Mental healthcare providers have utilized telehealth to provide treatment throughout the COVID-19 pandemic to make care at home more accessible and safer. However, many mental health clinicians and patients face several challenges in adapting to its use. Dr. Steven Chan, a member of the Psych Congress and Psych Congress Elevate Steering Committees, highlighted the challenges behavioral clinicians face when using telehealth technology to provide treatment.
If You Choose To Offer Telephone Telehealth
At a recent Psych Congress Regionals session on telepsychiatry, Steven Chan, MD, MBA, advised healthcare providers to have backup computers, laptops, or phones if the technology fails to ensure secure telehealth treatment for the patient. Dr. Chan said, “It is essential to retrieve both the patient’s phone number and an emergency contact in case another mode of communication fails, or there is a crisis.” Also, while the US federal and many other governments around the world have made exceptions to enforcement of laws such as HIPAA in the United States and PIPEDA in Canada, the laws did not go away. Only the enforcement of these laws has been relaxed. Many of the announcements of the relaxation of these laws clarify that licensed professionals offering unconventional telehealth approaches such as the telephone for treatment need to let their clients and patients know of the risks. Additionally, while enforcement of laws has been relaxed, many basic ethical codes have not been relaxed.
Pros and Cons of Telephone Telehealth
During the virtual session mentioned above, Dr. Chan also told the attendees that many healthcare providers want to use telehealth for a long time because of the positive outcomes of using telehealth platforms. Reaching patients over long distances, ease of scheduling, reduced transportation barriers for patients in urban and rural settings, and lower financial costs for clinicians are some of the benefits of telehealth.
There also are several shortcomings of using a telephone for telehealth. Many clinicians prefer videoconferencing technology for treatment because it supplies much more information for the clinician to make more accurate interventions. Also, most clinicians have been treated to observe clients and patients, to watch carefully for nonverbals as indicators that belie words as they are spoken.
However, telephone sessions can be practical if the patient has a preference or has a poor Internet connection. Some people may not have access to computer technology or smartphones, may not be able to interact with computers or the Internet, or be overwhelmed at the thought of using the Internet for a variety of legitimate reasons. While there are many benefits of telephone telehealth sessions, such as shorter waiting periods; less exposure to illness and infections; and ease of use, clinicians still face some challenges using the phone for treatment. The clinicians can’t see the patient, environment, activities, and actions, making it hard to perform a mental status exam. They also cannot see who else is within ear-shot of the recipient of care, nor does it give potentially relevant information of activities being performed by that party during the intervention. Clinicians check with their legal or risk management department, get informed of best practices in their local community to avoid legal issues. Getting appropriate telehealth training is another way to minimize risk and fully understand how to deliver professional rather than amateur-level care when using technology.
Ethical Issues in Telephone Telehealth
It is in everyone’s best interest for the clinician to be aware of and compliant with the ethical nuances of using the modalities they choose to interact with their clients and patients. Informed consent is at the heart of all healthcare. Clinicians then must have an open conversation with the client or patient and let them know which services one can or can’t provide over the telephone. Along these lines, clinicians must have adequate training to meet their ethical mandates of having competence in the treatments they offer.
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