The virtual realm can’t save us

An investigation into the rise of online therapy

By Abby McCormick, Student Life Editor

Where do you go when you need help? When there are those moments in the semester too overwhelming to handle, to process, to sit still? When assignments pile up and you’'re wading through homesickness, isolation, or low self-esteem? What if you’'ve been struggling with your mental health? I don’'t ask these questions to scare you away. I ask them because when we talk about mental health, we’'re often not talking about the solutions, the compromises we make to ourselves, or the parts of ourselves that require gentleness and care.

Nearly fifty-seven per cent of McGill students who identify as disabled report having a mental health disorder. Late-night McLennan sessions are the norm, and the Wellness Hub’s record-long wait times persist. The mental health crisis at McGill is severe and growing.

Founded in 2019, McGill’s Student Wellness Hub aims to provide students with free access to counsellors, nurses, doctors, psychologists, and other health care practitioners. However, the Wellness Hub has been continually plagued by staff shortages and long wait times that have left it unequipped to deal with students’ demands for mental health services. Many staff move between volunteering for the students and working for the province’s health care system. When Quebec is unprepared to care for mental illness, on top of ingrained medical racism and sexism rampant in the health care system, the people who require treatment the most just have to wait, unserved and unseen.

In the wake of the Wellness Hub’s shortcomings and COVID-19 lockdowns that redirected the labour of medical workers, many students have turned to a more accessible alternative: Online therapy. With a plethora of apps from BetterHelp to Calmerry to Talkspace that offer mental health support at your fingertips, it is easy to understand why students are opting for these digital services.

Online therapy comes in a variety of forms, mainly asynchronous text therapy and synchronous talk therapy via phone or video call. Since the start of the pandemic, therapists have been increasingly offering telehealth to their patients to reduce health risks. Therapy and self-help apps have become increasingly popular for many stakeholders—those seeking care, therapists in need of work, and corporations or institutions with employees or students demanding greater access to health care. The global mental health apps market size was valued at $5.6 billion CAD in 2021 and is expected to expand at a compound annual growth rate of 16.5 per cent from 2022 to 2030.

Apps like BetterHelp match users with a therapist based on their profiles and offer live video call sessions. In these meetings, they often incorporate techniques used in in-person sessions, such as cognitive behavioural therapy (CBT), which focuses on recognizing and reframing one’s unhealthy thinking patterns, and acceptance and commitment therapy (ACT), which prompts one to embrace their thoughts and feelings instead of feeling guilty about them. In implementing these changes, the return to in-person post-pandemic may be seamless or potentially unneeded. Other platforms, like Brightside, offer asynchronous text therapy options, where users can text the licensed counsellor that they are matched with when they are struggling. While users may find challenges in communicating their needs through writing, the time it takes to text may allow them to clarify their thoughts and better express their needs. Clients have space beyond a weekly one-hour limit to share their struggles, which might facilitate more effective treatment.

This trend has travelled to the campus. Colleges and universities across North America have taken advantage of online mental health treatment by providing students with free access to therapy apps. For instance, as part of their pledge to achieve diversity, equity, and inclusion in education, the University of Kentucky began a partnership with Talkspace this year to offer its 30,437 students free counselling services.

These apps also specifically target big clients like corporate workplaces and higher education institutions, marketing themselves as the key to higher employee productivity. But this raises the question of whether companies might rely on virtual mental health services instead of creating proper, non-exploitative working conditions.

At McGill, the Student Wellness Hub provides students with access to Therapy Assisted Online (TAO), a self-directed platform that combines educational materials for mental health and professional development. The service is available to anyone but especially targets higher education, employers, and health care organizations.

Released in 2015, Maple, one of the Student Wellness Hub’s partners, aims to connect its users to a licensed physician within minutes. Users are prompted to enter their symptoms and they are then paired with a physician with whom they can chat via text or video call, and receive a diagnosis or prescription. This platform makes it easier for students to receive a diagnosis, which are often difficult to acquire, especially if an in-person visit to the Hub is not possible.

One of the Hub’s other partners, keep.meSAFE, provides 24/7 access to professional counsellors whom students can contact via phone or chat. The platform has also partnered with other Canadian universities including the University of Toronto, Toronto Metropolitan University, and the University of Guelph.

Both the Wellness Hub and keep.meSAFE, however, only offer multi-session support with an assigned counsellor in the short term. Self-guided platforms like TAO are best used as mere ​​complementary efforts to talk therapy, which experts recommend as a first-line treatment for intense cases of mental illness. And you can’t forget the potential for these services to contribute to the underfunding and privatizing of health care and take the pressure off the federal and provincial governments to provide comprehensive mental health care for all.

As a result, students who require more personalized long-term treatment, but are deterred by high expenses, insurance concerns, or the difficulty of finding the right therapist, may turn to therapy apps that advertise themselves as the solution to all barriers to access. BetterHelp’'s stated mission is: “Making professional therapy accessible, affordable, and convenient—so anyone who struggles with life's challenges can get help, anytime and anywhere.”

This was the case for Jordan*, who experienced an “all-time low” shortly after beginning their studies at McGill. Jordan’s feelings of isolation and academic stress initially led them to seek help at the Wellness Hub.

“I was told that they had an opening in two months, but I was like ‘What do you mean? I’m in a crisis situation right now. I need someone right now,’” Jordan said in an interview with The McGill Tribune.

After being deterred by these lengthy wait times, Jordan turned to BetterHelp as a means of finding a therapist. They purchased their monthly plan for $340 per month, which granted them access to a phone call once per week with a licensed counsellor.

“I gained a lot from it,” Jordan said of their BetterHelp experience. “It was nice to talk to someone who would listen to me and agree with everything I said, but push me.”

Martin Drapeau, a clinical psychologist and professor of educational and clinical psychology and psychiatry at McGill, sees online therapy as one of the positives to have come out of the COVID-19 pandemic.

“It’s become a ‘mainstream’ practice that continues to be used at rates that are significantly higher than pre-pandemic,” Drapeau wrote in an email to the Tribune. “It is simply more convenient for most people, clinicians included, [and] now that it has become mainstream, clinicians are getting better and better at delivering online therapy.”

Nate Fuks, director of the Virginia I. Douglas Centre for Clinical Psychology and assistant professor of clinical psychology at McGill, cites fewer financial barriers as a key advantage to telehealth and therapy apps.

“Some online mental health platforms make therapy more accessible financially, which is an important consideration for students—students have limited financial resources and therapy can be really expensive these days,” Fuks wrote in an email to the Tribune.

Jordan’s experience with BetterHealth did not, however, meet their expectations when it came to financial accessibility.

“At the end of the day, it’s still a business. It’s not cheap and it’s not accessible to everyone, which is kind of what was advertised,” Jordan said.

Since the platform was not financially sustainable over time, Jordan opted to stop using the platform once their mental health crisis subsided.

Though online therapy may be effective for some patients, Drapeau highlights that, for those suffering from certain mental health disorders, in-person treatment is preferred.

“[Online therapy is] not recommended […] for anxiety disorders that require exposure, [like] social anxiety and phobias,” Drapeau wrote. “It is also not recommended for children, individuals who have ADHD, [or those who] have a possibility of suicidal ideation, although adjustments can be made.”

Fuks points out that face-to-face interactions are often key to cultivating a safe space for people to open up about their mental health struggles.

“In person, therapy usually happens in the therapist’s office, which often becomes a space psychologically associated with safety and security—necessary variables to make the therapy work,” Fuks added. “A lot of clients, as well as practitioners, find establishing a good working therapeutic alliance easier in person than online.”

For students living in communal settings, in particular, Fuks explains that difficulty in finding a private space for virtual therapy sessions can be a barrier to making the most of mental health care.

“Sometimes it is challenging for clients to find a private soundproof space where they can speak freely, without the fear of being overheard by their roommates or family members,” Fuks said. “This negatively impacts clients’ ability to feel safe to speak freely about any subject in their lives, which is central to productive work in therapy.”

Despite advertising themselves as a universalizing service, therapy apps exclude those who do not have access to a private space, a stable internet connection, and a laptop or phone.

Many have also critiqued therapy apps’ lack of guaranteed protection for their users’ personal health data. A 2020 investigation from Jezebel found that BetterHelp information was being shared with Facebook, including metadata of messages between patients and therapists.

Drapeau believes that these safety concerns could be alleviated with proper governmental regulations regarding patient data safety.

“There are guidelines for online practice. When these are followed, online therapy is perfectly safe,” he explained.

While Jordan benefitted from BetterHelp, they echo Drapeau and Fuks’ preference for in-person therapy—an experience that they had prior to moving to Montreal.

“In person, you can’t really hide behind the screen,” Jordan told the Tribune. “It pushes people to share more quickly, [whereas] online really depends more on your willingness to share.”

Limited in the number and diversity of its own counsellors, McGill's Wellness Hub relies on outsourcing students to their virtual telehealth partners—Maple, keep.meSAFE, and TAO—when they cannot meet the needs of different student communities. The Hub website, for instance, directs students seeking a Black or Indigenous counsellor or a counsellor of colour to keep.meSAFE.

Minority groups, including racialized, disabled, low-income, and 2SLGBTQIA+ students, already disproportionately face structural barriers to receiving mental health care. McGill should not be able to offload the responsibility of providing care specific to the trauma and mental health experiences of such students through telehealth partnerships. McGill should, instead, focus on providing specific and comprehensive care in any commitment to combating anti-Black racism and redressing settler colonialism.

For Jordan, reaching out for help was a struggle in itself against the heavy stigmatization of therapy.

“More so in the Black community, people don’t really do therapy. I really had to push for it with my family,” Jordan explained. “I do recommend it, but there are still these cultural barriers.”

The Hub remains an important stakeholder in improving mental health on campus. Dr. Vera Morono, Director of the Student Wellness Hub, cites greater flexibility as a key reason for the Hub’s continued use of online care.

“Virtual therapy offers a flexibility that increases accessibility for many users by allowing for shorter appointments, reducing physical barriers, more adaptable schedules, etc.,” Morono wrote in an email to the Tribune. “That flexibility is further enhanced with supplementary apps and services like keep.meSAFE, which offer expanded and vetted care options such as 24/7 support, care providers in multiple languages, self-guided care, and more.”

The long-term effects of shifting therapy into the virtual realm are still unclear. As virtual services are integrated into university infrastructures, it is important to remember that third-party apps and services are fundamentally businesses seeking to profit off of students’ demands for mental health resources. They are not accessible or effective models of care for everyone and should not be the be-all and end-all solution to McGill’s mental health crisis.

While online therapy apps do increase access to therapy in many ways, more investment must be directed toward the root causes of the rise of mental health problems on campus: McGill’s hustle culture, rising tuition costs, food insecurity, and an ableist post-pandemic climate, among others. We shouldn’t just digitize what we should transform.

* Jordan’s name has been changed to preserve their anonymity.

Illustrations by Shireen Aamir, Design Editor