Twice as many people with mental health conditions are being given virtual therapy on the NHS compared with before the pandemic began.
An Observer analysis of data from private providers, cross-checked against NHS figures, reveals around one in three mental health treatments in England are delivered online, up from one in five in 2019, and one in 10 in 2017. Patients with mild to moderate depression or anxiety can be referred to app- or web-based, self-guided cognitive behavioural therapy (CBT) courses, instead of traditional face-to-face talking therapies.
While some patients undergoing online therapy receive weekly phone or video calls with a therapist to discuss their progress, many are expected to work through the exercises themselves.
These patients are typically introduced to the programme by a healthcare professional, who then reviews them at the end of the virtual course.
But some experts are concerned that not all patients who need it are being offered in-person treatment.
“Talking therapies can be hugely beneficial for people with a range of mental health problems and we welcome any move to make sure that more people can easily access this type of treatment,” said Gemma Byrne of mental health charity Mind.
“However, it is crucial that people with mental health problems always have the option of face-to-face treatment, as we know many people, particularly those living in poverty, are excluded from being able to access digital treatment options.”
Rates of people experiencing mental health problems have soared in recent years, increasing pressure on NHS services. A record 688,000 people completed courses of therapy in 2020-21, up 24% from 554,709 in 2017-18, according to NHS data.
But figures obtained by the Observer from private providers suggest at least 32% of patients in 2020-21 were referred to third-party online courses, compared with about 10% in 2017-18. It means that more than 220,000 patients are now receiving virtual therapy every year.
Sean Duggan, chief executive of the NHS Confederation’s Mental Health Network, said the health service “should embrace” digital healthcare because it enabled providers to “intervene early” and cut waiting times for patients. One in 10 patients with mental health problems wait longer than six weeks for a first appointment with NHS Talking Therapies, also known as Improving Access to Psychological Therapies.
Duggan said people with busy lifestyles often preferred to access services digitally, but he admitted there was a risk others would feel excluded.
“We saw in the pandemic, [when] we put everything on a digital application because we had to, a lot of service users were saying: ‘We feel excluded’,” he said in a recent interview. “Now we have to listen to that – we can’t provide these wonderful services and leave people behind us. I don’t think we will, but we’ve got to be aware of that.”
The health watchdog Nice has approved three online CBT courses for NHS patients with depression: Beating the Blues, by 365 Health Solutions; Deprexis, by Ethypharm Digital Therapy; and Space from Depression by SilverCloud. It has also approved another six online courses for anxiety, post-traumatic stress disorder and body dysmorphic disorder.
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In the past decade nearly 700,000 NHS patients have been referred to third-party virtual therapy services run by SilverCloud – the leading private supplier of depression and anxiety online CBT courses to the NHS – which is owned by US-based telemedicine firm Amwell.
The figure includes more than 415,000 patients with mild to moderate depression or anxiety who took its online self-guided CBT courses.
While NHS therapists spend nearly four hours per course supporting patients undergoing traditional therapies, SilverCloud says therapists spend just 1.5 hours in total with every patient taking its online courses.
It claims that by saving therapists’ time, more patients can be seen quickly, before their symptoms escalate to a point at which they would need more intensive treatment.
“Digital tools offer the opportunity to help services better cope, as well as preventing them from becoming so overwhelmed in the first place,” said Dr Derek Richards, head of research at Amwell. “Early intervention is critical in preventing a patient’s mild to moderate symptoms from worsening – which has a twofold benefit: economically for the NHS, but more importantly, it reduces the personal cost to patients.” But he added online therapy may not suit everyone and that it was still up to healthcare professionals to identify “who may and may not benefit”.
An NHS spokesperson said: “Record numbers of people have been accessing NHS mental health services, and our world-leading talking therapy services have helped more than 1.2 million people access treatment in 2021-22, an increase of 20% on the previous year.
“By offering people the choice of a face-to-face, phone or online appointment, and expanding services and modes of delivery, more people are able to access Talking Therapies for anxiety and depression, and we will continue to work with systems to ensure we provide the best access and treatment for people who need mental health support.”
