Over the past two weeks, my closest friend and I have regularly traded our worst Covid-19 anxieties over text. She’d tell me she couldn’t stop crying, worried about her parents’ job security and an abrupt transition to working from home. I was nervous about extensive self-isolating, scouring the news every few minutes for bright spots amid mostly tragedy-ridden headlines. Suddenly stuck in our rooms, it’s fair to say that our mental health had plummeted, and we were — and both continue to feel — overwhelmed, stressed, and incredibly sad.
Admittedly, our coping strategies weren’t great, either. They comprised mostly of sharing the worst Covid-19-inspired tweets, separated by the usual supply of vague platitudes. But at one point, she seemed to be feeling worse and worse and I — with no sort of mental health training — no longer felt I had the right words to respond in the moment. I was worried about her, but I didn’t know if what I had to say was helpful or harmful.
So I directed her to a service I’d used before called Crisis Text Line, which facilitates text-based conversations with volunteer crisis counselors. She took my recommendation and sent her first message to the service in the middle of a work day.
Texting in the time of crisis
That people are seeking digital sources of mental health support isn’t particularly surprising. The Covid-19 coronavirus pandemic is fueling demand for digital mental health tools as apps, chatbots, and text-a-therapist platforms report an influx of users in search of much-needed help. Given the current realities of life in our increasingly digital world — and the demands of social distancing — it makes sense that people turn to remote sources of psychological support.
The spike in interest in these digital mental health tools, which appear to vary in quality and scope, isn’t specific to a single company. TalkSpace, which calls itself an online therapy company, reports that the volume of users on the platform is up about 25 percent since the middle of February and that growth is accelerating. One of its primary competitors, BetterHelp, says the number of new members starting its service has spiked and that the number of new users who mentioned concerns about stress and anxiety during the past two months has more than doubled compared to the same period last year. Meanwhile, mental health chatbots Wysa and Woebot have also seen usage go up.
Demand extends beyond chatbots, too. Crisis Text Line, the tool I directed my friend to, reports that its volume of messages has jumped by more than 116 percent since Monday. Keep in mind that the service isn’t meant to be a long-term source of care, and you’re generally chatting with a volunteer counselor, not a licensed therapist. Still, when I’d last used it, I was comforted by the immediate response and by the idea that I was — anonymously — talking to another human.
Struggling to adapt to a world embattled by a pandemic, others seem to be looking for sources of support as well.
“In relation to coronavirus in particular, they’re using words like ‘scared,’ ‘terrified,’ ‘overwhelmed,’ ‘panicking,’ ‘paranoid,’” Crisis Text Line’s chief data scientist and co-founder Bob Filbin told Recode. “There is a consistent feeling of anxiety that we’re seeing increase.”
Now, the service reports that one in every five conversations mentions “virus,” “coronavirus,” or “Covid-19.”
All of this makes sense. With the coronavirus pandemic, we now face a global death toll that’s only expected to rise, the threat of a global economic recession, and the sadness of knowing our lives will probably never return to the way they once were.
But we are also overwhelmed by the immediate impacts of this pandemic. For instance, there are the stresses of social distancing and working from home while trying to homeschool our children. There’s also the pressure to make ends meet after a sudden layoff, the struggle of navigating self-quarantine in a shared home, and the toll of not being able to embrace our older and immunocompromised loved ones. So it’s no surprise that people are increasingly flocking to digital mental health services.
In addition, the pandemic will likely make managing any preexisting mental health conditions more difficult. Experts say that social distancing will likely cause a sort of social recession that could be especially harmful for older adults. Speaking for myself, I’ve found the sudden adjustment to days mostly spent inside and with limited interaction with my friends difficult to manage.
Getting to know the different types of digital mental health tools
Amid a pandemic, people are understandably seeking out mental health support online. That means patients of traditional therapists are moving toward telehealth-based platforms, using services like Zoom and Skype to video chat with their providers. Services like BetterHelp and Talkspace, which have users message therapists throughout the week, are also seeing increased activity. Even mental health chatbots are observing growing traffic, almost certainly due to Covid-19.
To adjust for social distancing, therapists and other mental health care professionals are flocking to online platforms to provide care. While the field was already moving in that direction, the US government has recognized that the Covid-19 pandemic has created an immediate, increased need for digital health services, notes John Torous, the director of digital psychiatry at Beth Israel Deaconess Medical Center.
“We’ve seen already the federal government and CMS take these steps to make sure that we can increase access to telehealth, and I think that’s a positive step,” Torous told Recode. “You can almost see that even the federal government is realizing that we have to evolve our mental health system.”
Earlier this week, Medicare announced that it would temporarily expand coverage for providers using telehealth-based services, including mental health counseling, and the government is also making it easier for patients to use apps like FaceTime and Skype. Meanwhile, the Drug Enforcement Administration is also making it easier to “e-prescribe” certain controlled substances, including those that treat mental health conditions.
But services that provide what’s called “asynchronous” counseling are also seeing growing interest. BetterHelp and Talkspace are two of the biggest apps in the space, and both generally have users exchange messages, to which the platforms’ licensed therapists then respond. These services tend to be a cheaper than traditional therapy — Talkspace’s cheapest plan is $260 a month — but Torous cautions that they don’t substitute for meeting regularly with a therapist.
Conversations about coronavirus have dominated platforms like this recently. Neil Leibowitz, the chief medical officer at Talkspace, says that the traffic to the platform has surged and that volume on the app is up. According to polls of Talkspace therapists, many clients say they’re worried about what could happen if they become infected with coronavirus or how they should manage the logistics of working from home.
“Maybe before, they were talking about stress at work or anxiety related to relationships,” Leibowitz told Recode.
Other tools that don’t involve any humans at all — chatbots — are also seeing an influx of interest. The X2 Foundation says that the number of users mentioning coronavirus to its AI-powered mental health chatbot “Tess” has shot up 20 times in the past week. “Tess” has also seen some of its dialogue adjusted to address the coronavirus. Meanwhile, other chatbot creators are racing to incorporate content related to coronavirus-related anxiety.
“We can’t get that out quick enough, to be honest,” Alison Darcy, the CEO and founder of Woebot, told Recode.
Then there’s Wysa, which calls itself an “AI friend.” This chatbot has responded by releasing specific toolkits for “pandemic anxiety” and “isolation wellness” — which has now seen the highest usage across all the app’s services.
Knowing the difference between chatbots and doctors
Apps and chatbots are not the same as in-person mental health care, including video-chatting with a therapist. Potential users should be very aware of this, as well as whether a tool is actually claiming to provide health care, whether it claims to be HIPAA compliant, and to be wary of what data they might collect. Torous, the psychiatrist from Beth Israel Deaconess Medical Center, says that many of these services actually call themselves “wellness” tools, not health care tools.
“It’s not saying don’t use them; it’s saying be an informed consumer of health care, like you would for anything,” Torous said. “I think even the people who make them would say they’re not close to a substitute for care.”
According to a 2019 study evaluating mental health apps, mental health apps will often try to bolster themselves with scientific language despite lacking high-quality evidence of their efficacy. Overall, Torous emphasizes that there isn’t reason to believe that these tools can substitute for professional mental health care, and research shows that people often don’t continue to use them long-term.
“It’s easy to download an app,” he added. “The evidence suggests that it’s kind of hard to stick with these things.”
And while artificial intelligence-based chatbots might be able to respond to your questions immediately, they are still a far cry from speaking with another human. As Torous points out, these chatbots “don’t always understand humor or sarcasm.” Still, he cautions that even if there’s no particular evidence that a tool might work, it’s still possible that an individual will find even an imperfect chatbot to be helpful. When I tried Wysa and Woebot, I found them both a bit simplistic, but I could see how a conversation might help me slow down my thoughts. I still found it somewhat comforting to type out a list of everything on my mind, even with a finicky bot that I know — deep down — doesn’t understand a word I’m typing.
Meanwhile, platforms that claim to connect a therapist directly to patients have faced controversies of their own. Talkspace was the subject of a 2016 investigation by The Verge, in which therapists said the app hadn’t created the right mechanism for reporting patient safety issues, among a slew of other problems. BetterHelp, meanwhile, has faced criticism for sharing data with social platforms like Facebook, and for its use of YouTube influencers, who were profiting from fans’ mental health struggles, according to some critics. Users have also complained that digital mental health services ultimately just aren’t that helpful, as the Guardian and the Outline have both reported.
There’s also the question of whether the therapists and counselors who power existing mental health tools have the capacity to handle a potential surge in demand. Several companies said that they were prepared to manage an increase in demand.
“A lot of therapists who were doing just a few hours with us every week now basically do it full time because their other sources of income and channels of service are down now,” said Alon Matas of BetterHelp.
Meanwhile, Crisis Text Line’s Filbin echoed this sentiment, pointing out that its volunteers work from home, so the pandemic is “a moment a distributed network is really set up for.”
The Covid-19 pandemic will not go away anytime soon, and its immediate effects — and the long-term aftermath — will inevitably strain an already-strained and inadequate US mental health infrastructure. Like much of our work, spiritual, and social lives, it’s clear that the social distancing required by this pandemic will leave people turning to preexisting digital platforms and tools, however insufficient or flawed, hoping to fill in the gaps.
My friend hasn’t texted the Crisis Text Line since that day, she explains in a message; she’d need to feel as bad as she did before: “not necessarily feeling suicidal but feeling extreme hopelessness and the desire to just disappear.”
She reports that she’s thought about texting again but hasn’t yet felt the need. While the first time didn’t erase all of her anxieties, and she still frequently feels overwhelmed, the tool seemed to do what many of these platforms and tools are attempting to offer: a mechanism to sort through your thoughts, even if just for a brief moment. Just an immediate response was comforting; the counselor, she tells me, was validating and helped her feel “rational.”
And she says she appreciated that someone was available to listen sympathetically, even when I wasn’t.
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