision of Psychiatry Services. The type of information can include:
2.1.2 Contact details
2.1.3 Role/health services provided
2.1.4 Connection with Call to Mind
Call to Mind generally collects information about clients for the provision of Psychiatry Services. Call to Mind collects personal details to facilitate or arrange health services, maintain client records, manage service demand and in some cases, provide health services.
Where Call to Mind provides a health service, Call to Mind will collect Health Information and Sensitive Information. This information is needed to co-ordinate referrals for the Psychiatry Services and ensure deliver of the appropriate services.
The types of information collected can typically include (this list is not exhaustive):
2.2.1 Contact details (name, address, telephone number, email address, next of kin)
2.2.2 Age, date of birth, gender, marital status
2.2.3 Driver’s licence number, Medicare number
2.2.4 Medical history, treatment records, images, photographs, family medical histories
2.2.5 Referrals to and from other practitioners and their reports
2.2.6 Ethnic origin (for example, to assess your eligibility for free health services)
2.2.7 If payments or co-payments are required, banking/credit card details
2.3 Website visitors
For our website visitors, we collect information such as your IP address, internet service provider, the web page directing you to our website and your activity on our website. This information is usually anonymous and we do not use it to identify individuals. However, due to the nature of internet protocols, such information might contain details that identify you. This information is collected to ensure that our information has reached its target audience.
2.4 Prospective employees and directors
We collect Personal Information regarding prospective employees, regarding their skills, interests, qualifications and experience to:
2.4.1 Assess their suitability for potential employment with us; and
2.4.2 Match them to suitable projects or roles.
3. HOW WE COLLECT YOUR INFORMATION
We may collect Personal Information (not including sensitive information) from people through our marketing, business development, operational, human resources, research or other activities.
We have a general policy to collect Personal Information directly from you, unless it is unreasonable or impracticable to do so.
We will need your written consent to collect Sensitive Information (which includes health information) about you.
3.1 Health providers
We generally collect Personal Information directly from individuals. However, for some health providers, we may collect your Personal Information from colleagues or other health providers and stakeholders, or clients.
In some cases, we collect your Personal Information from public sources (for example national health practitioner register, internet) or through your memberships (for example with peak bodies).
Call to Mind usually collect Personal Information directly from individuals and their referring clinican unless it is unreasonable or impracticable to do so. We collect Health and Sensitive Information with your consent in a fair and unobtrusive way.
We also collect information about clients from:
3.2.1 Clients and their representatives through forms, agreements, mail, email, telephone, in-person inquiries and website inquiries
3.2.2 Referrers and third parties (eg specialists or providers outside the clinics or the programs)
3.2.3 Publicly available sources of information
3.3 Website visitors
We collect data from our website using various technologies, including cookies. A cookie is a text file that our website sends to your browser which is stored on your computer as a tag identifying your computer to us. You can set your browser to disable cookies. However, some parts of our website may not function properly (or at all) if cookies are disabled.
3.4 Prospective employees
We generally collect Personal Information directly from the prospective candidate, but may also do so from recruitment agents, recruiters, referrers, referees, Call to Mind officers/employees or other knowledgeable parties where relevant to the recruitment process.
We collect information about employees and others directly from those persons.
In some cases, we collect information about such persons:
3.5.1 Through forms, agreements, general inquiries
3.5.2 From researchers or contractors engaged by Call to Mind
3.5.3 Public sources (for example national health practitioner register)
4. DIRECT MARKETING
4.1 Collecting information indirectly about an individual for marketing to that individual
If Call to Mind plans to engage in direct marketing using or disclosing information collected:
4.1.1 Indirectly about that individual, or
4.1.2 From the individual and the individual would not reasonably expect us to use or disclose the information for marketing purposes,
Call to Mind must first obtain consent, unless an exception set out in the APPs applies.
All subsequent direct marketing you receive will include an easy opt-out procedure if at any time you wish us to cease sending you information.
4.2 Collecting information directly about an individual for marketing to that individual
If we collect information about you and you would reasonably expect us to use or disclose the information for the purpose of marketing, we will use an opt-out procedure in all our marketing communications. This means you will be able to easily unsubscribe from all future marketing communications.
5. PURPOSE FOR WHICH WE COLLECT AND DEAL WITH YOUR INFORMATION
As a general principle, we only use Privacy Information for the primary purpose for which we collect the information or a secondary purpose related to the primary purpose for which you would reasonably expect us to use the collected information. All the information collected by Call to Mind will be used only for the purpose providing the Call to Mind Services or facilitating the Psychiatry Services.
We will make you aware of the purpose for which we collect your information by notifying you about all the relevant matters of that collection.
We will not use your information for an unrelated secondary purpose unless we obtain your written consent or an exception applies, such as it is impracticable to obtain your consent and we believe that collecting, using or disclosing your information is necessary to lessen a serious threat to the life, health or safety of any individual.
5.1 Health providers
We collect Personal Information regarding individual health practitioners and the employees, volunteers and officers of our health providers:
5.1.1 To facilitate referrals for clients accessing Psychiatry Services
5.1.2 In the course of contracting with them or arranging for the delivery of health services for clients
5.1.3 To distribute information about our activities and publications by way of direct communications/marketing to improve our health system and the health of our clients
We may collect Personal Information regarding your interests to personalise your interactions with us.
We collect and use Personal and Health Information for the purpose of:
5.2.1 Providing Call to Mind Services
5.2.2 Facilitating access to Psychiatry Services;
5.2.3 Managing service demands for the services we provide
The following are specific examples of when we collect and use your Personal Information:
5.2.4 To make appointments and send reminder notices
5.2.5 To communicate with other health practitioners as part of a multidisciplinary team or a referral
5.2.6 To maintain your personal information, our client records and other medical registers
5.2.7 To inform your nominated emergency contacts (next of kin) of a medical condition
5.2.8 To disclose your health information to paramedics and health professionals in a medical emergency
5.2.9 To use de-identified information to model or forecast service demand]
5.2.10 To liaise with a person’s nominated representative or family members where needed
5.2.11 To improve our services through quality improvement activities, audits, surveys and program evaluations
5.3 Prospective employees
We use Personal Information about our prospective employees predominately to consider the application.
5.4 Website visitors
We use information regarding website visits for the purpose personalising of your website visit or to enable remarketing website functionality.
Call to Mind may also collect and use Personal Information from others for our operational, human resources, research referral or other corporate activities.
6. CROSS BORDER TRANSFER OR DISCLOSURE OF INFORMATION
In the event we engage in cross border transfer of information, such as routing or storing information on cloud servers located overseas or transferring information to an office of our company overseas, we will ensure that adequate security mechanisms are in place to protect your information. For example, we will enter into a contract with the cloud server that complies with the APPs and ensures the information is for the limited purpose of storing and managing the Personal Information.
7. MAINTAINING THE INTEGRITY, CURRENCY AND SAFETY OF YOUR PRIVACY INFORMATION
This section explains how Call to Mind holds your Privacy Information, how you can access your Privacy Information, update your Privacy Information, complain about an alleged breach of the APPs or make any related enquiry.
7.1 Maintaining currency of your information
Call to Mind relies on accurate and reliable information to deliver its services. If we are satisfied that any of the information we have about you is inaccurate, out-of-date, irrelevant, incomplete or misleading, or you request we correct any information, we will take reasonable steps to ensure the information held by us is accurate, up-to-date, complete, relevant and not misleading.
If we disclose your Privacy Information that is later corrected, we will, or else you may ask us to, notify the entity that received the incorrect information about that correction.
Should we refuse to correct the information, we will explain the reasons for refusal. We will also show you the complaint procedure if you wish to lodge a formal complaint about our refusal.
7.2 Safety of your information
All Privacy Information is securely stored using appropriate physical and/or electronic security technology, settings and applications, and by ensuring staff dealing with privacy information is trained in our privacy policies and procedures.
This policy are designed to protect Privacy Information from unauthorised access, modification or disclosure; and from misuse, interference and loss.
8. ACCESSING YOUR INFORMATION OR LODGING A COMPLAINT
8.1 Accessing and correcting information
You are entitled at any time, upon request, to access your Privacy Information held by us. We will respond within a reasonable time after the request is made and give access to the information in the manner requested by you, unless it is impracticable to do so. We are entitled to charge you a reasonable administrative fee for giving you access to the information requested.
Should you be refused access to your information, we will explain the reasons for refusal – any exceptions under the Privacy Act or other legal basis relied upon as the basis for such refusal – and, if you wish to lodge a formal complaint about our refusal, we will explain the complaint procedure.
8.2 Lodging a complaint
The Privacy Officer will make good faith efforts to rectify the issue and respond within a reasonable period after the complaint is made.
8.3 Contact details
Dr David Carmody
Call to Mind
Phone: 0438 643 217