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With a growing demand for mental health services, online mental health services have emerged as an alternative treatment option. 

 By Isaiah Hui & Patricia Ricafort

Elizabeth, who declines to reveal her last name, first started receiving counselling at the age of 13 after being recommended for counselling through a school screening. The Year Three student of the Chinese University of Hong Kong (CUHK) now receives counselling from a private counselling centre. She usually attends in-person sessions at the centre, but she has moved her sessions online last-minute twice as she woke up too late. She did not have enough time to commute from her home in the New Territories to the centre in Central. 

“The online situation was never ideal. It was usually when I was running late but I needed to speak to my psychologist because I have to keep the appointment,” the 21-year-old says.

Her first online session was through a WhatsApp call and her second session was through a Skype call. But she did not find online sessions as beneficial for her as in-person sessions.

“It was hard to fully focus on the session,” the university student says. During her online sessions, she felt distracted and began to multitask due to the online environment. 

Elizabeth also found online counselling inappropriate for discussing her emotional issues. “Online counselling is just a different experience altogether. The environment feels too casual for dealing with heavy issues,” she says. 

Elizabeth finds the process of preparing for physical meetings better for her mental health. 

“I think getting ready for seeing someone (in-person) grounds me more,” she says. “When you go to attend (physical) counselling sessions, you get yourself ready and out of bed. You force yourself to do things that you normally wouldn’t do when you’re very depressed,” she adds. 

She acknowledges the convenience of virtual counselling services, yet she prefers in-person services. 

The Other Side

While Elizabeth did not have a positive experience with online counselling, others find online counselling beneficial. Jessica Yeung Chen-yee is the founder of Common Care Central, an online counselling platform that matches clients with therapists for virtual counselling sessions. 

Yeung started the platform in June this year after personally trying U.S.-based online counselling services and realising that Hong Kong residents could benefit from a similar service.

Yeung acknowledges that some people like Elizabeth would not prefer online services. Yet she observes that others thrive in an online environment.

“With the online format, there is almost like a physical barrier between a client and a therapist. The client feels a lot safer. There is something about talking through a screen that makes some people feel more relaxed,” she says.

Yeung also notes that online services have some advantages over in-person services. She believes that one advantage of online counselling is minimizing the stigma in seeking mental help. “The reason why I wanted to launch an online-only platform is because a lot of the time, online decreases the stigma,” Yeung says. 

“Online, what we’re trying to do, is to minimize (the stigma), by creating an easy and convenient portal where people can ask for help without having to ask for referrals. We want to bring that stigma down so that they’re more comfortable taking their first step,” she adds.

Yeung also notes that online counselling tends to be more cost-friendly compared to in-person services. “We do understand that for a lot of people, affordability is a blocker for them getting help,” Yeung notes. “Online, we are able to reduce a lot of costs,” she adds.

An online platform reduces costs by removing many overhead costs associated with in-person counselling. “Most of the time, the high price range is because of their room rental costs being extremely high in Hong Kong,” Yeung says. “Because the counselling is online, the therapists are able to remove that overhead administrative cost. We also help them with the marketing, so we pass on that savings to clients,” she adds.

A Shift In Attitude

Yeung’s venture comes at an opportune time as mental health among the population has worsened. A survey released by the Mental Health Month Organising Committee revealed that people in the city have worsening mental well-being, especially after the double whammy of social unrest and the pandemic. The survey revealed that the average well-being score for Hong Kong is 45.12 out of 100 in 2020, which is significantly lower than those in previous years.

Source: Mental Health Month Organising Committee

52 out of 100, a score lower than or equal to this in the World Health Organization- Five Well-Being Index (WHO-5) indicates poor well-being and is an indication for testing for depression under ICD-10, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems.

With the pandemic stimulating online lifestyles, interest in online counselling is growing as well. Stefani, who declines to reveal her full name, is a Year Four student of the Chinese University of Hong Kong. She began receiving counselling at the CUHK Wellness & Counselling Centre for anxiety and stress after entering university. 

She has always attended counselling sessions in-person, but her sessions were sporadic due to scheduling difficulties. “Sometimes I would not be able to book my counsellor. Either she would only be available at the times when I’m not, or she would be overbooked,” Stefani says. 

She gave up booking counselling sessions in her third year of study at university after her counsellor was overbooked three times.

The 21-year-old is strongly considering restarting her counselling sessions online now due to the pandemic. “I don’t really feel like going to my counselling centre, but I still want to get counselling. So I think I’m going to have to look into online counselling,” she says.

Stefani has not tried online counselling sessions yet, but she believes online counselling sessions are more convenient than in-person sessions. “I’m doing classes online anyway. Online counselling will just make the sessions easier to fit in,” she says. “I can save time on commuting to the counselling centre and that would work better with my schedule,” she adds.

Comparison of Counselling Services in Hong Kong as of October 2020

* $400 fee applies only to Counsellors-in-training, who are students enrolled in a Masters of Counselling programme and practice counselling to fulfil practicum hours.
** $1000 is a special rate offered to those earning less than $30,000 per month, applying only to Cantonese counselling sessions.
Source: Common Care Central, The Hong Kong Psychological Counselling Centre, and St. John’s Cathedral Counselling Service

Choosing the Best Service

Pan Jiayan, associate professor of the Department of Social Work at the Hong Kong Baptist University (HKBU), researches on mental health and online cognitive behavioural therapy. She believes self-motivated, digitally competent clients with high self-learning ability are more suitable to consider online mental health services.

“Online counselling is a supplement to face-to-face counselling. Online counselling can save therapist time by leaving clients to learn various cognitive behavioural skills online by themselves. Therapists can spend less time to help clients apply these skills to deal with their own issues to improve their mental health,” Pan explains in a written reply to Varsity.

“Blended mode of service delivery with both online and offline counselling may be more suitable for the Hong Kong context. It may be a feasible solution in Hong Kong to fill in the service gap of huge demands for mental health service and shortage of mental health professionals,” Pan says.