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. Method We assessed the readability of evidence-based eMH programs in Australia using two measures of reading age. Results The literacy required for eMH engagement is beyond the reach of most Australians. Discussion Text-based eMH programs may exacerbate the treatment gap rather than relieve it.