In a recent New York Times article, Dr. Carolyn Turvey suggested the need for collecting identifying information from patients. The author of that same article then quoted the opposing view of a spokeswoman for an online therapy company. The spokeswoman explained that 90% of therapists using their platform don’t collect identifying information, because “Patients with a strong desire for anonymity might log off.” Rather, she suggested, “If you’re counseling and it escalates, we would call 911.”
Dial 911 Without a Name or Address?
If you’ve ever dialed 911 to report an escalating client, you probably know that such an effort is fruitless without identifying the name or address of the client. This type of superficial approach to mandated reporting and potential emergencies is raising eyebrows among many professionals.
We all know intakes can be tricky. Intakes conducted exclusively through email or a camera are even more challenging, especially if the professional is untrained in the specific use of their chosen technology for mental health. Handling abuse reporting and emergencies is yet more complex online. In the face of these challenges, some companies have decided to just dial 911 when there’s an “escalation”? What precisely do they plan to tell the 911 operator?
Ours is a serious business, all too often dealing with abuse, suicide and homicide. Ethically, we need to use evidence-based protocols for emergency practices whenever offering professional interventions to any consumers — even if our services are online, are offered for free or if consumers pay for them directly with a credit-card swipe.
Deviate from the Standard of Care?
Add to these complexities the lack of registration with a referring medical system, hospital, other real-world group or trusted professional where the client has identified themselves fully, and we have just significantly altered the basic premise upon which most of the telehealth research has been predicated. In other words, working with unidentified consumers significantly deviates from the standard of care. It throws caution to the wind and puts us, as well as consumers at undue risk.
Who Will Serve to Anonymous?
Some practitioners operating online consider it imperative to offer services to unknown, unseen, undocumented consumers worldwide because “these people need help, too.” Indeed, people worldwide need help. The question really is, “What is our best and most responsible approach as professionals?”
Perhaps starting with developing a solid evidence base in our scientific literature is one solution to answering this question. Might the next solution be to train professionals in evidence-based models for serving anonymous clients online? Should that all occur before offering such services online?
Despite the pressures to turn a profit in today’s marketplace, some telehealth service companies are poised for success without raising such questions about adherence to legal and ethical mandates. See HealthLinkNow, also cited in the same NYT article.
Safety First: Do No Harm
While some less conservative practitioners argue that the world’s population needs help and we should offer it to them however we can, we at the TeleMental Health Institute strongly advise that we proceed with caution. We draw the line at serving anonymous clients and patients, at least until technology improves.
It won’t take that long. Many promising devices are now being developed to conduct routine measurement of body functions. Other remarkably small and inexpensive devices are available for patient identification. As described in my 3-part series on smartphones (Part I, Part II, Part III), we can safely focus on mhealth and smartphone “apps” for reduced levels of care to people worldwide — without involving the risks of substandard intake procedures involving direct care.
Online practice is not an excuse to throw out our time-tested safety procedures, simply because clients “prefer” anonymity, are willing to pay for it, or “can be helped” by reduced levels of care.
That’s my opinion. What’s yours?