Unaccredited online therapists are “preying” on the desperation of people with mental health problems as the NHS struggles to meet rising demand, in many cases exacerbating people’s issues, experts warn.
Vulnerable people are being exploited by “unethical” private websites which charge large sums of money for therapy sessions via online chats – with some services even being used as a tool to project religious and spiritual beliefs. There is growing concern many of these websites operate using unaccredited counsellors who are not medical professionals and do not have the minimum training standards to treat serious mental illness.
Currently, there is no legal requirement for therapists to be a member of a professional body. But experts strongly recommend anyone seeking therapy should be treated by someone who is on a register accredited by the Professional Standards Authority for Health and Social Care. Obtaining this accreditation requires a minimum of around 400-450 hours of college-based therapy training, which usually takes no less than four years.
But there is a growing number of alternative courses available to aspiring therapists which are quicker and less expensive, and can be completed in as little as a year. Due to the lack of legal framework around regulation, this has led to a “very wide spectrum of people calling themselves counsellors”, according to experts.
A number of privately run websites offering therapy have been described as “unethical and exploitative” by former users, who said rather than helping them, the experience caused them heightened stress. One website states it offers “convenient, affordable, private” online counselling and offers the opportunity to talk with a “licensed, professional” therapist online.
But accredited mental health professionals have told The Independent there are concerns the therapists are often unaccredited, and sessions can leave the client feeling “overwhelmed”, sometimes serving only to exacerbate their condition.
Former users have posted negative reviews about one of the private websites, with one person writing they were “slapped onto a paywall” the moment they had opened up and shared their issues. They said the abrupt nature of being served an online bill could risk pushing them “over the edge” if finances are particularly tough. They added: “The behaviour of this website in this instance is unethical and they need to be stopped from practising until they fix this experience and set clearer expectations for their visitors. They prey on the ill and desperate.”
Another said the therapist they spoke to insisted there was a “spiritual solution” to their problems, saying they were “clearly using the site as a means of finding desperate, unhappy people to recruit to their belief system”.
Kate Anthony, British Association for Counselling and Psychotherapy (BACP) fellow and co-founder of the Online Therapy Institute, which offers training to therapists on working online, told The Independent the lack of regulation of online therapy was a “serious concern”.
“There’s no regulation, except for small professional organisations that insist on members having been trained. But those are specialist organisations. Anyone can set up a website that charges for therapy,” she said. “There are certainly people, out there exploiting vulnerable people, who aren’t best placed to treat them. It’s a serious concern that people who are not qualified are charging people for online support.
“Over the years I’ve seen a lot of these websites come and go, so it’s very difficult to get any sort of research in place to find out what the outcomes are. It’s a concern that so much counselling isn’t being regulated. If there are problems, the user would have to go to the professional association of the practitioner and create a complaint, which is quite a difficult and anxiety-provoking process.”
Ms Anthony added that due to the nature of the online world, mental ill-health sufferers are likely to reveal the full extent of their problems much faster, which can lead to further complications. “When clients get online they’re a lot more disinhibited than they would be face-to-face, so they can reveal a lot of very personal stuff very quickly – things they haven’t revealed before to anyone. This leaves the client feeling overwhelmed and can actually exacerbate the problem,” she said. “There are some platforms that use automated scripts. That’s a real problem because whether it’s online or not it’s about human interaction.”
Terry Hanley, programme director of the doctorate in counselling psychology at Manchester University, echoed this, saying the rise in people seeking psychological support online is being capitalised by private practitioners. He also pointed out that many sites operate globally and nuances in language are often lost in translation.
He told The Independent: “It seems to be an opportunity for private practitioners to add another string to their bow. There’s very little regulation monitoring of what goes on in that area. You can cross countries very easily. This can risk misinterpretation, particularly if you’re talking about text – language becomes a bigger issue. Even terms like counselling and psychotherapy mean something different in different countries.
“We know the use of internet helplines has gone up exponentially, and it’s hard to document how much the private industry is getting. But you can see there are lots of private practitioners who have set themselves up in that area – which suggests a lot of people are using them.”
The warning comes as a growing number of patients are being directed to webcam and instant messenger appointments by the NHS itself, as commissioners across the country seek out alternatives to traditional face-to-face therapies to ease pressure and wait times. Figures published by The Independent earlier this year show an almost ninefold rise in webcam and instant messenger appointments through the NHS’s flagship mental health scheme between 2012-13 and 2015-16, compared to a 144 per cent rise in overall appointments.
The number of appointments carried out this way, under the Improving Access to Psychological Therapies (IAPT) scheme, in England, rose from 5,738 to 49,475.
It comes as a recent report found NHS mental health services in England and Wales face a “potent mix” of rising demand and cuts to the workforce, leaving many patients having to wait months or even years before they can access treatment. The drop in services has resulted in people with psychological issues turning to the internet for help – fuelling the unregulated online market.
Mr Hanley said a number of cognitive behavioural therapy (CBT) programmes offered under this scheme, such as Beating the Blues and FearFighter – which are both free to access – can help some patients, but for others risk “batting them away” from more appropriate face-to-face services.
“There’s a big wave of developments in computerised CBT, which have benefits of increasing access hugely, and for some people that will be incredibly useful, but it also seems to be batting people away from accessing services that might be more appropriate for them,” he said. “For people with higher levels of distress it’s a sticking plaster on a very big wound. Six sessions with a programme isn’t the same as face-to-face sessions for someone who’s had a horrendous history of sexual abuse. It can’t be a one size fits all.”
Responding to the concerns, an NHS England spokesperson said: “We now have the biggest national programme for talking therapies, with more people receiving treatment than ever before. There’s no single right way to receive care and evidence shows online services can help, particularly when backed up by face to face support.”