Great Expectations and e-mental health: The role of literacy in mediating access to mental healthcare

Background and objectives e-Mental health (eMH) resources are designed to provide early intervention and treatment to patients with common mental disorders.They have been proclaimed as a key strategy to address the treatment gap for disadvantaged patients who have difficulty accessing face-to-face services.The evidence for the efficacy of eMH is good, but clinical trials often fail to report the key demographic characteristics of participants, including literacy levels and socioeconomic disadvantage.Risk factors for poor literacy include low socioeconomic status, cultural and linguistic diversity, rurality and Aboriginal or Torres Strait Islander background.These are also the patients most in need of services. MethodWe assessed the readability of evidence-based eMH programs in Australia using two measures of reading age. ResultsThe literacy required for eMH engagement is beyond the reach of most Australians. DiscussionText-based eMH programs may exacerbate the treatment gap rather than relieve it.IN RECENT YEARS, increasing numbers of e-mental health (eMH) programs have been designed to provide treatment and early intervention to patients with depression, anxiety and other common mental disorders (Box 1).These tools can be used with health professional support or independently by patients.Recent government initiatives, including the Fifth National Mental Health and Suicide Prevention Plan, 1 have suggested eMH provides a solution to the significant treatment gap that exists for patients with mental health conditions, especially those who cannot access face-to-face services.2 Mental illness is more common among Aboriginal and Torres Strait Islander peoples, 3 people in rural and remote communities, 4 and people with low socioeconomic status. 4 Unfortunately, these people access mental health services at far lower rates than the general population.5 There is an assumption that eMH will address this treatment gap by providing an accessible, affordable, empowering and patient-centred solution for these patients and others who currently lack access to mental health services.6