By SAIRA PEESKER
Special to The Globe and Mail
Monday, July 9, 2018
The clients Lindsay Killam sees as an alcohol-abuse counsellor are often professionals: people who don't have a lot of free time and typically don't want to broadcast that they're in treatment.
That's why they meet with her online.
Ms. Killam is national clinical program director for Alavida, a Vancouver-based startup that offers web-based treatment for problem drinking, using a combination of cognitive behavioural therapy (CBT), physician oversight, prescription drugs and an online diary monitored by the client's treatment team.
The company has contracts with several employers, whose employees can use it without the boss knowing their identities. It's one of numerous online counselling services now available in Canada, at a time when employers are increasingly seeing value in providing mental-health care to staff. Despite some lingering skepticism that online counselling is as good as face-to-face therapy, more companies are choosing this option.
"People can access this in rural areas, or in somebody's office during their workday," Ms. Killam said, noting that 200 people have gone through the program so far, with 88 per cent reporting an increased feeling of control over their drinking by the end. "It breaks down all the barriers that traditional treatment might have," such as leaving home for an extended period of residential treatment or leaving work for appointments.
Alavida employs doctors and counsellors licensed to work from British Columbia to Quebec, as well as California, with a staff of about 30. The treatment follows the model of Finland's Contral Clinics, an evidencebased method that allows clients to define their own goals, which could include controlled drinking, reduced drinking or abstinence.
Problem drinking accounts for $7.1-billion in lost productivity a year nationally, according to a 2015 report by the Chief Public Health Officer of Canada - something Ms. Killam sees as a clear sign that alcohol counselling could be good for business.
Insurance benefits expert Chris Gory says many companies are now taking that perspective.
He's seen a surge in employees' use of all kinds of counselling services, something he attributes to decreased stigma toward mental illness.
"It's money well spent," he told The Globe and Mail. "Ten years ago, people might not have used [work-provided counselling], but now people are willing to say, 'I need help.' " Mr. Gory is the founder of Insurance Portfolio Financial Services, which provides benefits coverage to about 85 companies.
He says numerous online counselling services have emerged to meet the demand, both as standalone startups and through established employee-assistance programs such as Aspiria.
He says online counselling offered as part of a larger employee-assistance program (EAP) remains cheaper owing to economies of scale, noting most EAPs cost between $3.75 and $6.50 an employee, per month, with no lump-sum payment upfront.
Web-only services have a couple of different payment models, he said, describing a quote one of his clients got from video counselling site Inkblot. One model would see the employer pay a much lower monthly per-employee fee, around $0.75, but an employer then buys a block of 50 counselling sessions in advance, with each session costing $37.50.
The other option was to pay $10 a month for an all-inclusive package.
Canada's largest EAP provider, Morneau Shepell, offers several forms of online counselling: video sessions with a therapist, a web-based CBT program and text-based group therapy. The CBT program launched in June and is gaining traction with employers, said the company's vicepresident of research and integrative solutions, Paula Allen.
"The research says that when it's delivered online, it is as - or sometimes more - effective [than in person]," Ms. Allen said.
CBT, which focuses on changing patterns and developing coping tools, typically requires numerous visits when sought in person.
Morneau Shepell's online program involves self-guided assessments, exercises and reading assignments that are completed by the client.
Ms. Allen notes that online CBT isn't right for everyone - including people with literacy issues, discomfort with technology or problems focusing. She also cautions that, as with in-person forms of therapy, not all programs are created equal.
"It's important to make sure it is a high-quality CBT program," she said.
Martin Perry, the founder of Nous Talk, a video-focused therapy startup based in Waterloo, Ont., and Toronto, says part of the reason he got into the field was to encourage quality therapists to work online.
He says much of his business comes from the United States, and that individuals continue to drive the market more than businesses. He's working with a Canadian company of about 80 employees, however, to launch a therapy package in the coming weeks.
"Most of their team are millennials," Mr. Perry said, noting many of the managers are in leadership roles for the first time and find that stressful. "Mental health is something [employees] want."
He said making it easy for workers to seek help prevents small issues from growing and affecting the business. "It reduces absenteeism, adds to team morale and just makes a better culture."
While the technology facilitating web-based mental-health care is becoming more advanced, some therapists have been working online for years. New Yorkbased clinical social worker Elizabeth Zelvin started offering webchat sessions in 2001, before video-chat technology was widely available.
She has long heard the criticism that you need in-person, face-to-face contact to truly connect with a client, but strongly disagrees. She says when communication is stripped down to text - removing the way someone looks or how they sound from the equation - it's often easier to get to the essence of the problem.
Further, Ms. Zelvin's passwordprotected online chat room allows clients to download a log of their session, holding "the therapist as accountable as the client for every word ..." she wrote to The Globe in a chat-based interview.
Looking at the big picture, most employers are still hedging their bets when it comes to contracting web-only services, says Mr. Gory, the insurance expert.
He expects that to change soon, though, as the offerings continue to increase and provide more depth.
"Telephone is still the predominant way for people to get help," he said. "[These services are often] used at a time of crisis, so you want to have someone available to you if something goes on."
Alavida's Lindsay Killam conducts an online counselling session. The Vancouver-based startup employs doctors and counsellors licensed to work from British Columbia to Quebec, as well as California.