Ash Catton


PhD Candidate, Clinical Psychology Student

Is E-Therapy a solution to the 'mental health crisis'?


September 09, 2021

(Opinion) Imagine a highway: a popular multi-lane highway designed many years ago to handle peak-hour traffic. Having reached its maximum capacity for peak hour traffic only a few years later, there are now long queues of cars waiting for hours just to get home, with many now avoiding the highway altogether. Clearly, there are two options: Either add more lanes to the highway or reduce the amount of traffic that needs it in the first place. One of these options is more ‘future proof’ than the other, but it requires a massive paradigm shift.

The mental health crisis is like this, with public service usage steadily increasing each year for over a decade. Capacity for public mental health services was reached a long time ago and is now typically reserved for the most extreme cases. That means many people who need mental health assistance don’t receive it. The government’s response so far has been to throw money at the problem; to add more staff, more services - in effect to build more lanes. As with the highway, this solution isn’t future proof, as it is certain that the new capacity will eventually be reached. So, what’s the mental health equivalent of reducing the traffic? How can we reduce the demand for mental health services? This is where e-therapy can help.

E-therapy is a type of psychological help given over a digital device and includes everything from talking to a therapist over Zoom, to playing a game that’s been tailored as a type of therapy. While e-therapy isn’t a direct substitute for getting help from a psychologist in person, it can help people reach the same goals as conventional therapy. These goals include education about how and why people may be in distress and how they can progress beyond their current difficulties. It can also help with skills training, such as relaxation and social skills alongside problem solving abilities tailored to the persons unique situation.

To the governments credit, they recognised the potential for e-therapy during lockdown of 2020 and invested in some digital platforms. However, this has recently been criticised by health professionals as investing in a solution to offset the extreme impact of such a chaotic and distressing time. Specifically, the solutions invested in, Mentemia and Melon, run the risk of invalidating mental struggles by normalising and emphasising the importance of mental wellbeing. This is the wrong approach. While e-therapy is suitable for mild to moderate severity struggles, it should never be used as a frontline crisis intervention – and a nationwide lockdown may be considered such a crisis. What is needed are forms of e-therapy designed as a proactive, not reactive, solutions to build resilience among vulnerable people before they get to a state of extreme distress.

There are some encouraging initiatives that are already available. Here in Aotearoa, researchers at the University of Auckland created SPARX, a videogame created to provide skills that a therapist trained in Cognitive Behavioural Therapy (CBT) might administer in person. SPARX was designed for 12–19-year-olds who struggle with mild to moderate depression and anxiety, which means it may be able to help those who do not meet criteria for public health services and help them before things get worse. SPARX can be played on a PC or mobile device and is free to use – it’s also designed with Māori cultural elements that gives it a distinctly Aotearoa feel. The game includes an educative element that teaches young people about the role of thoughts in creating and reinforcing feelings of depression and anxiety, encourages them to see their problems in different ways and develop solutions, and teaches social and relaxation skills.

SPARX also validates the experience of mental struggles by letting the user know that many others feel as they do. Local research conducted on SPARX shows that may be as effective as conventional treatment and has been adapted for Australian, Dutch, and Japanese groups with similar results. This tells us that e-therapy not only has the capacity to reduce the demand for mental health services, but it could be just as effective as using the service itself. In other words, it’s like getting to where you need to go without using the highway.

Similarly, another anxiety CBT program, BRAVE, was deployed between 2014-2018 across Canterbury to help young people who may not meet criteria for public services. BRAVE has many of the same treatment goals as SPARX and has been adapted for both children of different age groups and their parents. The evidence shows that these young people noticed their anxiety levels drop after the just first few sessions with the program.

Taken together, these examples illustrate just how potent e-therapy can be.

Not only can e-therapy reduce the amount of traffic on the highway, but it can also overcome the problem of helping those who won’t or don’t feel able to use the highway at all. For reasons of geographic isolation, shame or anxiety around getting help, e-therapy overcomes these barriers. Most people have access to an internet connection and an electronic device – this is all that is needed to access some of these programs. In addition, people are more anonymous than they would be in a therapy setting, and they can access these programs when they feel ready – not when their therapist has free slots in their diary.

E-therapy allows people to get help when publicly funded assistance is unavailable or too daunting to pursue. Therefore, it is evident that the government’s plan to add more lanes to the highway or invest in solutions without examining their research base is not only failing to future-proof our mental health system, but it is inevitable that therapy will continue to be inaccessible to so many vulnerable people. If the highway is reserved for the most extreme cases, we need to help everyone else before they get to such a desperate position. For this reason, e-therapy is a solution worth researching and investing in.