title: Procedures for risk management and a review of crisis referrals from the MindSpot Clinic, a national service for the remote assessment and treatment of anxiety and depression.
abstract: BACKGROUND
  The MindSpot Clinic (MindSpot) provides remote screening assessments and therapist-guided treatment for anxiety and depression to adult Australians. Most patients are self-referred. The purpose of this study was to report on the procedures followed to maintain the safety of patients and to examine the circumstances of urgent referrals to local services made by this remote mental health service.
  
  
  METHODS
  A description of the procedures used to manage risk, and an audit of case summaries of patients who were urgently referred for crisis intervention. The reported measures were scores on self-report scales of psychological distress (K-10) and depression (PHQ-9), the number reporting suicidal thoughts and plans, and the number of acute referrals.
  
  
  RESULTS
  A total of 9061 people completed assessments and consented for analysis of their data in the year from 1 July, 2013 to 30 June, 2014. Of these, 2599 enrolled in online treatment at MindSpot, and the remainder were supported to access local mental health services. Suicidal thoughts were reported by 2366 (26.1 %) and suicidal plans were reported by 213 (2.4 %). There were 51 acute referrals, of whom 19 (37.3 %) lived in regional or remote locations. The main reason for referral was the patients' self-report of imminent suicidal intent. The police were notified in three cases, and in another case an ambulance attended after the patient reported taking an overdose. For the remaining acute referrals, MindSpot therapists were able to identify a local mental health service or a general practitioner, confirm receipt of a written case summary, and confirm that the patient had been contacted, or that the local service intended to contact the patient.
  
  
  CONCLUSIONS
  Around 0.6 % of the people seeking assessment or treatment by MindSpot were referred to local mental health services for urgent face to face care. The procedures for identifying and managing those patients were satisfactory, and in every case, either emergency services or local mental health services were able to take over the patient's care. This review suggests that the uncertainty associated with taking responsibility for the remote treatment of patients who disclose active suicidal plans is not a major impediment to providing direct access online treatment for severe forms of anxiety and depression.
authors.affiliation: MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia. olavn@ozemail.com.au.|University of Sydney, 92 Parramatta Road, Camperdown, NSW, 2050, Australia. olavn@ozemail.com.au.|University of New South Wales, Anzac Pde Kensington, NSW, 2033, Australia. olavn@ozemail.com.au.
authors.forename: Olav
authors.initials: O
authors.lastname: Nielssen
authors.affiliation: MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia. blake.dear@mq.edu.au.|Macquarie University, Balaclava Road, North Ryde, NSW, 2019, Australia. blake.dear@mq.edu.au.
authors.forename: Blake F
authors.initials: BF
authors.lastname: Dear
authors.affiliation: MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia. lauren.staples@mq.edu.au.|Macquarie University, Balaclava Road, North Ryde, NSW, 2019, Australia. lauren.staples@mq.edu.au.
authors.forename: Lauren G
authors.initials: LG
authors.lastname: Staples
authors.affiliation: MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia. rebecca.dear@mq.edu.au.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dear
authors.affiliation: MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia. kathryn.ryan@mq.edu.au.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ryan
authors.affiliation: MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia. carol.purtell@mq.edu.au.
authors.forename: Carol
authors.initials: C
authors.lastname: Purtell
authors.affiliation: MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia. nick.titov@mq.edu.au.|Macquarie University, Balaclava Road, North Ryde, NSW, 2019, Australia. nick.titov@mq.edu.au.
authors.forename: Nickolai
authors.initials: N
authors.lastname: Titov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000554:Ambulatory Care Facilities; D001008:Anxiety Disorders / Q000628:therapy*; D001315:Australia; D003419:Crisis Intervention / Q000379:methods*; D003866:Depressive Disorder / Q000628:therapy*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D019114:Remote Consultation / Q000379:methods; D012308:Risk Management; D057566:Self Report; D059020:Suicidal Ideation; D055815:Young Adult