THE USE OF TELE MENTAL HEALTH
“Being able to get care anywhere is our new reality.”
-Jane Ortwig, Executive Director of PSYPACT.
Since the pandemic, the concept of receiving medical services virtually has increased a lot. Research shows that only 11% of participants used telehealth before 2019, but 76% were interested in using telehealth during the pandemic.
Among the different medical fields that provided online services, outpatient services in the psychology field were the most accessed by people. Furthermore, mental health studies conducted during the pandemic have confirmed that symptoms of acute stress, anxiety, and depression, as well as suicidality, have been increasing.
I chose this topic because of one of my classes this semester. As part of this class, we had to choose a facility where mental health services were provided and volunteer for at least 9 hours a week there. I chose a counseling center where therapists were available both in-person and via zoom. Every time I had to schedule a new client, I had to ask them if they preferred to see the therapist in person or via telehealth and throughout the semester the one question that I thought over a lot was whether this was a good option or not.
There are a lot of pros and cons to using telehealth. Some of the advantages are:
1. Convenience: Being able to communicate with the therapist from the comfort of their home could help clients not cancel their appointments. Telehealth also enhances vulnerability and disclosure. Whenever we think about therapy we usually think about a patient on a couch and a therapist nearby, instead of a formal office setting where it could put a lot of pressure on the client. Something along the lines of the below image-
But sitting at home on the couch or just the fact you are in a place where you’re comfortable could make a person very much relaxed and more prone to having open conversations. Another advantage is that online therapy provides accessibility to individuals who are disabled or housebound as mobility can be a big issue when it comes to accessing mental health care.
2. Generally less expensive than traditional therapy: It saves money that can be spent on transportation. For instance, if someone lives in a remote area, traveling back and forth to the therapy center could cost a lot of gas money, but with online therapy, it wouldn’t cost them as much as it would with in-person.
3. Eliminates fears of running into known others in the waiting area of the therapy office: For various reasons, people would want to keep the fact that they go to therapy a secret. So if it’s from their homes that could encourage them to reach out more.
4. With apps like BetterHelp, a direct communication line to the therapist: One of the services they offer is being able to text the therapist at any point. So if someone is having a panic attack they could immediately text the therapist and ask them what they could do. I found this really helpful because it reminded me of one of the things, Dr. Wen was talking about in the book Lifelines. It was something along the lines of how useful it’d be if there were emergency services but for mental health. And using telehealth sort of gives clients access to immediate help.
5. A good option for remote areas: Online therapy offers access to mental health treatment to people in rural or remote areas. Those who live in rural areas simply might not have access to any other form of mental health treatment because there are few or no mental health practices in their area and providing an online option can encourage them to seek out mental health services.
But on the other hand, there are cons to using online mediums for therapy as well.
1. Confidentiality: Since information is being transmitted online, the situation makes privacy leaks and hacks more of a concern. Technology problems can also make it difficult to access treatment when you really need it. If there are minors and overbearing parents then that could create a potentially unhelpful situation as well. For instance, some parents will want to know everything that goes on in the sessions and for people who live with their parents, it could cause further problems for them.
2. Not appropriate for serious-psychological illnesses: If a person has a serious addiction or has more severe or complex symptoms of a mental health condition, online therapy may not be recommended unless other in-person therapies or treatments are also involved in the plan. As the scope of online therapy can be limited, so it is may not effective for more complex situations.
3. Overlooks body language: If a patient is using text-based therapy, therapists cannot see facial expressions, vocal signals, or body language. These signals can often be quite telling and give the therapist a clearer picture of a person’s feelings, thoughts, moods, and behaviors. Some delivery methods such as voice and video chats can provide a clearer picture of the situation, but they often lack the intimacy and intricacy that real-world interactions offer.
4. Ethical and Legal concerns: Online therapy eliminates geographic restraints, making the enforcement of legal and ethical codes difficult. Therapists can treat clients from anywhere in the world, and many states have different licensing requirements and treatment guidelines. For instance, there are many states in America where you can be a licensed mental health professional with a master’s degree, but most states require a doctoral-level education. So enforcing these rules can be a little difficult.
Ever since the pandemic, we are having to adapt more and more digital mediums to our lives. However, along with that we also have to ensure we tackle the problems that come along with it, like privacy, fairness, transparency, and accountability. This is our first pandemic in a digital era and with that, we have observed and will observe a plethora of digital solutions. Just like in-person therapy, tele-mental health is also an imperfect approach so while it does have its limitations, it can be very effective with a certain subset of the population who are not in a major crisis or require more intervention.
But sitting at home on the couch or just the fact you are in a place where you’re comfortable could make a person very much relaxed and more prone to having open conversations. Another advantage is that online therapy provides accessibility to individuals who are disabled or housebound as mobility can be a big issue when it comes to accessing mental health care.
2. Generally less expensive than traditional therapy: It saves money that can be spent on transportation. For instance, if someone lives in a remote area, traveling back and forth to the therapy center could cost a lot of gas money, but with online therapy, it wouldn’t cost them as much as it would with in-person.
3. Eliminates fears of running into known others in the waiting area of the therapy office: For various reasons, people would want to keep the fact that they go to therapy a secret. So if it’s from their homes that could encourage them to reach out more.
4. With apps like BetterHelp, a direct communication line to the therapist: One of the services they offer is being able to text the therapist at any point. So if someone is having a panic attack they could immediately text the therapist and ask them what they could do. I found this really helpful because it reminded me of one of the things, Dr. Wen was talking about in the book Lifelines. It was something along the lines of how useful it’d be if there were emergency services but for mental health. And using telehealth sort of gives clients access to immediate help.
5. A good option for remote areas: Online therapy offers access to mental health treatment to people in rural or remote areas. Those who live in rural areas simply might not have access to any other form of mental health treatment because there are few or no mental health practices in their area and providing an online option can encourage them to seek out mental health services.
But on the other hand, there are cons to using online mediums for therapy as well.
1. Confidentiality: Since information is being transmitted online, the situation makes privacy leaks and hacks more of a concern. Technology problems can also make it difficult to access treatment when you really need it. If there are minors and overbearing parents then that could create a potentially unhelpful situation as well. For instance, some parents will want to know everything that goes on in the sessions and for people who live with their parents, it could cause further problems for them.
2. Not appropriate for serious-psychological illnesses: If a person has a serious addiction or has more severe or complex symptoms of a mental health condition, online therapy may not be recommended unless other in-person therapies or treatments are also involved in the plan. As the scope of online therapy can be limited, so it is may not effective for more complex situations.
3. Overlooks body language: If a patient is using text-based therapy, therapists cannot see facial expressions, vocal signals, or body language. These signals can often be quite telling and give the therapist a clearer picture of a person’s feelings, thoughts, moods, and behaviors. Some delivery methods such as voice and video chats can provide a clearer picture of the situation, but they often lack the intimacy and intricacy that real-world interactions offer.
4. Ethical and Legal concerns: Online therapy eliminates geographic restraints, making the enforcement of legal and ethical codes difficult. Therapists can treat clients from anywhere in the world, and many states have different licensing requirements and treatment guidelines. For instance, there are many states in America where you can be a licensed mental health professional with a master’s degree, but most states require a doctoral-level education. So enforcing these rules can be a little difficult.
Ever since the pandemic, we are having to adapt more and more digital mediums to our lives. However, along with that we also have to ensure we tackle the problems that come along with it, like privacy, fairness, transparency, and accountability. This is our first pandemic in a digital era and with that, we have observed and will observe a plethora of digital solutions. Just like in-person therapy, tele-mental health is also an imperfect approach so while it does have its limitations, it can be very effective with a certain subset of the population who are not in a major crisis or require more intervention.
Sources:
https://mental.jmir.org/2020/12/e23776#ref15
https://coronavirus.medium.com/whos-most-at-risk-in-the-covid-19-mental-health-crisis-2f1ddd5bba9c
https://mental.jmir.org/2020/3/e18848/
https://europepmc.org/article/MED/32682460
https://www.jmir.org/2020/6/e19284?utm_source=TrendMD&utm_medium=cpc&utm_campaign=JMIR_TrendMD_0
https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
Good report, Pranathi. It's been widely observed that our mental health system is increasingly dysfunctional, perhaps a judicious expansion of tele-health would be a step back in the direction of systemic reconstruction. Ideally, though, face-to-face human connection of all sorts including mental/therapeutic won't ever go away entirely.
ReplyDeleteThank you! That's true, no matter how many alternatives we can find to receiving therapy, nothing can replace the in-person interaction with a therapist.
ReplyDelete-Pranathi