Scottish health boards too dependent on online therapies when treating mental illness

Mental health patients are being forced to rely on online therapies due to 18 week waiting times for treatment.

Computerised cognitive behavioural therapy (CCBT) is being used to treat people with severe social anxiety and other conditions as a substitute for one on one counselling.

Judy Stafford, a spokesperson for the British Association for Counselling and Psychotherapy said: “Whilst online therapy does have some beneficial qualities, there is insufficient evidence to conclude that CCBT should be used instead of face-to-face therapy as a treatment for anxiety or depression.”

The use of talking therapies as a means to help people coping with mental health issues is widespread.

Modern techniques of delivering this, through computers, tablets and phones via the internet, are being used increasingly regardless of doubts over their effectiveness.

Despite the Scottish Government becoming the first in the world to create waiting time targets specifically for psychological therapies, the NHS has failed to meet the maximum 18-week goal in nine of the country’s 14 health boards.

However, NHS Greater Glasgow and Clyde (NHSGCC) has defended its use.

Colin McCormack, head of adult services at NHSGCC, said: “Internet or stand-alone computer delivered therapy is increasingly common. It comes in many forms – interactive with a therapist, moderated or reviewed by a therapist or self-help. Sometimes this is ‘guided’ self–help.

“There is a strong evidence base for the use of CCBT, and it works for many people.

“It is instantly accessible and users are able to dip in and out at their leisure. It is very private and it works.

“In terms of reaching a large number of people at a very small cost, they are immensely efficient financially.

“It is not a stop gap or a cheap alternative – it is a very useful service.”

The technologies used for this alternative remedy are a progression from volunteer-led telephone listening services such as Samaritans and Breathing Space.

However, these facilities have sought to distance themselves from being compared to CCBT.

Problems surrounding the use of the service include lack of engagement with the computer programmes designed to provide the therapy as well as issues accessing and logging on to the system in the first place.

There are also concerns over the fact that in order to make online mental health help available, it must be outsourced to external sites out with the NHS such as Big White Wall and Living Life to the Full.

Mr McCormack admits that, while this can provide a boost to those on long waiting lists, computer-based therapy should not totally replace psychotherapy with a qualified professional.

There are also concerns surrounding confidentiality.

He said: “Generally speaking, providing a full structured therapy over a phone or computer is not ideal, and obviously not the same as being in the same room and getting visual cues.

“One note of caution is that sometimes things can be recorded with these modalities – and you need specific consent to do that.”

The outcry has come from mental health charities, such as the Scottish Association for Mental Health, comparing the failure to hit targets in Scotland to those in England, where over 60% of patients are seen by a psychotherapist within 28 days.

Despite the criticism, NHSGGC insist that counselling delivered via the internet could be helpful to some patients.

Mr McCormack said: “Clearly, video-based remote therapy has advantages, particularly in rural areas.

“It tends to be appropriate where a patient’s psychological distress is less complex or severe and is best used as something to get an idea of what the patient might further need.

“In that sense, these therapies are no more or less effective than others. Face to face isn’t necessarily best.”

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