Deana Kirkby, national operations manager of Talking Therapies at health and social care organisation Turning Point, reveals the on the ground concerns of service users and organisations supporting them around the transition to remote therapies during the height of the Covid-19 pandemic. As well as reflecting on the challenges and lessons learnt from that transition and the indispensable role that digital and blended therapeutic methods will have to play to meet the demands of future mental health care.
“Will I continue to get support – and how?”. That was the question many people in mental health treatment asked when lock-down hit last March.
Social distancing forced everyone into an unexpected and unprecedented reality, where human contact was restricted. For Turning Point, that meant switching our NHS talking therapies services, including Improving Access to Psychological Therapies, pretty much overnight to online such as to video or telephone-based help.
This created a raft of new challenges. Privacy and security issues had to be addressed, and we had to ensure support could be accessed from any device. You can’t just assume everyone has an iPhone or a tablet and can utilise Skype or Zoom.
The move to remote support also represented a whole new – and for some daunting – experience for those accustomed to accessing sessions face-to-face and for individuals new into treatment.
- See also: 'Virtual mental health in our post-pandemic world'
- See also: 'Quantity or quality? Mind’s report on remote therapy asks questions about standards of care'
Reluctance to revelation, with the digital revolution
George* came to Turning Point for what he expected to be a one-to-one appointment. Instead, he was 'disheartened to discover that – due to Covid – the therapy session would be conducted over the phone.
To be with 'a person' was a clear preference for Sarah, who was initially concerned about therapy online. Not having physical contact with her 'supporter' made her hesitant about giving the service a try.
It’s an apprehension shared by others over the past year and by some practitioners who have raised concerns that the quality of therapeutic relationships may suffer. How can you exercise professional judgement in a phone session without visual cues? And surely the lack of physical human contact is a barrier to connecting with your therapist?
However, these doubts about digital therapy have turned out to be unfounded in the case of George and Sarah and for many others like them.
As George admits in feedback to our Wakefield Talking Therapies service: “I couldn’t have been more wrong. Zoe (his therapist) has been amazing. Our six (telephone) sessions have really made me make positive steps and understand where my triggers are. I feel able to continue those changes.”
This is echoed by Louisa, who also has been helped by Wakefield and says: "I've felt encouraged and supported to find the answers from within…I was a little sceptical about telephone sessions, to begin with, but they've worked really well for me."
- See also: 'Digital revolution for mental health'
- See also: 'Will virtual counselling replace in-person therapy?'
Reflections on meeting the demands of the pandemic’s mental health crisis and the post-Covid future
The reality is that remote services delivered digitally or over the phone have been in existence long before Covid-19. From online cognitive behavioural therapy to video support, remote digital treatment in some form is being delivered to hundreds of thousands of patients.
‘Blended’ online therapy is one of the digital approaches offered by Turning Point. What happens is a therapist reviews online work and provides feedback on progress.
During the pandemic, the number annually entering treatment for this therapy increased by nearly a quarter to 800 people for Wakefield alone. This compares with 580 between March 2019 to the end of February 2020, and the recovery rate of 51% is just above the national average of 50%.
Another digital innovation is My Turning Point, an online tool for mental health and substance misuse services that provides advice on anything from healthy eating to dealing with low mood.
Shorter waits for treatment, greater flexibility over appointment times and not having to travel are among the benefits of remote NHS mental health treatment accessed during the pandemic, as highlighted by a recent survey by Mind.
As Sarah discovered, there’s no bother of having to organise time off to attend sessions, and she could work through the exercises at her own pace and in her own time.
She says: "I'm so pleased now on reflection that I opted to give this (digital) way a try…(it) had many benefits that I hadn't really considered, such as the convenience of it.
“I felt she (her therapist) was always there at the end of the phone for me, and via emails, which gave me unexpected confidence.”
However, there are downsides, including technology issues and confidentiality, according to the Mind findings, which also revealed some people struggle to use remote support.
Although engagement has been positive with our digital services, people have been discharged because they didn’t want to take up the offer of treatment delivered remotely. Instead, some want to wait until the service is fully face-to-face.
For some, it’s impossible to deal with emotional trauma and severe mental health issues without face-to-face support. So, we’ve done all we can during this last year to provide sessions in person, where needed, while following social distancing guidelines.
We’d all like to turn back the clock and for Covid-19 never to have happened. If it’s possible for anything good to have come from this crisis, it’s been the opportunity to embrace change and new ways of working.
Lessons from the last year
One lesson from delivering services during Covid is that choice should underpin innovation. Treatment has to be made to work for each individual by providing a range of options so that no one is left behind.
Digital therapy has proved vital for the ability of mental health services to continue offering treatment during these extreme times. But the resumption of our face-to-face support is increasing week by week, with therapists returning to clinic venues.
No one knows what the future might hold. Or when the pandemic will end and with it the restrictions that Covid imposes on our lives.
But being there for people in person is – and will always remain – a big part of what Turning Point does.
*All case study names have been changed