The NYU Dispatch

How online counselling is filling the void in the mental healthcare system

What do you do if you suspect that yourself or someone close to you is undergoing a mental health crisis? The situation is not as far-fetched as you may believe it to be. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) in February 2014, nearly one-fifth of all adults in the US suffer from some kind of mental illness every year, a statistic which- according to some experts- may be seriously understating the magnitude of the problem.

It is a well-documented fact that the mental healthcare system in the US is increasingly struggling to cope with the magnitude of the crisis. While former president Barack Obama increased access to mental healthcare, the unfortunate reality is that the mental healthcare infrastructure in the country has not yet been adequately scaled up, and so capacity for treatment of patients is still well short of demand.

It is a telling statistic that the average length of in-house stay for mental health patients in the US has plummeted from 20-30 days in the 1980s to around a week in the present era. Extraordinarily, the number of patient beds in American mental institutions as of 2016 were around the same levels as the 1850s, when the population of the country was about a tenth of what it is now.

As it stands now, there is every possibility that the situation is only going to get worse, with on-going attempts to reverse the provisions of Obama’s healthcare law, which required health plans to include coverage for mental health disorders. To be sure, the global situation is far worse, with experts estimating that the mental healthcare system serves no more than 10 per cent of patients.

But coverage is far from being the only problem in the context of mental healthcare. In most, if not all societies, there exists a stigma around the issue of mental disorders. The situation is, if anything, far worse in developing or underdeveloped countries, where awareness about the nature and gravity of mental disorders is low or at times even non-existent. In such an environment, the lack of coverage can at least partly be put down to the fact that there isn’t enough demand for such services in the first place.

The economic impact of the lack of mental healthcare facilities is staggering. According to a study conducted by a group of health economists at the behest of the World Economic Forum, the impact of mental disorders in 2010 was estimated at USD 2.5 Trillion- almost equal to the GDP of the United Kingdom, the fifth biggest economy in the world.

Fortunately, it is not all doom and gloom for the sector, at least in the USA. There exists a silver lining in the fact that insurers still find healthcare policies that incorporate mental healthcare services to be a profitable business. In fact, some insurers plan to expand their Obamacare footprint in the country despite the present climate of uncertainty.

Also, several corporate entities have come to realise the importance of the psychological wellbeing of their employees. Major global entities like Unilever, American Express and Prudential have initiated programs for managers and senior leaders which are specifically designed to help improve the mental health of their employees. By all accounts, the initiatives are beginning to yield fruit.

Another factor coming to the rescue of patients is the advent of online counselling. Thanks to the proliferation of high speed internet and video chatting facilities, online counsellors partly fill the institutional void caused by the failing healthcare system. There also exists the fact that people living in smaller towns or rural areas seldom have access to anything beyond basic healthcare in their immediate vicinity. Given the constraints of costs and distance, online counselling would nothing short of an unmitigated blessing for such people.

The jury may still be out on the effectiveness of online counselling as compared to in person treatment. Nonetheless, some experts are of the view that certain therapy methods are just as effective, whether delivered from a distance or through personal consultation. For instance, studies have established that cognitive behaviour therapy (CBT, which focuses on developing mechanisms to cope with disturbing thoughts, attitudes of behaviour), whether administered from a distance or face-to-face, was equally effective for health conditions like obsessive compulsive disorder or post traumatic stress disorder. What ultimately determines the effectiveness of online counselling is the nature of the problem and the kind of therapy sought to be administered.

Since online counselling is still a fairly new concept, research into the scope and effectiveness of it is naturally in a nascent stage. There exists the possibility that the practice will evolve to assume a wider role than it has assumed until now.

With the spectre of slow economic growth and rising unemployment in developed countries, it is likely that the current healthcare crisis is not going away anytime soon. Given that context, online counselling could have an important role to play. It may not supplant the traditional mental healthcare system, but it can partly fill a void. For patients whom the present system is unable to service, something is better than nothing.

This article was contributed by fellow NYU students. If you would like to make a contribution to the NYU Dispatch, please email us.

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