Remote mental health interventions work – but not as a replacement for face-to-face support

As social distancing measures are lifted, mental health services that have been forced to operate almost exclusively remotely are now shifting their attention to how to re-introduce face-to-face support. Many will be making decisions about how to embed and expand elements of what worked well during the pandemic - because whilst Covid-19 has been a huge challenge for organisations supporting young people with their mental health and wellbeing, it has also emerged as a phase of intense creativity and innovation. This next stage is crucial and will require evidence-informed decision-making in policy and practice. Youth Access’ rapid review of current research into remote interventions to support young people’s mental health, launched today, is the latest stage of our efforts  to support this work.

Our findings suggest that remote interventions can lead to improvements in young people’s mental health and wellbeing, and young people who choose to access support this way were generally very happy with it. Remote working can allow services to work flexibly, accessibly and adapt their ways of communication to fit the needs of young people, including those who have traditionally found it difficult to access face-to-face counselling.

Remote support can be offered as an alternative to young people who may find it difficult to access face-to-face support due to a change in life circumstances or mental health, or as an option for young people who don’t feel ready to engage in longer term therapy. In this sense, remote interventions, when offered alongside face-to-face support, can help to build a service that is truly young person-centred, giving young people more choice and control over how, and how much, they want to engage, whilst making the service accessible to those who find it difficult to attend face-to-face support.

However, we know from the experience of lockdown that remote support is by no means a silver bullet. Concerns around digital and phone support include long waiting times for drop-in services, with no guarantee of accessing support before closing time. They include the lack of ‘real time’ responses to young people’s needs, especially when communication is by email or text, and increased difficulties in developing strong therapeutic relationships or progressing to the later (more impactful) goal planning stages of the therapeutic process. Using technology also runs the risk of additional disruptions to sessions (e.g. due to problems with the sound or video quality of a call) and there remain serious concerns regarding the lack of access to a computer, phone or the internet for whole swathes of the population.

Moreover, for those young people who can access it, remote interventions are not always suitable, and to view them as a like-for-like replacement for in-person support in the long-term is problematic. While survey studies have found that most young people were interested in trying remote mental health support, the majority of those attending face-to-face sessions were not comfortable with it being used as a replacement for these services and there were very high dropout rates in trials of remote interventions (where young people were randomly selected to receive a remote intervention, rather than choosing to access it themselves). Conversely, most young people accessing online chat or telephone support said they preferred to receive support in this way rather than face-to-face. As such, our findings have shown what we have always known to be true: young people are not a homogenous group and should not be treated as such.

It's crucial that practitioners traditionally trained in face-to-face work are supported to transition to remote working, in particular those who are newly qualified practitioners, were furloughed or have had limited to no experience of providing sessions remotely during lockdown. As we emerge out of crisis response and look to reflection and recovery, we must take the opportunity to ensure those providing remote support are able to take the time to receive training to continue their work safely and accessibly. Such training, at a minimum, should cover consent, risk management and safeguarding, privacy and confidentiality as they relate to remote interventions, as well as ethical and legal considerations required for this work. It should also cover the impact that remote work can have on communication and power dynamics between the young person and practitioner, and how to adapt to these new challenges.

If not supported correctly, staff can become one of the main barriers to adoption of remote modes of support. Our research has found that staff often felt that remote support was not aligned with their professional values, role and responsibilities, and can require staff to re-think their ways of working and identity. In addition, there is some evidence that staff can remain resistant to providing remote support in services that had adopted it, even when it was working well and was popular amongst young people. In these cases, training around the strengths of remote support, and the experiences of young people may be helpful, as well as training around how to increase engagement among young people. This should also be included in undergraduate and entry-level training for mental health practitioners.  

This review has important findings for remote mental health interventions which, supported by the wealth of anecdotal evidence and experience gained from the past three months, will be essential in this next phase of reflection and eventual recovery from the pandemic. However, research needs to go much further. There is an urgent need for more robust evaluations into the effectiveness of remote support, including comparative studies looking at the outcomes of remote vs face-to-face interventions. We need more investigation into the experiences and perspectives of staff, who are likely to be far more familiar with these types of interventions, to help us understand if and how the challenges presented in this report may have changed. And, crucially, we need research to help us understand the experiences of young people, particularly those who had to switch from face-to-face to remote support during lockdown, and those who would not otherwise have chosen to access remote support.

There is lots to do, but we mustn’t waste this key moment to learn from the lessons of lockdown, confront the challenges presented by remote working and capture the innovations necessitated by the crisis. This new period of transition presents a unique opportunity to build a mental health system that blends remote and face-to-face support, meets young people’s human rights, and is accessible to all. The research community must be at the forefront of this.