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I tried to fix my mental health on the internet

Joe Madden

About three weeks ago, Facebook essentially U OK HUN?-ed me by repeatedly placing the below ad for e-counselling service BetterHelp in my timeline. I'm not sure which of my posts FB's algorithm decided was a cry for help (maybe the one about shouting at my laptop during 'Making A Murderer'?) but suddenly invites to try BetterHelp kept popping up amidst all the ones for snazzy jackets and takeaways. “Get help!” they pleaded. “Get happier!” they seemed to promise.

Screen shotFacebook

Anyway, as it happens, I am slightly tweaked in the head – so well played, Facebook algorithms. From the age of about 13 onwards, I've suffered from higher-than-seems-normal levels of anxiety, and while I've mostly come to terms with being jittery and a bit doomy, I certainly wouldn't mind being less so. I've had counselling before, and it does help. But could e-counselling not only re-hinge my mind, but do so without me having to put trousers on and leave the house?

And pulling back from my own (relatively low-key) issues for a moment, could e-counselling be the answer to the mental health issues escalating amongst under-30s? With cuts to mental health services really starting to bite, digitised therapy could be just the ticket for young adults who already filter nearly every aspect of their lives – friends, work, sex, entertainment – through a screen.

Not everyone is entirely convinced that shifting mental health care online is the way forward. “For me, what works in therapy is when you meet someone face-to-face, in the same room,” says London-based psychotherapist Sandra Tapie. “You get to know not only what it's like to talk to the person, but how it feels to be in a room with them. Using Skype is the next best thing: it's 'good enough', but it doesn't create the closeness, the intimacy, that really gets people to open up and explore things.”

“I've carried out some research into Skype counselling,” says London-based psychotherapist Dr Aaron Balick, “and it's not the 'functional equivalent' of traditional counselling; it's just not quite the same thing. It's really important that people who engage in it are aware that it's a different experience from being in the room with someone, speaking face-to-face."

Joe Madden on SkypeBbc

“In terms of accessibility, it's a good start and definitely better than nothing. It'll hopefully lead them to eventually showing up in the room. However, if you're struggling with relationship issues, attachment issues, or deeper issues, it's better to be in the room with someone. Skype and the internet offers a distance from your counsellor that may not be helpful.”

In cases of mild depression, the NHS is now directing some patients towards online programmes rather than face-to-face counselling, a phenomenon that concerns Dr Balick.

“My fear is that it's happening more and more for economic reasons, rather than because it's what's best for people. If it's rolled out just to save money and there aren't critical questions being asked about these services, that's not good. But then, I'm always very sceptical of people who are either very very pro or very very against online mental health care. It's a case of asking the right questions."

Well, if the future of mental health care is all about IMs, FaceTime and 'OMG, which neuroses R U?' quizzes, I decided I'd find out what that brave new world would be like. I signed up for four very different online mental health services – ranging in cost from free to £100 a month – and ran my anxieties through them all, simultaneously, for a week. Here's what I discovered.

Grand and important disclaimer in the name of all that is scientific:

What I'm doing here is reviewing my experience of using each mental health service, rather than its effectiveness - because even the most wizard-like therapist isn't going to 'cure' you in just one week. I'm simply comparing each service to the experience of sitting in a room and blarting on about yourself to a therapist. Nod if you're with me. Okay, cool - let's mental health!



How does it work?

As seen on FB (by me, anyway), US company BetterHelp is the corporate behemoth of the e-counselling game. They claim to have 500 licensed counsellors working for them, each with at least three years of experience.

After filling in a questionnaire to ascertain what particular flavour of mental you are, you're paired with a counsellor, who you can mercilessly swap for a different one at any time. (I got Dr. Laura Dabney, from Virginia). You then kick off an instant messaged therapy session that both you and your counsellor can drop in and out of, and which could, in theory, go on and on until one of you eventually died.

What does it cost?

You get a free seven-day trial - much like a free Netflix or Amazon Prime trial, except with way more questions about what your childhood was like. After that, it costs from £24.50 a week for unlimited message-based counselling and one 'free' phone session with your counsellor per month. Yeah, I don't get how it's free either, but whatever.

What was good?

If you find the idea of baring your soul to a stranger a bit awks, filtering that through instant messaging might be helpful. You won't get the same connection as with face-to-face counselling, but the semi-anonymity may make it easier to open up if you've been drinking two bottles of rum and dancing around in your dead nan's wedding dress every night.

She first ascertained the scale of my anxiety, what triggers it – social situations, meeting people for the first time – and then dived headlong into my fractious childhood (divorced parents, strained familial relationships, bullied in junior school). She was pretty nosey tbh, but then that's her job, isn't it?

Overall, the service is impressively slick. The conversation can be a little stop-starty at times, but it was actually a far smoother and more on-tap experience than I expected. I even got speedy responses to messages over the weekend, which was unexpected.

What was bad?

The fact you can edit messages before sending them means you're unlikely to blurt out something unguarded and revealing in the heat of the moment. So profound moments of realisation may be hard to come by if you can't get a relaxed flow going.

Who do I think it might it be good for?

Anyone with a low-end mental health issue who's cool with getting counselled in a very internet-y, 2016-y way. If you're living under the blackest, bleakest cloud imaginable and need serious attention (and possibly some meds), BetterHelp probably isn't for you.


Big White Wall

How does it work?

Part social network, part group therapy, Big White Wall is an NHS-approved service for people with common mental health issues - depression, anxiety, the standard-issue classics. Anonymous users create Bricks - misery-memes, basically - using the in-built image editor (random example: a thunderstorm pic overlaid with the text “here comes the fear again”). The user then adds text about issues they're currently dealing with, posts their Brick onto the Wall, and awaits supportive responses from other users.

It's kind of reverse-Instagram, where all the pics are designed to make you sigh in grim solidarity, rather than scowl with spiteful envy.

What does it cost?

It's free if you get an NHS referral, and also free for some university students and members of the armed forces. Otherwise, it's a fairly hefty £24 a month.

What was good?

The social networking aspect is a winner, as it connects people who might otherwise feel utterly alone (in theory, anyway - more on that later). And there's depth to the site beyond the Bricks gimmick: there are plenty of quizzes and 'live' courses to take, and the 24/7 presence of the trained Wall Guides (forum mods, basically) is reassuring. Nobody wants the lunatics taking over the asylum, LOL, jst jking.

What was bad?

Online social networks need to hit a certain scale to work, and Big White Wall just isn't there yet. Alarm bells started ringing when I grabbed the Android app and noticed it'd only received 1,000 downloads. Unfair-but-relevant comparison: Instagram has 500 million. I then posted my first Brick, which I gave the dramatically EMO-y title Hear Comes The Fear Again, and which detailed how my anxiety can effect me in social situations (short version: I either flee or get drunk). Aside from a friendly message from a Wall Guide, I got no responses. Two, three, four days later - still nowt. Looking around the site, few of the Bricks have more than one or two responses. It's not exactly a buzzin' mental health party in there.

It's a good idea, but needs waaay more members - and it's not getting them by charging £24 a month. I'm no Zuckerberg, but why not make the service free, and fund it with ads? You've got a captive audience there already!

Who do I think it might it be good for?

Oh, loads of people - if loads more people join. Catch 22, see.



How does it work?

This service offers counsellors who are happy to do sessions with you over the internet; Monica Sala was the top Google result, so it was her I went for. Turned out she was booked up for a few weeks however, so she hooked me up with her colleague Rakhi Chand. We exchanged emails, I filled in a questionnaire about my tiresome mind, we set a date and time for our Skype call, and I Paypal-ed her the fee.

What does it cost?

A one-hour Skype sesh is £50. If you're a skinflint or you're blind or you want to doodle upon your naked body during the session, it's £3 cheaper for a voice-only Skype.

What was good?

It was essentially a traditional, face-to-face counselling session, except I was in Manchester and my counsellor was in Amsterdam. You get all the benefits of a properly attentive counsellor without having to travel or sit around in a waiting room beforehand, shiftily avoiding eye contact with everyone around you. Her technique involved asking only minimal questions and not attempting to fill awkward silences with conversation – if you were cynical you could interpret that as her doing very little for her 50 quid, but that hands-off style encouraged me to ramble on aimlessly, which is a surprisingly good way to discover deep, weird things about yourself.

What was bad? Skype chats with a best mate can feel weirdly stilted, so you can imagine how clunky one with a stranger to whom you're messily opening up can get. Mostly it was fine, it really was, but the first couple of minutes were a teensy bit knuckle-bitey.

Who do I think it might it be good for?

Anyone who wants to try 'proper' therapy but doesn't have the time or ability to travel for sessions, and anyone who's somehow gone and got themselves barred from every counsellor in town.

E-counselling still feels like it's finding its feet: there are useful tools out there for the mild-to-medium prang-brained, but, as yet, no killer app that feels destined to reinvent mental health care for the hashtag age. What form might that ingenious wonder app take? No idea. If I knew that, I'd be off making it, instead of here, recklessly toying with my mental well-being for your half-distracted amusement.

You can find links to organisations that can offer advice on mental health issues here.