Digital mental health: not so accessible after all?

Chloe Kent 28 October 2019 (Last Updated October 31st, 2019 10:20)

With increasingly long NHS waiting lists making it difficult for patients to access in-person talking therapies, many private companies are launching their own mental health support apps as a viable, easy-to-access alternative. However, many of these come with their own accessibility barriers.

Digital mental health: not so accessible after all?
But just because these platforms are expanding access to mental health treatment, it doesn’t mean the problem is now solved. Credit: Shutterstock

BetterHelp is one of the most well-known digital therapy platforms, and claims to be the world’s largest provider of e-counselling. Costing between $40 to $70 a week, users from around the world are matched to an accredited therapist who specialises in the type of issues they’re dealing with. Patient and therapist can then communicate through messaging and live chat sessions, as well as phone and video calls.

Digital mental health companies operating in the UK are often recommended by clinicians as an alternative option to cash-strapped NHS mental health services. Patients in some areas face over a year on waiting lists for just six weeks of cognitive behavioural therapy (CBT) on the NHS, and many are sent out of their local area for treatment. The most recent statistics available show 5,876 patients were sent out of their local area in 2015/16, including one who was sent from Somerset to NHS Highland, 587 miles away.

But digital platforms come with their own caveats. BetterHelp, for example, is prohibitively expensive for a lot of patients. Billed monthly, even the cheapest payment plan will cost users $160 a pop (roughly £125). The NHS currently estimates that a private therapy session costs between £10 to £70 depending on where the patient lives, meaning that in many cases, those who can afford to set this kind of money aside may as well see a private therapist in-person.

The Therapy Couch founder Claire Goodwin-Fee says: “[Mental health apps] can be really useful but in my opinion are limited and cannot replace the relationship between a client and therapist. The safe exploration and space to reflect is better face to face, where there is less likelihood for misunderstandings and the nuances of the humanness of a person can be fully explored and understood.”

People aren’t willing to pay

It’s not just cost that can put these digital platforms out of reach for a lot of patients. Many digital mental health services are completely free for users, but the technology is available only to certain individuals rather than being open-access.

Spill, for example, matches users with a qualified counsellor with whom they can begin exchanging instant messages. However, it’s not publicly accessible to anyone who might like to use it, but exclusively through select employers and universities.

If a company decides to end their contract with Spill, active users have a 30-day grace period to end their relationship with their therapist, which can be extended at the counsellor’s discretion. Users also have the option to become individual payers.

A Spill spokesperson said: “Spill was originally a B2C service, but we found there just wasn’t much pickup and people weren’t willing to pay. So we decided to put the finances in the hands of employers and universities, whilst championing the message of taking accountability for your workforce and student body’s wellbeing.”

Available on the NHS – but not everywhere

Difficult commercial launches aside, some digital counselling services, like Big White Wall and Ieso Digital Health are actually available through NHS pathways.

Big White Wall, a digital counselling service which provides access to an online peer support community as well as live therapy, is commissioned through higher education institutions and employers throughout the UK, available to all serving members and veterans of the UK military and their relatives, and can be accessed through select NHS clinical commissioning groups (CCGs), Trusts and Improving Access to Psychological Therapies (IAPT) services.

The same is true of Ieso Digital Health, an online CBT service that operates over instant messenger. Ieso is commissioned through approximately 60 NHS services throughout the UK – but not everywhere.

“It’s just because of the way that the NHS commission services,” says Ieso Digital Health chief clinical officer Sarah Bateup. “They don’t commission nationally, they commission regionally. Our long-term mission is to enable people everywhere to access evidence-based psychological therapy.”

Ieso Digital Health informed Medical Device Network that, should a patient move out of the NHS jurisdiction which gave them access, they would continue to be able to receive care.

Bridging the treatment gap

Of course, it’s not the fault of these digital solution providers that their technology isn’t the instant, free-at-point-of-service quick-fix that would be available to patients in an ideal world. Their aim is to help patients, but they’re still private companies who need to pay their staff.

Psychotherapist and counsellor Helena Lewis says: “Private practitioners certainly shouldn’t be a block to using mental health apps, they should be a supportive and informative gateway.”

Plus, digital mental health solutions come with their own unique benefits. They help overcome stigma by letting patients seek mental health treatment from the comfort of their own home. If patients can struggle with physically getting to a therapist’s office, be it through illness or geographical inconvenience, then chatting to a certified therapist through an app can be their only option.

Wellness app Remente’s CEO David Brudö says: “The key point here is that, due to the shortage of psychologists beside the accessibility and scalability that technology provides, mental health apps have emerged as a viable tool to bridge the mental health treatment gap.”

But just because these platforms are expanding access to mental health treatment, it doesn’t mean the problem is now solved. If you live in an area where your local NHS has long waiting lists for talking therapies and isn’t signed up to one of these platforms, and you can’t access them through your university or workplace or afford to go private, then you’re still out of luck. Unfortunately, the battle to expand mental healthcare coverage to the masses isn’t done and dusted just yet.