Potentially suicidal clients and patients pose one of the most rigorous challenges faced by telemental health professionals. This brief article will give a glimpse of the advance preparation you might consider. Institutional Telemental Health Practice Many institutional work settings already have emergency response systems in place. Examples of such organizations include the military, the Veterans Administration, hospitals, clinics, employee assistance vendors (EAP), suicide hotlines, etc. They are organized with local community networks to help you with suicidal threats or attempts. Independent Telemental Health Practice If you are a solo, small group or agency, you may have few if any emergency response systems in place for delivering services outside your local community. If you have nothing but a Google search to help you find an appropriate rescue team or other resources in a far-away location, you may find yourself not only panicking when faced with a suicide threat or attempt, but unsuccessful. Traditional telehealth systems have consistently operated with emergency safety as a first priority, and expanding telehealth access as a second priority. With that in mind, you may want to consider taking these preparatory steps:
- Understand emergency telehealth protocols by reviewing the related scientific literature, as well as relevant state and local law. Study the ethical codes from your professional association(s). If their specificity is lacking, write to them and urge them to support your attempts to expand your income sources and be more detailed now. Do not rely on a website disclaimer telling consumers to go elsewhere in case of an emergency.
- Briefly write your practice plan, including the technologies you plan to use, populations you wish to serve, and your emergency response in cases of suicide, homicide and abuse reporting. Submit this plan to your malpractice carrier, licensing board, and professional association ethics board(s). Ask for approval. Some such groups will tell you they can’t give you approval, or that you don’t need to go to those lengths. That’s ok. Even if they inform you that they can’t approve of your work, these communications will legally document that you have sought the advice of your peers, which can be one of your best protections in court. This process will also help you clarify your own thinking about appropriate professional behavior, and let them know they need to address telehealth more comprehensively. Be an advocate.
- Consider how you operate in your brick-and-mortar office to prepare for suicidal patients. Do the same online. For example, take a medical history, obtain records, discuss your suicide, homicide and abuse procedures up front. Engage in an informed consent process that includes a discussion of risks and benefits. Discuss your policies regarding failure to appear for sessions, failed technology, and an alternative way to establish contact (telephone). Go a step further and obtain names and contact numbers of a local family member and medical provider; and ask your patient to document the conditions under which you will contact these parties.
- Get all tax, ethical and legal advice in writing. Then show that written statement to your legal counsel. Some legal verbiage is subtle. Take the opening of an online office seriously and invest the up-front dollars needed to manage your risk. After all, you will not have much office overhead to pay.
- Conduct a traditional in-person intake unless you can thoroughly document your reason for not doing so. Make sure your rationales for deviating from this standard are supported by research, and not just the fact that someone is ready to pay you for services, or that you want to help them. If you can’t render full professional services online, work with someone who will, and serve as their specialty consultant (such as described in this webinar and other available models.)
- Arrange for a practice session with all new clients first, so you both won’t be impeded by the technology during in-session time. (Some affordable vendors will conduct this practice session for you.)
- Get to know your clients’ community emergency backup systems, as telehealth practitioners have done for decades. Most consumers, even in rural areas, have physical access to some type of clinic, nurse or other healthcare service. Focus on serving a limited number of distant communities and develop your referral networks in those communities. Enjoy the freedom and diversity allowed by telepractice, and sleep well at night.
Is Studying Telehealth Worth the Trouble? Telehealth is one of the most rapidly growing areas of healthcare. Technology-based healthcare is poised to be a 6-billion dollar industry by 2020. Handling emergencies in telehealth is nothing new. Existing telehealth emergency models were developed decades ago — and are both safe and effective. It’s time mental health practitioners look at evidence-based, reimbursable models, and find their place in this exploding industry. Start now by studying existing suicide prevention models for telehealth or join a well-coordinated telehealth training program to guide you. Take advantage of our free webinars and other trainings. Consider these recent articles:
- Luxton, David D., June, Jennifer D., & Jinn, Julie T. Technology-Based Suicide Prevention: Current Application and Future Directions. Telemedicine and e-Health, January 2011, Vol. 17, No. 1: 50-54.
- Luxton D.D., Sirotin A.P. &, Mishkind M.C. Safety of telemental healthcare delivered to clinically unsupervised settings: A systematic review. Telemedicine Journal and E-health. 16(6). 2010 Jul-Aug, 705-11.