Bill works with a concrete washdown crew in the Pilbara, just one of many young men employed by the mining industry in Western Australia. Originally from Sydney, Bill has found himself on the other side of the country, far from home and his old school mates, working long hours in a very 'blokey' environment that can be very tough at times. Although the financial rewards are significant, Bill has found himself feeling quite alone and without access to any emotional support. However, a quick Google search turned up a new counselling service called OnlineCounselling.com.au.
On the other side of Australia, in far north Cairns, Alicia is a teenager battling severe agoraphobia. After years of being bullied at school, Alicia's anxiety deepened until it became impossible to leave her family home without enduring a panic attack. She had tried different medications – Valium, Zoloft, Effexor – just to name a few, but they didn't address the core issue of how she felt about herself. Alicia's GP was a nice fellow and offered occasional home visits, but he wasn't a therapist and couldn't provide the assistance she required. During a recent visit from a friend, Alicia learned about a new website offering online counselling via Skype, and immediately registered with the service.
People all over Australia have difficulty accessing qualified psychologists and counsellors for a large variety of reasons. Geographically, more than 81% of Australian psychologists work in major cities, with the remainder in rural and remote areas. For example, in South Australia more than 92% of psychologists work within the metropolitan area. Specialist psychologists holding an endorsement (which requires extra years of post-graduate study and training) are even more underrepresented in some regions. In a review of psychology workforce data, the Psychology Board of Australia stated "[a close] view of the statistics reveals an uneven distribution of psychologists with an endorsed area of practice across the country, with some areas of practice having no practitioners in some states or territories."
A very telling statistic reported by the 2013 National Health Workforce Data Set (NHWDS) estimates the number of psychologists per 100,000 people for a particular region. In major metropolitan cities the study found an average of 91 psychologists per 100,000 people, 41 per 100,000 in rural areas, and only 30 per 100,000 in remote areas. Therefore, people living in major cities have two to three times more access to psychologists than those living in rural and remote regions.
* (For comparison purposes, there are an average of 380 medical practitioners per 100,000 people in major Australian cities).
The data suggests there is a high need to improve access to mental health services in rural and remote communities, and online counselling is one solution. With the high market penetration of iPhones, iPads and other smartphones, anyone with access to the internet and a web camera (installed on most new phones) can now arrange a virtual 'visit' with a psychologist or counsellor online.
Another group of people who can benefit from improved access to counselling services are those who are homebound due to a physical or mental illness, or are unable to easily access transportation. Clinical psychologist Jonathon Walker runs a bulk-billed home visit service in Melbourne and reports high uptake of his services amongst cancer patients, people with agoraphobia or severe depression, mums who can't afford childcare, and older adults who can't drive.
"Being able to receive counselling at home is a great relief for many people who have difficulty leaving the house, and online counselling is a virtual extension of my home visit service", said Jonathon. When asked whether clinic-based or online counselling is superior, Jonathon replied, "while face-to-face counselling is likely to be slightly more effective in terms of quickly establishing a therapeutic relationship – proximity helps in this regard – there is a severe shortage of psychologists willing to make home visits or live in rural areas, so online counselling is immeasurably better than no counselling at all".
“There is a severe shortage of psychologists willing to make home visits or live in rural areas, so online counselling is immeasurably better than no counselling at all”
With a fee of $35 for a 30 minute online counselling session, Jonathon believes his new service is both convenient and affordable. "Prior to November 2006, the so-called 'dark days' before the introduction of Medicare rebates for psychologists, clients would have to pay around $150, completely out-of-pocket, for a 50 minute psychology consult. For ongoing, weekly counselling these fees start to add up quickly, and not surprisingly only the affluent could afford to see a psychologist for counselling on a regular basis."
(Edit – July 30, 2016: Online counselling is now completely free, and appointments are 50 minutes duration)
"The issue we have now is Medicare refuses to cover psychology services delivered via the internet. Whether that's a good or bad decision isn't for me to judge, but it forced us to be creative in order to find a cost effective solution to deliver counselling services to people who might be struggling financially. To achieve that goal we cut out the major costs of running a counselling service - leasing office space, renting business telephone lines and office-based internet, travel time, marketing, administration - even petrol, car maintenance and parking can add significant costs to running a counselling business. Often a third of a psychologist's fee is simply covering expenses, and our online counsellors avoid these expenses completely by working from their home offices."
"Our other strategy to keep fees as low as possible was to reduce appointment duration from 50 minutes to 30 minutes. Having worked in full-time therapy roles for the past 10 years it became apparent the most important therapeutic work was achieved in the first 30 minutes of a session. The final 20 minutes is usually spent going over the same issues, or less critical issues, so we thought it might actually be more efficient to have shorter, more affordable appointments. As an analogy, GPs are forced to get a lot done in 15 minutes, and half an hour with a GP feels like a long appointment. Likewise, 30 minute counselling sessions force our practitioners to work efficiently and address their clients' most pressing issues without any fluffing around."
"After two months of trialling these shorter appointments, several benefits have emerged for both our clients and our counsellors – clients can check-in with their counsellors more frequently without breaking the bank, and counsellors are reporting less mental fatigue, which tends to happen after hour-long, back to back appointments. Counsellors are also really enjoying the variety of clients they see – normally their client base is dependent on their physical location, but our counsellors are speaking to a huge range of clients from all over Australia. On any given afternoon I could be speaking to Bill from Pilbara, and 45 minutes later I'm counselling Alicia from Cairns – the diversity is amazing."
The Online Counselling website is due for launch in early 2016 but started to receive bookings soon after being indexed by Google. "I wasn't quite prepared for such a strong initial response, and I'm still in the process of interviewing more counselling staff. In a few months we'll have enough counsellors to accommodate demand, but in the meantime we're still taking bookings and doing our best to see everyone. This is new for us and also new for Australia, so it's a very exciting time for all involved."
For more information, or to access online counselling services, please visit OnlineCounselling.com.au
Media enquiries may contact Jonathon Walker, Clinical Psychologist, via the website.
 How do we improve psychology services for all Australians?
 Psychology Board of Australia: The value of diversity in the profession
 Australian Institute of Health and Welfare: Psychologist workforce
 Australian Institute of Health and Welfare: How many medical practitioners are there?