Introduction to tele-psychology during the pandemic





The COVID-19 pandemic has altered the way that health and mental health care is provided to the community, creating increased anxiety and fear of the unknown for many, disruption of regular daily activities of life, coping skills and social support, and necessitating social isolation for safety, and leading many to feel hopeless and helpless. However, it has also necessitated some useful changes in the practice and delivery of psychological services, allowing patients easier access to mental health services through the use of telehealth or remote platforms. Telehealth or telemental health is the delivery of mental health care services at a distance, using multiple technological communication means (internet, telephone, web-based video conferencing, etc.) to effectively assess and treat patients in need.


Prior to COVID-19, most states frowned upon the delivery of health/mental health care services via telehealth, seeing it as inferior to in-person care and fearing that technology might present challenges for the effective delivery of psychological services. In mid-March 2020, many state officials across the US quickly adapted to the immediate crisis created by COVID and the need many patients had to seek help. As a result, governors throughout the US adopted a more flexible approach to ensuring that patients’ continuity of care would be maintained and began to view telemental health and telemedicine as an integral service that would ensure the safety of both patients and health providers, in light of a spreading COVID-19 virus with no effective treatment in sight. While most states were not fully equipped to manage the influx of need for telemental health delivery, they responded by being permissive of most telecommunications platforms that would allow patients to access care without disruption as a result of abrupt lockdowns and social distancing. Some state mental health associations offered immediate help via pro-bono services to those in remote areas or who would not otherwise have access to a mental health provider, allowing psychologists the opportunity to help, via telemental health, across the state despite financial or physical limitation.


Due to COVID, it became imperative that patients receive the same level of care virtually that they would in-office; there was initial skepticism as to whether telemental health would result in clinicians missing important visual or behavioral cues that could be seen in-office, or whether patients would feel comfortable using a phone, iPad, or other devices to seek help. Telemental health was launched, and one essential tool to ensure open communication about the process of telemental health was the use of patient consent for telemental health. Ensuring that patients were presented with the limitations of an online platform versus in-person treatment, as well as obtaining a patient’s verbal consent and/or written signature prior to beginning telemental health treatment, helped to manage patient expectations. Consent for telemental health would address the limitations of technology that might cause interruptions or disconnections in treatment, as well as addressing the concerns of those who might feel that telemental health is less comprehensive than in-person methods for diagnosing certain disorders and, may result in inconveniences such as a need to return to in-office visits, or even breaches in privacy that may inadvertently occur in patient environments or otherwise if others gained access to networks during sessions. Some patients initially wondered if tele-therapy would feel impersonal as it involved limited face-to-face contact with their clinician. Most have expressed relief at the ease and convenience of having frequent access to great help.


When performing a telemental health visit, a host of information is important to ascertain. A thorough history is required including a current list of health conditions, prior diagnoses, prior treatments, a list of health providers, and medications. You will also need to gather contact information/living arrangements specifics and details of the patient’s social support. By remotely gathering a comprehensive history, this allows the clinician to provide help to the client and the ability to collaborate with other providers should the need arise. Limitations may exist for those at high risk, and these individuals may not be suitable for a tele-therapy/tele-assessment modality. Those individuals who are at high risk may require more comprehensive screening and risk assessment, as well as safety plans that include local crisis resources and family support.


While obvious limitations exist in a telemental health approach as it relates to physical assessment, some self-report assessments may be scanned or sent electronically to the patient in advance; patients may also download certain assessments on patient portals. If some situations necessitate an in-person visit or assessment, extra precautions should be taken and prescreening should be carried out so that both the patient and doctor remain safe. This would include face masks, UV light and fans, sterilizing surfaces, and testing materials after each patient is seen, maintaining adequate spacing in between patients and during in-office visits, and ensuring that the patient and psychologist are more than 6 ft apart in testing situations.


Many telehealth platforms existed prior to COVID-19, and others have emerged. Regardless of the remote platform chosen by the clinician, the key is to ensure familiarity with the technology, competency, and expertise, and to make sure that patients fully understand the process and technology in which they have agreed to participate. Many patients view telemental health as a positive resource, citing its convenience and ease of access to immediate expertise among its various benefits. Clinicians have also responded positively, stating that tele-therapy lowers cancellation rates, and allows psychologists the flexibility to reach more patients in rural or outer lying areas who are in need, reducing wait times and providing much-needed resources to meet patients’ immediate needs. While the COVID-19 pandemic has caused most individuals to socially isolate and withdraw from normal routines as a matter of safety, it has also allowed for greater connection and access to professional expertise, right at one’s fingertips, via tele-therapy. Though our world has surely changed as a result of the COVID 19 pandemic, it is encouraging to note that some practices, like telemental health, are here to stay and will forever positively change the landscape of mental health delivery.

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Oct 30, 2021 | Posted by in NEUROLOGY | Comments Off on Introduction to tele-psychology during the pandemic
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