Telehealth: Mental Health Care, Delivered Through the Internet
Professionals and industries have increasingly leveraged the power of the internet to disrupt or innovate within their fields. There are now digital services that can bring groceries to a person’s front door, help them find convenient transportation within their city, and even build new relationships and social communities.
But many people may be surprised to hear that mental health care is also one of the services being made available through the internet. For example, a patient who has recurring therapy sessions with a psychiatrist or another mental health provider may be able to attend these sessions by video chat. An individual who is having suicidal thoughts can access a suicide hotline website and can digitally chat with a dedicated, compassionate and helpful counselor or representative.
Offering health practitioners valuable treatment skills that can be delivered through digital methods is a leading focus of the online Nurse Practitioner Certificate program at Regis College.
This convenient accessibility through digital means now makes mental health care a field of telehealth, where electronic tools or methods of communication are used to provide health care services. Take a look at how the internet is reshaping mental health care.
Overview of Mental Health Care
There are several different types of mental health afflictions and illness. These conditions can range in level of severity and chronic duration, and require different treatment options. Mental health care professionals work with patients to diagnose symptoms and illnesses, and find treatment options in an effort to improve their lives.
What is mental illness?
According to the National Alliance on Mental Illness (NAMI), “a mental illness is a condition that affects a person’s thinking, feeling, or mood. Such conditions may affect someone’s ability to relate to others and function every day.” Oftentimes, mental health conditions can be caused by several factors, including family history, life or career experiences, internal biochemical processes, and more. Approximately 20 percent of adults experience a mental health condition yearly, while one in 17 lives with a serious mental illness such as schizophrenia or bipolar disorder, NAMI reports.
Some types of mental health conditions include ADHD, anxiety disorders, depression, and psychosis, each afflicting a person’s brain and health in a unique way. These conditions can be treated through means such as medication, psychotherapy, and brain stimulation therapy. Individuals with mental health conditions can be treated by a variety of practitioners who possess various health specialties and levels of education. Social workers, counselors, therapists, psychiatrists, and mental health nurse practitioners are among the professionals who can assist a patient, depending on their specific illness and level of severity.
What are the difficulties in treating mental illness?
Even though there are dedicated professionals and effective treatments to help individuals with mental health afflictions, there can often be a roadblock to securing treatment. Oftentimes, individuals do not seek help because of the stigma associated with mental health conditions. Because mental health conditions don’t necessarily show visible symptoms like other illnesses, it can be more difficult for people to recognize them or take them seriously. Additionally, individuals with mental health afflictions might be afraid of being labeled negatively because of their illness.
Also, it may be difficult for someone with a mental health condition to realize they have a condition in the first place. Because mental health conditions can impact a person’s thinking, afflicted people may believe themselves to be in perfect health. These particular issues and others are being addressed and improved on, thanks in large part to the ability of mental health care services to be delivered through the internet.
The Significance of Telehealth in Mental Health Care
The increased use of telehealth in mental health care is significant for many reasons. It indicates a heightened awareness that mental health care is just as important as other types of health care, that services can be effectively provided through electronic or telehealth means, and that more individuals may be treated for mental health conditions.
The value of online mental health care
“Treating mental health, in particular, becomes easier, less costly, and less stigmatized when behavioral health treatment can take place in a virtual setting,” writes Jeff Lagasse for Healthcare IT News. An individual who has a mental health condition but is reluctant to seek help in a clinical setting could potentially use an online therapy platform and speak with a certified therapist.
For those living in underserved communities, where access to adequate mental health services can be a problem, online mental health care can be an invaluable resource. According to a report published in the American Journal of Preventive Medicine, 65 percent of non-metropolitan counties lacked a psychiatrist, and 47 percent of these counties lacked a psychologist. Online care has provided a potential option to individuals in these areas seeking treatment for mental health conditions.
The challenges of online mental health care
However, there are challenges within online mental health care. According to the American Psychological Association, while web therapy can be convenient and comfortable, it may not be the most effective tool for each person, depending on their mental health condition. Some therapies might require patients to be physically present with a practitioner for them to receive more appropriate treatment. Additionally, individuals who use web therapy may be working with a professional who is not licensed in their state, and in some instances, the service may not be eligible for reimbursement by their insurance provider. Even though web therapy can be less expensive, patients and clients should make sure their insurance will specifically cover web-based therapy treatment sessions.
Safety and Security for Mental Telehealth Services
When using mental telehealth services, it’s important that individuals and patients abide by necessary security measures to make sure their health, safety, or information is not jeopardized. A research article in Health Affairs notes that potential privacy risks of telehealth can include “lack of controls or limits on the collection, use, and disclosure of sensitive personal information,” “routine transmissions from a medical device” being collected by the device/app manufacturer in addition to the health care provider, and misunderstanding of privacy guidelines.
These and other issues can put more of the privacy burden onto patients rather than practitioners. Additionally, if a computer or digital device is ever subject to an attack, sensitive information that a patient has shared with their medical provider could be at risk.
Health Affairs recommends that certain security controls be implemented to help ensure data privacy between patients and practitioners. These controls include data encryption to ensure that sensitive data is secured, as well as providers potentially distributing telehealth software and devices in face-to-face settings. For patients, they can work to ensure their digital devices are secure, that the platforms they engage in telehealth are secure, and that the practitioners with whom they communicate are trustworthy and certified.
Telehealth Applications for Children’s Mental Health
Like adults, children and adolescents can use telehealth techniques. They can video-conference with doctors or therapists, as well as engage with particular digital apps or resources to find information to improve their condition.
Legal boundaries for children’s mental health
Telehealth practitioners—wherever they may be practicing—must follow the same laws regarding consent and practice that in-person practitioners do. Parents can serve as a guiding influence to help children discover potential mental health practitioners, or a child can also research practitioners to which parents may provide consent for treatment. Additionally, state laws can vary regarding what age a child must be or what type of treatment they are allowed to consent to without their parents.
However, because a child may qualify for consent in certain situations, that doesn’t necessarily mean a mental health practitioner may be willing to provide treatment. According to a report in Innovations in Clinical Neuroscience. “A psychiatrist should still satisfy him or herself that the minor patient possesses the capacity and maturity to understand to what he or she is consenting. Thoroughly document under what circumstances the minor is being allowed to consent to treatment on his or her own behalf.”
Challenges of providing mental telehealth services to children
Children can face more difficulties than adults when using the internet to address or improve their mental health. According to Psychiatric Times, children who have used the internet to search for health often found “irrelevant or inconsistent online health information. In addition, respondents noted that they felt overwhelmed by the responsibility of prioritizing the retrieved results.”
Additionally, increased casual use of the internet can negatively impact a child’s mental health overall. Cyberbullying is one of those cases that can lead to anxiety, depression, and even suicide among children.
According to a report in the Journal of Medical Internet Research, “few apps have been specifically developed for children and adolescents, and the benefit of mental health mobile apps for this population is unclear.” These apps include the Mayo Clinic Anxiety Coach, an app that aims to help reduce anxiety among users; and SmartCAT, an app that incorporates both usage from young individuals and a treating clinician to also help treat anxiety.
Online mental health can be a valuable tool for children and adolescents if used effectively. A good starting point would be to meet with a clinician or practitioner to get a firm recommendation or understanding about what online mental health platforms might be of benefit. Parents can help their children navigate misleading or contradicting information online, enabling them to more easily find an online mental health tool that will help treat and address their condition.
Licensing and Training Requirements for Telehealth in Nursing
As telehealth and online mental health resources become increasingly available for patients and practitioners, there are gaps that are arising involving the training and implementation of these services. “Literature related to preparing nurse practitioners to utilize telehealth for practice is limited,” according to a report in Dove Medical Press. Although “one study found that 77 percent of faculty surveyed identified a need for training in telehealth. The cost of starting a telehealth program was also identified as a barrier to programmatic implementation.”
Licensing and training requirements can vary depending on the level of responsibility or type of health care environment in which a nurse may be working. According to the report in Dove Medical Press, it would serve nurses to be well versed in the two “basic types of technology used in telehealth.” These include store-and-forward technologies as well as videoconferencing systems.
But a crucial area where nurses should develop professional expertise is in telehealth etiquette. This includes “proper camera positioning, elimination of office or clinic noise, the removal of personal objects located within view of the camera, and even the clothing choice made by the provider,” Dove Medical Press reports. All of these can impact the quality of care when treating a patient.
Small subtleties in communication, like looking away to take notes or not making eye contact with a camera, can be seen as disrespectful to the patient. Similarly, small physical variances, like leaning forward and nodding one’s head, can communicate empathy and effectively build trust between a patient and practitioner. Because it can be more difficult to gauge things like humor or sarcasm when using remote communications, practitioners should carefully choose their words when speaking to patients to make sure no message is misconstrued.
The Future of Mental Telehealth Services
Telehealth services can be of great benefit to individuals and patients seeking care for mental health conditions. While these internet-based services can pose certain challenges, they provide many advantages. Telehealth can serve those who may not have access to trained practitioners in their current area, or are seeking a mental health treatment option that can be more convenient. Telehealth can also be more affordable, depending on factors like type of treatment or if a treatment is covered by insurance.
As technology continues to evolve, so will the field of telehealth—with clinics, hospitals, and other health care organizations using these services to deliver advanced and convenient mental health care.
The online Nursing Practitioner Certificate program at Regis College is an excellent place to start for students who wish to become involved in telehealth. The program exposes students to the latest digital technologies that are shaping health care, inspiring them to provide exemplary treatment options to patients and individuals across the globe.
American Journal of Preventive Medicine, “Geographic Variation in the Supply of Selected Health Providers”
American Psychological Association, “What you need to know before choosing online therapy” Dove Medical Press, “Telehealth and eHealth in nurse practitioner training: current perspectives”
Journal of Medical Internet Research, “Mental Health Mobile Apps for Preadolescents and Adolescents: A Systematic Review” Innovations in Clinical Neuroscience, “Consent to Treatment of Minors”
National Alliance on Mental Illness, “Treatments”
Psychiatric Times, “Digital Mental Health for Youth: New Evidence but Still Much Unknown”