Therapy is only one click away, is the message of a multitude of start-ups utilising technology to connect ‘users’ to treatment. Promising interconnectivity, ease of use, and convenience, apps and online platforms are transforming everyday access to services, and especially so in healthcare.

However, despite that optimistic vision of treatment on-demand, eternally at our fingertips, digital technologies pose significant challenges for mental health treatment.

The future of therapy?

Prior to the pandemic, digital NHS mental health services were limited, with only a small number of therapies such as Computerised Cognitive Behavioural Therapy (cCBT) being delivered online or via apps.

Although, the digitalisation of services is a key policy aim of the NHS Long Term Plan. The 2019 document set out ambitions for a 2023/24 deadline to build on the available technological options and support the development of new apps, digitally-enabled therapy models, and online resources to support mental wellbeing and post-therapy recovery.

These plans were unsurprisingly turbocharged over the last year due to restrictions on face-to-face contact, meaning that mental health services across the country had to quickly adapt to a new way of working and offering treatment.

Though this move did not work for everyone, as concerningly, research conduct by Mind during the Spring of 2020 discovered that many people were finding it difficult to access services over the various platforms, or they found that digital therapy was unsuitable for the treatment of their mental health condition.

A respondent in a Mind briefing illustrated this point: “I wouldn’t have got sectioned if I hadn’t had a terrible experience accessing therapy within my house digitally. They wouldn’t have let me leave the building in the state I was in the session. I left the group, turned my webcam off; no one checked up on me for an hour after the appointment. By that point, it was too late."

Trying to Connect report

Mind's new report, 'Trying to Connect’, details patient experiences in accessing mental health treatment remotely via phone or online during the pandemic. The findings reveal a mixed picture that shows that while digital therapy is here to stay and is beneficial to many, screen therapy also struggles to meet the needs of some and can actually exacerbate already established economic and social inequities.

The survey demonstrated that, while there was widespread support for remote services, one in three found support from services given over the phone was challenging to use. One in four responded that their mental wellbeing worsened as a result of using this form of contact.

Of those who access therapy via the phone or online, the data showed:

  • Almost two in three preferred face-to-face support.
  • One in ten said they often or always had issues accessing services.
  • One in three replied that they were often or always worried about confidentiality.

Respondents who preferred face-to-face support did so for various reasons.

A lack of privacy was a significant concern for many. For some, home is not a safe environment to speak freely about their experience, or they felt inhibited due to a fear that family members would overhear them talking to their therapist.

One respondent replied to the survey: "I am in a difficult relationship, and therapy at home just didn't work for me; I was used to having the time for myself to go to therapy and the privacy. I couldn't talk properly at home."

Also, particular mental health symptoms meant that remote access was inappropriate for their therapeutic needs. For example, symptoms of paranoia, hearing voice, hallucinations, or dissociation meant that digital access had the potential to exacerbate symptoms.

Another respondent to the report said: "I hear voices, and they get louder on the phone… [Escalating] symptoms. Online I try to dictate, but emails trigger psychosis and mania."

There was also an appreciation of the in-person therapeutic spaces, as potentially they allow for negative emotions to be contained in the boundaries of a particular place that isn’t your home environment.

And importantly, with remote services the report found that there were safeguarding issues, as there was a concern that warning signs that someone was at risk of suicide or self-harm could be potentially missed, or that a person who is reluctant to share the extent of their illness may find it easier to conceal their symptoms in a phone or video call.

Another issue was that as accessing mental health support required the use of technology, many respondents to the survey found it hard to access services because, without reliable broadband or a good phone signal, remote access is nigh on impossible.

“I had to purchase a new computer because of software issues, borrowing the money off a family member, this added additional stress to my mental health issues.”

Additionally, another potential problem of access highlighted in the report was digital exclusion or poverty, an often-overlooked aspect of deprivation – the pandemic has made this all too clear. The Good Things Foundations underscored this problem pre-pandemic, reporting that digital inequalities are becoming a social determinate of health, and especially so for people with a disability who are 35% less likely to have the digital skills to access services online.

On the other hand, the report also emphasised the successes of integrating digital technologies into mental health care.

The survey found that nearly half of people who took up the offer of mental health support over the phone or online found it easy to use, and four in ten responded that their mental health got better after using this form of support.

In particular, people appreciated the shorter waiting times, with a third of people feeling that the waiting time for support was reduced when compared to face-to-face, and many thought that the extra distance between them and their therapist allowed for a sense of anonymity and was able to speak more freely about the challenges that they are experiencing.

A person surveyed commented: "It allowed it to be still quite anonymous as I didn't have to turn the camera on rather than face-to-face, and I still got the same help I needed, so I am in a much better place for it."

The importance of choice in remote mental health services

Mind said of their findings that they emphasise that people who require mental health support should be given the option of either face-to-face treatment or treatment via technology. And that decision should be flexible, so once that choice is made, people should have the opportunity to move to the alternative and still receive the timely and high standard of care they require.

Geoff Heyes, Head of Health Policy & Influencing at Mind, commented: “During the pandemic, services have quickly adapted to help stop the spread of coronavirus. NHS mental health services delivered over the phone or online have been a lifeline for many, with lots of people telling us having the choice helped with things like childcare responsibilities and working schedules, particularly for those struggling to get to face-to-face appointments.”

Mr Heyes added: “As restrictions continue to ease, and we begin to deal with the long-term impacts of the pandemic … it’s really important everyone is offered a range of options – including face-to-face treatment - so that they can pick the most convenient and appropriate option. Online therapy cannot be seen as an easy answer to fixing growing pressures on overstretched mental health services. There is no cheap fix.”

Additionally, some of the key recommendations in the report highlighted the role of government, NHS policymakers, and mental health professional in safeguarding patients when they use these services so that patients don’t fall through the cracks and that the ‘digital first’ policy priority of the NHS Long Term Plan does not exacerbate established health inequalities or drive down standards of care.

The transitional trend from physical to virtual settings may feel like the inevitable roll of progress to a bold new era and part of the technological and social zeitgeist. However, the findings of Mind's report stresses that the understandable urge to get more people support through technology needs to be balanced with contemplation of the impact of that transition, thinking carefully about how it will affect the mental health of the ever-growing number of people who require care based around quality, not quantity.

 

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