Crossing the digital divide

I have worked in roles developing and developing digital interventions and provisions for the past two years. This is long enough to hear and observe scepticism from allied professionals. The general consensus among these sceptics is, well, it's not really therapy is it?

It would be naive to say that digital mental health interventions are not without their challenges. I'm not here to negate these, although I would encourage you to acknowledge that there is a growing evidence base supporting the efficacy of such interventions in a plethora of service-user populations and provisions. 

But we must recognise that the pandemic has brought about a paradigm shift. We have physically shut out doors and can no longer work with clients face to face in the way that we would normally. Lockdown and social distancing has changed our lives in many ways. It is worth considering that our lack of freedom to travel, socialise and connect is actually reflective of many people's daily lives already. For example, those who live alone in a new city. Elderly people who have no family or friends nearby. People with mobility difficulties who cannot travel without support. We are now being forced to experience the lives of the most vulnerable in society for ourselves. And, if you ask yourself what is bridging the gap to ensure you maintain connectedness during this time, you are likely to realise that it is digital access. 

Everyone is doing their best to adapt to the new normal. This includes psychologist and other mental health professionals. Having attended a recent Healthtech and Digital Health (HETT) event (via Zoom of course) I was so pleased to hear that NHS leadership are embracing digital care and recognising that digital services play a vital role in enabling people to access high high quality care, avoiding excessive wait lists and stigma issues. It has become apparent that digital interventions are no longer regarded as a plausible option, but a fundamental necessity. The rise is technology in recent years mean that we now have access to a plethora of valuable, evidence-based digital methods and means of therapeutic intervention and service provision.  

However, despite our good intentions, there is one thing we must not forget one thing: Digital access is a privilege. The Internet Access Survey (2019) revealed that 7% of households in the UK do not have access to the internet. That is approximately 5 million people. Lack of IT literacy skills was the primary factor for 34% of this group. More than one third of the population do not have mobile broadband access. Tens of millions more are reliant on pay-as-you go services to make phone calls or access their healthcare. This statistics highlights something very important: the digital divide. 

The Good Things Foundation (a charity that tackles digital exclusion) released a poignant statement that highlights the devastating affects of the digital divide during the Covid-19 pandemic. People are finding themselves shut in their homes, facing social isolation with no means of communicating with the outside world.

As we adapt and adjust to the current circumstances and rely more heavily on technology to support vulnerable people with their mental health, it is becoming more apparent that digital access is a social determinant of health. After all, without the means and resources, how are people going to access and receive the support they need right now? What are the potential adverse impacts this will have on their health and wellbeing? 

It seems like Covid-19 has starkly highlighted the inequalities that exist without our digital society. The internet was once seen as a luxury, but now it is a necessity. Without it, your health and wellbeing is on the line.  

I reflect that as more of us transition into using digital technology to delivery mental health care, it can be a wonderful or a damaging thing if we do not carefully address digital inequality. This is because digital interventions can go one of two ways; they can be inaccessible to so many but have the potential to be accessible to everyone. 

In my day-to-day work, I have seen first hand the rapid increase in the use of digital interventions. For one digital platform alone, registered service-users has increased by roughly 375% in the past two months. Going back to the 'old way' of accessing care might not be the best thing for patients or the health system, but we must ensure that these provisions are delivered equitably. As psychologists, we have an important role to play beyond the therapy room (or "zoom" if you like!). As digital platforms are becoming a fundamental part of a psychologists tool-kit, we must also actively drive the need for equitable distribution of digital resources for every household. Of course, this must be embedded at the wider policy level and involve political recognition and engagement. Without this, digital interventions are at risk of embedding inequalities further. 

Grace Bamber

Senior Assistant Psychologist 

Digital Interventions