Government-funded online centres are providing new treatment opportunities for those with mental health problems. Claire Laurent reports

Self-help was once confined to books and evening classes.

Now computers can provide people with therapy in privacy and at their own pace.

According to a study by the Royal College of Psychiatrists, 91 per cent of potential users of services want access to self-help psychotherapies via a computer system, with people willing to pay an average of£10 per computer session. With the development of government-funded 'online centres', access to computers is set to improve, as will uptake of self-help for mental health, if a pilot project of a compilation CDROM in the centres takes off.

Most of the packages available are aimed at treating mild to moderate anxiety or depression, with some targeted at specific problems such as eating disorders or sexual dysfunction. Some are available on conventional desktop computers, others on palmtops, others via interactive voice response (IVR), which links a telephone to a computer.

Beating the Blues is one of the latter, developed by Dr Judy Proudfoot, a research psychologist at the Institute of Psychiatry, together with interactive healthcare company Ultrasis. The programme (in common with most of the others) delivers treatment based on cognitive behavioural therapy (CBT) which, Dr Proudfoot says, 'has been shown to be as effective as antidepressants'. The programme is undergoing a randomised controlled trial.

Restoring the Balance, a programme developed by the Mental Health Foundation, is aimed at the less sophisticated computer user. Its graphics, text and instructions are simple and it is designed to be used in a primary care setting.

Restoring the Balance has been tested in primary care by Dr Meredith Robson, clinical psychologist at Hammersmith, Ealing and Fulham mental health trust. She says the computer makes economic use of time but is not necessarily tailor-made to the client and that people who enjoy meeting others with the same difficulties may miss out.

It was Dr Robson's idea to approach the Department for Education and Employment with the idea of making self-help CDROMs available in the online centres. The project was taken up by the Mental Health Foundation which worked with developers of other packages to put together a compilation CD-ROM - taking extracts from Restoring the Balance, Beating the Blues and three others: Stress Manager Plus, Fearfighter and Cope.

The package is being piloted in 20 online centres situated in community centres, shopping centres and even a funfair, with the aim being to ensure access to computers for everyone, with 6,000 promised over the next two years. It is hoped to reach those who may never go to their GP, or who, if they do, may never get to see a clinical psychologist because there are so few available.

Cost of the programmes varies enormously, with top-of-therange technology such as Beating the Blues likely to cost around£60 per patient, the Stress Manager Plus package a one-off price of around£100 and Restoring the Balance£25 for individuals.

It has been mooted that the programmes could be useful for those on waiting lists - even obviating their need to see a specialist. But Dr Robson voices caution: 'I feel very strongly that waiting lists should not be there and there is a danger of maintaining a waiting list in this way.'

User groups generally welcome the packages.

A spokesperson for MIND says:

'It might be all that some people need.We feel It is a useful addition to the range of therapies currently available, particularly for people who do not find it easy to talk.'

Chris Williams, senior lecturer in psychiatry at Glasgow University, developed a CBT course called Overcoming Depression in book form, shortly to be made available as an interactive selfhelp CD-ROM package.

He said: 'I would see computers as being an important way of delivering treatment, but they are not for everybody.

'Many of our patients prefer one-to-one work with a practitioner to using a computer.

What we need are a range of ways of delivering psychosocial interventions.'

Dr Jim White, consultant clinical psychologist at Clydebank health centre, has recently completed a pilot study of a three-session stress management computer package. The results were, he says, 'probably as good as individual therapy at primary care level'.

However, when the package was provided in public libraries in Glasgow, the results were not quite as good.

Dr White puts this down to the fact that 'there is absolutely no human contact with the library based computer'.

He is looking at maintaining the community-based approach while trying to estimate just how much therapist time is necessary.

He says community-based availability is important. 'The vast majority of people with anxiety and depression do not get past the GP. We are keen that people can get access to this without having to jump through hoops.'