Online mental health is increasingly forming a part of national mental health initiatives. Within the British government mental health system or the National Health Services (NHS) as it is known, online mental health services now form a significant component of service delivery. Individuals with problems like anxiety and depression are turning more and more toward online services provided by the NHS such as webcam and instant messenger. The NHS and the general population are progressively viewing the Internet as a cost effective, accessible and preferred mode of treatment delivery. Let’s explore this trend and some of the reservations that have been expressed with regard to it.
In an article recently posted in the Independent (20 March 2017), a British online newspaper, the growing trend toward using online mental health services was highlighted. According to The Independent between the years 2012/2013 to 2015/2016 there has been a nine fold rise in clients seeking help through online modalities in contrast to a 144% increase in those making appointments more generally. In real terms this means that the number of people making online appointments went from 5 738 to 49 475. In January of this year Teresa May announced increased funding for online mental health services. The British government has committed over 60m Pounds to developing technology for online mental health services including apps for digital CBT. The services currently offered by the NHS cover the entire range of online possibilities for mental health delivery. These NHS platforms include Ieso, a system where therapist and patient communicate via instant messenger. This service is available in 37 commissioning regions and take up of this service has doubled every year. Big Wall is another service offered by the NHS which offers peer support groups and webcam therapy. SilverCloud is an online digital CBT program where clients complete CBT modules via the computer, and also connect telephonically with a therapist who monitors their progress.
According to The Independent article, the advantages of these kinds of services include their appeal as an alternative to traditional in person therapy. They offer a way of engaging with therapy to people who may struggle to access therapeutic services or typically feel uncomfortable with seeking therapeutic help. For instance men may be inclined to view help seeking as a sign of weakness, but may be more comfortable with a service offered on their own turf. The convenience, accessibility and affordability of these services are core advantages.
While the general public and NHS seem to be going full steam ahead with offering and making use of online mental health services, some individuals have expressed reservations with regard to this shift in the style of service provision. Steve Flat, a mental health professional within the NHS, views online therapies as “fly(ing) in the face of what it is to be human” (The Independent). He sees these kinds of services as reinforcing of the social isolation so characteristic of many mental health conditions by creating a distance via the camera or messaging. He, along with other therapists considers this kind of online service as not allowing for the possibility of the more intimate connection characteristic of traditional therapy. Others such as Sarah Bateup, the Ieso Clinical Director, have responded to these concerns by saying that an intimate therapeutic relationship can indeed be formed via online services, citing the many Ieso instant messenger transcripts she has read where according to her a warm, emotional therapeutic connection is present. Helen Morgan, chair of the British Psychoanalytic Society states in The Independent article, “There’s such a pressure now on people to be happy. I’m worried about the rise of quick and easy interventions for what are often very complex problems where people need to become known and understood and be in a room with someone building a relationship.”
While there does seem to be a niche for these kinds of services concerns have been raised regarding the watered down, short term, quick fix approach which they imply. These kinds of services also full the need for government to tick the boxes and measure their success according to numbers and not necessarily according to the efficacy of the intervention. Online mental health interventions offer an important resource but there is a risk over simplifying and over standardizing government mental health provision.
The Independent – Huge surge in online mental health appointments attacked by specialists