When Aino Korhonen*, 69, saw an advert for online mental health therapy in a newspaper, she went to her GP and asked if she could be referred to try it.
The lifelong Helsinki resident had been diagnosed with depression and had attended a few sessions with a psychologist but the two didn’t get along. She remembers: “We didn’t [seem to] talk the same language. I went a couple of times and it didn’t help me at all.”
Korhonen knew it was time to try something different when she turned up for an appointment only to sit and wait until she was informed that the psychologist was ill. “I was shocked. Somehow they hadn’t managed to contact me. I decided this wasn’t working. I couldn’t come here and not see anybody. I needed something else.” she says. Her GP agreed.
While online therapy is viewed with some scepticism in the UK, in Finland the service, Mental Health Hub, is used by every hospital district in the country. It was first set up 10 years ago by Prof Grigori Joffe and Dr Matti Holi at Helsinki University Central hospital in response to fragmented mental health services and because it is hard for patients in rural areas of the sparsely-populated country to get help.
It’s a win-win for patients, for professionals, for [hospital] management and for the taxpayer.
The online portal includes a questionnaire to determine whether users have mental health problems, along with a signposting service to show people where to go for help. The hub also provides self-help tools for those who don’t need professional help. Three years ago, it started offering therapy courses with qualified mental health professionals for people with mild to moderate mood disorders. Anyone can access it but a referral is needed for therapy. The hub also offers education, training, advice and consultation opportunities for mental healthcare professionals, as well as various tools for measuring mental health.
Patients can access computer-assisted cognitive behavioural online therapies for depression, alcohol misuse and a wide rage of anxiety disorders. They log on to watch videos and complete written exercises designed to highlight destructive behaviour and how to avoid it. If they have questions or worries, they can message a mental health professional who will reply to them with advice or encouragement.
It has proved popular. Funded by the hospital district in Helsinki, HUS and the government, in November 2016 the hub had 80,000 unique users, compared with 53,0000 in November 2015 – a rise of 70% year on year. The total number of unique users in 2016 was 545,000, equal to roughly 10% of the Finnish population; this has grown from 218,000 users in 2014 and 400,000 in 2015, the year the hub became available nationwide.
For Korhonen the service was invaluable. She remembers: “I started doing it and good heavens this was very good for me. I could do it very early in the morning because I normally wake up early. I could do it last thing in the evening. The exercises were very versatile. It really worked for me. I started appreciating myself. I changed my harmful beliefs into something creative. I got rid of my automatic negative thoughts. I changed them into positive ones.”
Preliminary evidence shows that the therapy provided works as well as that provided in a more traditional face-to-face setting, according to HUS director of strategy, Dr Visa Honkanen. Research shows that over a three month period, patients’ depression levels reduced by 10 points, as measured by Beck Depression Inventory, a widely-used instrument for measuring the illness. If someone were to have moderate depression and their BDI score dropped 10 points, they would be left with very mild or no depression.
Honkanen adds, however, that the idea of Mental Health Hub is not failsafe. He asks: “What if we have cases where self help tools say that everything is OK and then a young person harms him/herself. Who is responsible? Of course we would be.” This situation has not arisen yet in Finland but Honkanen recognises that as digital services develop, it is an issue that will come more to the fore. Of course, this situation could occur with face-to-face therapy as well.
The service has been somewhat of a revolution for the healthcare professionals involved. Eero Matti Kovisto, a psychologist based at HUS who does part of his work online, was sceptical at first about whether Mental Health Hub would be effective. “It was scary [to start with], I was just wondering: ‘Does this help anybody?’ I had the feeling that something was missing [from the therapy].”
He recognises that online therapy is not for everyone and Mental Health Hub is only effective for certain mental health problems which don’t require intensive treatment, but he has seen firsthand how it can transform lives. He also sees that it creates a more equal relationship between the professional and the patient and gives more responsibility to the latter for their care. He sees his role as more like that of a coach: “I give my patients comments and they do the therapy independently. It’s a whole different role [for a healthcare professional] and internet therapy is a whole different thing.’
The service is also much cheaper than traditional treatment; the professionals providing therapy can take on a bigger caseload. Kovisto has 20 people he helps online, which just takes up one day a week. Joffe adds: “It’s a win-win for patients, for professionals, for [hospital] management and for the taxpayer.”
As for Korhonen, whose depression almost entirely disappeared after taking the course, she knew it had helped when in November she lost a close family member. “This was a real shock. I had just finished my depression treatment and I felt quite terrible about it. I still grieve but somehow I feel that because of this therapy I was able to manage. I can remember all the good things and be grateful for them. Without the therapy, I don’t know what I would have done.”
*Not her real name
- Sarah Johnson was in Finland to learn about what health initiatives are running in the country. The trip was supported by Finpro and Tekes, who had no say in the content of this article.
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What can the UK learn from Finland"s approach to mental health?
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