Privacy problems, tech issues and fears of being overheard by family or housemates have been just some of the hurdles people with mental health issues have faced when attending therapy remotely during the pandemic.

After the March 2020 lockdown was announced, many saw their face-to-face therapy appointments swiftly moved online or conducted over the phone.

A year on, while some have benefited from this way of communicating, more than a third (35%) of people surveyed by the mental health charity Mind said online or phone-based support from NHS was difficult to use, while a quarter (23%) said their mental health had actually got worse as a result.

Alissa, 31, who lives in Warrington and preferred not to share her surname, has been dealing with mental health problems for some time. Her wellbeing deteriorated dramatically in September 2020 when she tried to take her own life.

When she was discharged from hospital, she was told to contact her GP to access ongoing mental health support, but wasn’t sure where to begin.

The 31-year-old was put in touch with a counselling service through her work’s occupational health team, and was encouraged to self-refer for therapy. Her first three sessions were over the phone and Alissa notes that although these were swapped to a Zoom call, she felt they lacked a “personal touch”.

On top of this, she was struggling to get to grips with the tech. “For someone who isn’t competent in technology, accessing Zoom calls was quite stressful due to microphone and connection problems,” she says. “This again takes the personal element away from the service. I ended up asking them to postpone my counselling session, due to the type of support being offered not working for me, but this left me without any sessions for the last three months.”

During her lowest points, Alissa felt incredibly isolated. “I didn’t leave the bed and I hardly saw anyone,” she says. “I think face-to-face therapy helps with the isolation [if you’re] struggling with your mental health.”

She isn’t the only one who sees in-person support as a better option. Mind’s report found that of those who took up the offer of therapy by phone or online during the pandemic, almost two in three (63%) would have preferred to have met face-to-face. One in 10 said they often or always had technological issues, while one in three (34%) were worried about confidentiality.

When you’re discussing your life and mental health, you want to feel safe in the knowledge that nobody else can listen in – and privacy helps the mental health professional conducting the session, too, but for some, it has been an issue.

Katie, 30, lives with borderline personality disorder, generalised anxiety and mild depression. Before lockdown, she was being supported by a perinatal mental health team and receiving weekly home visits in east Devon from a community psychiatric nurse (CPN) after experiencing postnatal depression.

In March, her mental health deteriorated and she tried to take her own life. Around the same time, she was discharged from perinatal mental health services and home visits because of the pandemic. With the virus spreading rapidly through society, appointments began to happen remotely instead.

Katie experienced a series of confidentiality issues during online video calls. “At the first appointment, my CPN couldn’t log on properly or get me out of the virtual waiting room, so they agreed to continue by phone,” she says.

In one video appointment, a health professional she didn’t know joined the call by mistake, while another time she found herself online with a second patient due to an administrative error, she adds. “These incidents made me incredibly concerned and anxious about the safety and confidentiality of the system,” she says. In-person home visits with the community psychiatric nurse have since resumed which she is “very happy” about.

Those who took up remote support did cite a number of positives, including not having to travel to appointments, greater flexibility over appointment times and shorter waiting times.

For Rohan, 40, from Manchester, this helped ease his anxiety. At first he was concerned about being overheard at home and it took some time to get used to having the sessions in his kitchen. But he found online counselling “very useful” when his anxiety was high and couldn’t leave the house. “It helped not having to worry about factoring in time for getting ready and travelling to appointments easily,” he says.

However, these kinds of sessions don’t work for everyone – which is why Mind is calling on the UK government to make sure people who need support for their mental health are offered a range of treatments, including face-to-face appointments, so they can choose the options that best suit them. 

“During the pandemic, services have quickly adapted to help stop the spread of coronavirus,” says Leila Reyburn, the charity’s policy and campaigns manager.

“NHS mental health services delivered over the phone or online have been a lifeline for many, with lots of people telling us having the choice helped with things like childcare responsibilities and working schedules, particularly for those struggling to get to face-to-face appointments.

“Others, however, told us about stressful experiences and concerning breaches of confidentiality. Nobody should have to worry about the wrong healthcare professional or another client attending a confidential therapy session.”

Reyburn says the NHS has done an “amazing job” during such a difficult time, but adds that it is “worrying” that one in four of those surveyed said their mental health had worsened through accessing remote treatment.

“Online therapy cannot be seen as an easy answer to fixing growing pressures on overstretched mental health services,” she says. “There is no cheap fix.”

An NHS spokesperson said: “NHS staff have supported people during this difficult period and adapted our mental health services to the challenges of the pandemic, offering remote consultations when clinically appropriate to maintain care while protecting patients and staff.       

“Patients should now be offered a choice about how they access services to ensure they can get the most from their treatment and support and this is being built into all local plans as the NHS continues to expand mental health services as part of the Long Term Plan.”

Useful websites and helplines

Mind, open Monday to Friday, 9am-6pm on 0300 123 3393.

Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI – this number is FREE to call and will not appear on your phone bill).

CALM (the Campaign Against Living Miserably) offer a helpline open 5pm-midnight, 365 days a year, on 0800 58 58 58, and a webchat service.

The Mix is a free support service for people under 25. Call 0808 808 4994 or email help@themix.org.uk

Rethink Mental Illness offers practical help through its advice line which can be reached on 0808 801 0525 (Monday to Friday 10am-4pm). More info can be found on rethink.org.