Alexandra Pollard

Alexandra Pollard

Mental health care in an online world

11 May 2022

man sat on floor with illustrated thoughts and question marks coming from his head

Each year, Mental Health Awareness Week highlights the need to prioritise mental wellbeing. Digital mental health interventions offer a viable option for many people seeking support.

I used to put too much on my to-do list. Even when panic set in, I could not shake the thoughts that demanded everything ‘must’ get done.

While a small amount of stress can be motivating, mine had become unmanageable. I had burnout (physical and emotional exhaustion resulting from prolonged stress) and needed to face the underlying cause of what was making me tired, irritable and constantly overwhelmed. An online program used by a local mental health service I self-referred to set me on the path towards learning how to manage stress.

COVID-19 and the care gap

It was no coincidence that the stress I was experiencing intensified with the onset of COVID-19. During the first year of the pandemic, the global prevalence of anxiety and depression surged by 25%. Stress caused by isolation contributed significantly to this, as people were unable to seek support because of social distancing measures.

The demand for mental health services has grown globally, but limited resources have placed pressure on services and extended already lengthy waiting times. Even before the pandemic, only a fraction of people with mental health problems received treatment – an issue that has been exacerbated by low public spending on mental health, particularly in low- and middle-income countries.

The care gap has widened even more, thanks to disruptions to mental health services caused by COVID-19. With face-to-face care being restricted, many turned to technology for help.

woman in pink coat sat at train station platform with head in hands

During the first year of the pandemic, the global prevalence of anxiety and depression surged by 25%.


An abundance of online resources  

There is an astonishing amount of online mental health tools, including podcasts, blogs and smartphone apps. These resources come under the umbrella of e-mental health, defined as ‘the convergence of digital technologies with mental health services’. This involves using technology and the internet to support people’s wellbeing and deliver mental health information and services.

One area that has seen rapid expansion is e-therapy (also known as teletherapy and online therapy), which is the provision of mental health services by a licensed professional ‘via email, video conferencing, virtual reality technology, chat technology or any combination of these’. A study into web and smartphone apps recommended and used by the National Health Service (NHS) in England for stress, anxiety or depression found that e-therapy has a number of potential benefits, such as encouraging self-management, increasing treatment cost-effectiveness and reducing mental health professionals’ workloads.

However, without proper evaluation these interventions could cause mental, physical, financial and reputational harm. This is crucial, as the development of new interventions often outpaces the speed at which the research community can evaluate them.

Improving regulation also extends to the training and credentials of online therapists. As they can practise from virtually anywhere, it can be difficult to oversee their education and professional training, and whether they may be offering services they are not qualified to provide.

E-mental health interventions may not be able to replicate the empathy and emotional understanding that mental health professionals share with a person.


E-mental health may not work for everyone

While the program I used taught me a lot, I found myself questioning whether such a universal approach could really work at scale. The absence of non-verbal communication in e-therapy, for example, could hinder the development of a therapeutic relationship. E‑mental health interventions may also be unable to replicate the empathy and emotional understanding that mental health professionals share with a person. For this reason, e-therapy is not recommended for someone with a severe mental health condition such as schizophrenia or severe depression.

A person’s experience of e-mental health can be influenced by multiple factors, including age, technology confidence level and the effect of a mental health issue on cognitive functioning (e.g. memory, decision-making, perception). Some people, such as older adults, may require additional support to use digital tools as a result of changes in memory, vision or manual dexterity.

Safeguarding vulnerable people

E-mental health services are entrusted with deeply sensitive information, making data protection a priority. Sadly, people with mental health issues have already become the centre of a major data breach. In 2020, the records of thousands of patients of Vastaamo (a Finnish psychotherapy service provider) were hacked, with many being leaked online. This event highlights the importance of securing electronic medical record systems – and what can happen if they are not adequately protected.

People must be at the forefront of every e-mental health intervention, so they can feel safe and supported during a particularly distressing time. Although I can only speak to my own experience, the program I used empowered me to combat the stress I thought would never leave. This Mental Health Awareness Week, I hope that others also have the chance to access care that works for them, whether that be in person or virtually.


The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.