The looming battle over free online therapy (and why you should sign up anyway)

You may not know it, but there’s a battle for your brain playing out in boardrooms, legislatures, and parliaments around the world that could ultimately decide if you’re allowed to access online mental health services for free or if you should be made to attend subsidized therapy

The story goes like this:

• You’re absolutely desperate for help.
• Politicians and public health officials are frustrated by psychiatric waitlists and what it would cost to fix them.
• Dozens of startups offer cognitive behavioral therapy online, connecting patients with therapists who interact via text messages, videos, or email. Governments are investing millions to make these services widely available.
• Community therapists feel shafted because the money is leaving the city and undercutting the services they provide in person.

I write about mental health at stevenladurantaye.substack.com. Head over and take a look, and if you like what you see please subscribe!

The Canadian province of Ontario has invested millions in making a service called MindBeacon available to anyone in the province looking for some therapy to help them deal with the pandemic and the mental health strains it can present. Finding any way to address the expected wave of mental health cases coming through the system in the coming years is fast becoming a key government priority, and a homegrown solution makes a lot of sense on paper.

The company is publicly traded in Toronto and offers services worldwide, including modules that are lightly guided by a therapist or more intensive sessions live with a therapist over video.

It sounds like a no-brainer, but every good intention comes with a few strings.

You need to be crazy, but not TOO crazy

When I was coming off the back of what we used to call a “nervous breakdown,” I raced to the site when I heard it was available. I gave MindBeacon my email and filled out the entry exam made up of familiar questions about mood and activity levels. Did I like doing the things I used to like (not really), did I have suicidal thoughts in the last three months (boy howdy!), so I sleep more or less than usual (hang on, I’ll answer after this nap).

This was early December. Somewhere in the week between Christmas and New Year’s Eve, I received an email from MindBeacon thanking me for my interest but informing me I was too crazy to benefit from anything it had to offer (I’m paraphrasing, but not by much).

Now I’m no psychiatrist, but the last thing someone who just poured out the contents of their messy brain into a website that promised some relief wants to hear is that they are too crazy to be helped.

“Unfortunately, you fall outside of what we can successfully manage on the Beacon digital platform,” the email said. “Beacon is not equipped to support the challenges of substance abuse, suicide attempts, and more immediate and critical needs of clients.

Elliott Hudson told Global News he received the same email and found it jarring. His therapist said Hudson was stable when he applied, and being rejected knocked him off-kilter.

“It was extremely cold, impersonal, and discouraging to get an email back from a so-called mental health organization that says, you know, your problems are more than we can handle,” Hudson said.

I was suicidal in the previous November, hauled off the train tracks and into a mental hospital. I’ve been suicidal in the past. But when I asked MindBeacon for help, I was properly medicated and occupying the chunk of my brain that doesn’t understand the suicidal chunk of my brain. These things are complicated.

So I went back online and took another run at the questionnaire. I laid off the scary stuff, stayed away from any questions that hinted at hurting myself, and tried to present as a reasonably well-adjusted lunatic. The system determined I’d benefit from a CBT course focused on recovering from PTSD.

It’s not perfect, but what is?

A clinical view

A column in the Toronto Star slammed the programme as insufficient, saying not only does it not help everyone the program’s short duration means they may not get the entirety of the help they need.

“Many patients also require over 20 therapy sessions to recover, depending on their concerns,” the co-authors wrote (one is a Ph.D. candidate and the other a professor of clinical psychology). The roadmap’s short-term treatment focus would never be accepted in other fields. Cancer patients are not provided only partial chemotherapy.”

Now I’m also not a Ph.D. candidate, but I am a crazy person who could benefit from these services. Comparing some light counselling that focuses on changing the way you process your thinking to life-saving chemotherapy is even crazier than I am — it’s a strawman reclining on an analyst’s couch waiting for an argument.

They are against the digitization of mental health services and argue it doesn’t show compelling results. That’s true — but neither does any number of interventions. If we knew what worked 100% of the time, we wouldn’t still be strapping people to electroshock therapy tables or asking them to take handfuls of magic mushrooms in clinical trials.

“Patients must be understood within the context of their histories, relationships, identities, values, and cultures — not just reductive diagnostic labels,” they wrote. We must also address root causes of patient distress by supporting their pursuit of identity development, fulfilling relationships, meaningful engagement in daily life and genuine integration into society — not just treating symptoms.”

Slow down there, Dr. Overachiever

My “reductive diagnostic label” has opened the doors to treatments I’d never have known about otherwise. And what’s the about “just” treating symptoms — all those other stated goals sound lovely, but, honestly, I’m not particularly interested in working to understand how my cultural context has inhibited my meaningful engagement and genuine integration into society.

I just want some tips on feeling better, guys, which the online services provide. When I’m ready to do a complete psychological teardown and rebuild, I’ll keep you in mind. Still, for now, I’m happy with some calm online guidance and a steady-handed psychiatrist who’s quick with a script and understands brain chemistry.

Their final insult is that the MindBeacon platform and others like it have led the Ontario government to a “steady diet of McDonaldized psychotherapy.”

I never understand a McDonald’s burn. It’s the most successful restaurant in the world, and I’m never happier than when I pull out of the drive-thru and eat a hot double cheeseburger. Maybe the government should include free Happy Meals with each MindBeacon subscription.

The battle rages elsewhere

Funding for online services has flown under the radar in Ontario. But you can see the battles to come if you look across the border to Reno, Nevada. The mayor herself tried to access traditional psychiatric services for assistance and was stunned at how long she’d have to wait. She managed to get the city to budget $1.3-million to provide citizens access to Talkspace, another online mental health app.

The opposition has formed along the same lines, with the established professionals casting some nasty side-eye toward the digital startups moving in on their turf.

“Local therapists, distrustful of Talkspace and frustrated they hadn’t been consulted on how best to serve the community, were aghast,” reads an article on STATNews. “They wrote angry emails, submitted public comments before the city council, and put together an alternative proposal that would keep the money local. To many, the deal represented not only a threat to their own interests but a clinically dubious attempt to help people in need. Talkspace relies largely on text-based therapy, unlike traditional therapy, as well as live video sessions.”

While the established medical community is yelling at startups to get off their lawn, thousands of people have enrolled in the guided classes that promise nothing more than to help you reframe your thoughts in a way that may reduce stress and anxiety. My course is pretty superficial — there are about 1,000 words to read each week, and someone who I presume is not a bot sends encouraging emails when I finish a module and pretends to offer some insight to my answers.

For someone like me who isn’t as comfortable face-to-face as I am with written words, it’s not the worst thing ever. I don’t expect to wake up one morning cured of manic depression, but I have picked up some tips on processing complex thoughts and moving on from past traumatic experiences. There are worse ways to spend a bit of online time.

It’s a hugely dramatic shift in service delivery. When the dust settles, it’s hard to imagine both sides won’t be left standing exactly where they were, providing some lower-tier services online and more intensive interventions in person. But in the meantime, digital disruptors will get into more of our heads and try to make us think better thoughts (and governments are going to get us access).

I’m into it.