The NHS is facing a mental health crisis. Can Online Therapy help?
A handful of app-based and online services mean people can access help without waiting for a therapist, but how does this compare to face-to-face treatment?
Underfunded and squeezed to breaking point, the NHS is struggling to provide mental health care to everyone that needs it. In the UK, mental health conditions make up around 28 per cent of the total burden of disease, but they receive just 13 per cent of the total NHS budget. Meanwhile, the budget for adult social care, which provides ongoing mental health support, has been cut in real terms by 13.5 per cent in England over the last eight years.
“The entire NHS is suffering and the mental health system is a large part of the NHS - and it’s suffering too,” says Peter Kinderman, a clinical psychologist at the University of Liverpool. And as budgets have got tighter, demand for help has increased, too. “I think there’s been quite a profound change in the last 25 years, that people are now more willing to talk about their mental health,” says Kinderman. “But we just don’t have the systems to respond to it.”
Now a whole host of services providing therapy via video conference and app-based support promise to make it easier for people to access care when they need it. The question is, can digital tools help fill in the gap in mental health care opened up by years of budget cuts?
Richard Andrews, founder and CEO of Healios – an online service that lets people connect to therapists over a video link – thinks so. Healios is already being used by 20 NHS trusts, and provides support for 14 different conditions, including anxiety, depression and psychosis. People with a serious mental health condition who are referred by their GP to a secondary health service may be given the option to receive therapy through the Helios platform.
After enrolling with Helios, a person can directly book video consultations with a clinician who will provide support and coaching, helping them manage their condition. People can attend the remote sessions whenever and wherever they want, and also invite their family to join in if they like. People who involve their family in their treatment tend to achieve better results, Andrews says.
Delivering therapy sessions via video link might seem unconventional, but it has some clear benefits, Andrews says. It allows people to receive therapy in an environment they’re completely comfortable in, increasingly the likelihood that they attend all of their sessions. It also does away with the stress asking people to go a clinic to see their therapist. “When you’ve got depression, or psychosis, or social anxiety, this just puts so much more pressure and stress on you that you don’t need,” he says.
It seems to be working. A handful of studies comparing online cognitive behavioural therapy (a common treatment for anxiety and depression) to its face-to-face equivalent have found the two approaches to be just as effective. “Success for mental health treatment often means getting people to adhere for a certain number of sessions - so if you can get to ten sessions you’re really going to increase your chances of getting the full benefit of that therapy,” Andrews says.
And then there are the benefits to the NHS. A session with a Healios therapist costs the NHS about half as much as a face-to-face consultation. These savings largely come from doing away with the need for physical clinics and all those associated infrastructure costs. “When it comes to remote-based sessions, you’re just paying for clinical time,” Andrews says. Some of his clinicians work full time for Healios, but others already work in the NHS, supplementing their income by conducting Healios sessions in their spare time. Every session is recorded, to keep tabs on the quality of therapy being delivered.
Helios is at one end of the spectrum of a range of digital mental health interventions. Others, such as TalkSpace, let people exchange instant messages with licensed therapists. The company, which has one million users, has plans to allow clinicians to prescribe medicines through the app.
Other digital interventions don’t involve linking people up with therapists at all. The NHS recommends a list of 13 digital tools, which include online support communities as well as apps that help people manage their feelings by using techniques rooted in cognitive behavioural therapy. “Whilst they may be of very real value to some people, they’re not tailored to the individual,” says psychotherapist Robin Hart, who helped developed an NHS-recommended app called ‘Stress & Anxiety Companion’. Most of these apps allow people to record their thoughts or guide them through simple relaxation exercises – digital versions of techniques that therapists have used for years to help people manage mental illness.
For Hart, these apps are particularly useful for those he calls the ‘walking worried’. These are people who might not have severe enough symptoms to warrant a referral to a mental health specialist, but would still benefit from some help managing their thoughts. Freely available apps might also lead people who didn’t realise they had a condition to actually go out and seek help. “If they come to realise that by using an app, that’s no bad thing at all,” he says. “It immediately begins to destigmatise the condition.”
And for people with more serious conditions, these apps can’t replace time with a therapist, but could help them manage their condition while they wait for their next appointment. “We absolutely need to encourage the public and GPs to use these intermediate systems,” he says. “You can carry on the work of the therapy outside of the therapy room.”