One of the activities I do on my mental health first responder workshops is around barriers. I ask the group to throw out suggestions for what the barriers are for people reaching out for support. Most of the time I get very diverse lists, with the usual suspects cropping up - communication, stigma, guilt. One of the ones that comes up again and again though, is access. Access to the right services, access to the right people.
Yet access can also be about more than that.Yes, having the right support services available is crucial, and if we don’t have access to people we can trust and who can support us in a healthy way, we’re not likely to talk about our mental health. But even if the support service is in place, is it necessarily fit for purpose?
Some of the work I’ve been doing this year is around bringing mental health support to some of those who need it the most, but are less likely to access it, namely people who live and work on the streets. Mental health issues amongst the homeless and sex workers is a serious issue, however one of the barriers I’ve found, among many, is that the standard structure around counselling and therapy doesn’t fit. In standard counselling and therapy, you have a room, you advertise your availability, and people come to you. How is that going to fit for people who live on the street? They can’t come out to you. They can’t keep regular appointments. When someone’s life is chaotic, you can’t expect them to fit into the same framework as everyone else.
And when we think about it, that can apply to anyone. There are counselling and therapy services out there, but what if you can’t see someone face to face? What if the anxiety is too much? What if you work flexible shift patterns? Or are a single parent who can’t get time away from their kids to commit to travelling out to see someone? Does the current structure fit for people?
I’ve been thinking a lot about this lately, as I’m in the process of launching an online counselling and therapy component to my practice. I’ve been resistant to doing it for a while, because studies show that online counselling and therapy isn’t as effective as face to face therapy. However - and admittedly I have no studies to back this up - I’m fairly sure that online support is better than no support at all. And if I’m going to look at people from a holistic perspective, seeing all parts of someone, that has to include those people for whom face to face isn’t a good fit. They deserve support as much as anyone else.
There are options out there for people who can’t fit the normal structure of counselling. Online counselling and therapy, home visits, Skype sessions, telephone counselling - there are a lot of possible options out there. But as a profession, it’s our job to try and make support services as accessible as possible to as many people as possible, and a large part of that is making people aware that they have those options. It's no good offering those services if they're not something that we let people know they can access. Signposting is important. And we have to work to allow the same level of choice to people accessing these services as we would with face to face clients.
I'm still a big advocate of face to face therapy, I think it's the best way to create change in a person's life, and to begin a process of healing for someone who has suffered loss or trauma in their life. However if we focus solely on that, we alienate so many people who need support but cannot fit into the structure of face to face counselling and therapy.