Mental health therapy under lockdown

Readers may or may not know a lot about mental illness, although it is estimated that one in four people in the UK will experience mental health issues each year. 

A Kent therapy group communicated to KBL in April about their frustrations that their in-person mental health therapy had been halted since March 2020. They had gathered statements about their experiences of online therapy sessions during the lockdown periods. They were using these to petition to the authorities to re-start the regular in-person therapy sessions.

Who benefits from in-person mental therapy groups

The mental health therapy group, run by NHS professionals, is for those with severe personality disorder. A letter about Covid was attached to their petition which included some official definitions:

“Deep-seated relationship difficulties, difficulties in affect management, maladaptive and potentially destructive  coping mechanisms or high use of statutory services including crisis services.”

This service is for people with a sole diagnosis of a personality disorder. Not all members are referred prior to hospitalisation. Most are referred because symptoms of their personality disorder are making them too unwell and need intervention.

So it can be assumed that the group contains a variety of individuals suffering from such disorders. It is worth noting that Kent has been assessed as the English county with the highest incidence of such needs.

Lack of in-person mental health therapy causes distress

The extracts below are from the personal statements in the report:

“My daughter has been attending her therapy sessions online up in her room since March 2020, and at these times my wife and I feel anxious that we must remain present in the house to provide assurance and safety. We feel as though it would be better and safer if she was allowed to attend her sessions in a safer environment and also this would be less stressful for us.

“This situation with the online meetings has now come to a head and my wife and I believe it is well time for our daughter to return to her proper meetings…., it would be a welcome relief for my wife and I to hand the responsibility of our Daughter’s mental health back to those who have been employed to bear her care, thus allowing my wife and I the respite that we so much desire to have; to be able to leave the house and visit family etc, as those days when our family and friends are able to meet us, we have had no choice but to remain home to supervise our daughter while she is undergoing her online therapy.

“We see gymnasiums, garden centres and beauty salons opening everywhere, with folk milling around inside the shops and yet our family and friends who have been suffering from severe mental health for many years are prevented from accessing essential therapy, in a place that has been sanctioned, especially for their safety and protection, to help them overcome their disorders and anxieties, but instead are told that they must remain at home with a computer.

“I started the main group of the TC in January 2020 and had been there for around a month when it had to be moved online. For the first 9 months I was staying with an ex-partner and at the time was in a very abusive and controlling relationship which made it difficult for me to obtain adequate privacy and also feel like I could keep the confidentiality of the meetings secure for the other members. This often created added conflict and made it impossible for me to speak about my situation and use the space effectively, with therapists and members often having to ask me limited yes/ no questions.

“Since December I have been living full time with my parents and am struggling with similar problems around privacy, confidentiality, conflict and having limitations on how I can use the sessions without compromising my safety. I believe that if I had been in the building, I would have been safe to disclose more helpful information, been able to be more vocal in supporting others and generally not felt the need to mask my emotions and feelings to safeguard myself.

“Significant long-term difficulties that I was trying to address in the physical (in person) therapy were learning to develop independence (travel, money etc.), learning to manage a routine (getting up, washed, and dressed, organizing myself, sleeping etc.), and learning how to navigate and orient myself within a group therapeutically and socially. These things are virtually impossible online, and I feel it is having an ongoing negative effect on my progress and am concerned it is not being taken seriously. 

“Over the last year, the expectation for community members to fill in and become lifelines for each other during crisis has been incredibly worrying. It has been difficult to access contact from therapists and there has been a lot of missed communication and dependency on others who are also at crisis point.”

Summary of the problems caused by lack of in-person therapy

The points below were all written by members of the group:

  1. Lack of privacy as members can’t discuss problems frankly, especially if these arise from the home environment 
  2. Unstable group dynamics, with less opportunity to engage in challenging therapeutic discussion when members can easily log in and out
  3. Deterioration of practical routines for eating, preparing food, exercising, getting dressed, using transport etc
  4. Difficulties responding to members in crisis, with reduced time of online sessions, and the physical distance
  5. Technical problems with internet connections
  6. Over-reliance on e-contacts between members
  7. Unstable group, with members leaving or others, even some therapists, not attending
  8. Members have been denied other therapies because they are registered for this therapy which is not properly working 

How in-person mental health therapy could resume safely

The report then details how therapy could resume in the usual premises. The reason the authorities had given for not resuming sooner was that the rooms were too small to allow for 2 metre social distancing.  The writers of the report counter this by citing the government lockdown rules which allow for meetings of support groups of up to 15 individuals. Distancing of 1 metre is allowed provided other precautions are also taken. 

The latest news from this group is that building services have now measured the building and there is adequate space to allow them to resume meeting there in mid-June – and would have been enough for them to have continued in-person meetings throughout lockdown

Editor’s note: What I like about this submission is that it shows how patients do not have to remain passive. They can assume agency and group responsibility, even while suffering severe personality disorders.  We salute with respect the person, or persons, who pulled this report together from a variety of  people in therapeutic need.