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Is Telepsychology In Your Future?

Will telecommunications and cyber-applications transform mental health care?

We’re all watching as advances in telecommunications and information technology makes the world more connected than ever. But what will this mean in terms of providing mental health care to people in need? According to Marlene Maheu of the Telemental Health Institute in Cheyenne, Wyoming, that change is already underway. In an article published recently in a special issue of Professional Psychology: Research and Practice devoted to future visions of psychology, Maheu and her co-authors state that mental health professionals need to prepare as new technology transform the kind of services that will be available in the near future. They will also have to recognize the dangers and ethical problems that many of these new products will bring.

While there will always be a place for traditional treatment with face-to-face counseling, hospitals and treatment clinics are already making radical changes in terms of information and communications technology (ICT) and telemental health is now a reality in many health care settings. Along with providing health care workers in remote settings with continuing education available online, videoconferencing allows professionals to provide “virtual case management” on urgent and routine cases no matter how far apart they are geographically. The rise in telemental health options is just part of how ICT is transforming health care in general though many of the same ethical concerns still apply.

Using what Maheu and her co-authors called psychotechnologies (technologies that can be specifically used to provide mental health services), psychologists and other professionals can communicate with new clients, provide information on available services, stay in contact with patients through email and text messaging, and even provide those services online – something that has sparked controversy over concerns about patient confidentiality and how secure medical records in “the cloud” can be.

The demand for new services is certainly there already. With an estimated 87% of the world’s population having access to cell phones subscriptions and even people living in rural areas being able to use online video and broadband services, traditional mental health professionals are falling behind the curve. Nonprofessionals are taking advantage of this by providing their own online services which are often unregulated and, at times, harmful. Even a simple Google search can turn up a variety of Web pages on whatever mental health topic you can think of, many of them selling services or products of doubtful effectiveness but, through SEO and other marketing strategies, often score more “hits” than reputable professionals or even professional organizations.

Though mental health consumers need to be cautious, psychotechnologies provide a major challenge that traditional psychology is failing to meet. Online and telephone-based services are slowly being regulated and insurance companies (including Medicare and Medicare) are starting to reimburse therapists for their services but the quality of these services is still uneven. As psychotechnologies become more widespread, we will likely see them used more often in various medical settings that are typically understaffed. This includes prisons, hospitals, nursing homes, and in the military (especially for soldiers deployed in dangerous situations).

Researchers also need to find better ways of bringing psychotechnologies like computerized psychological testing and therapy into a consumer’s home safely and effectively. While Skype, Facebook, Twitter and other online platforms are already available for therapists and their patients to use, the lack of proper security would hardly be approved by most professional licensing organizations. That some practitioners are using methods like these now, along with regular email, to stay in contact with patients shows the importance of professional regulation and the need to develop proper guidelines for a new generation of mental health professionals to follow. As new ways of staying in contact are developed, mental health professionals need to be ready to adapt and develop services that are convenient for their clients.

Mobile devices like smartphones and tablets are another way mental health professionals and clients will be able to stay in touch, especially since these devices are already everywhere allowing instant access at any time, day or night. Using mobile devices, therapists can monitor clients during crisis situations, consult with colleagues, check professional literature, and contact emergency medical services as needed. Specialized mobile applications can also be used for monitoring patient symptoms, keeping regular video or audio diaries, preparing case notes, and eventually for monitoring biometric information such as heart rate and galvanic skin response to measure patient stress. While psychotechnology apps are already available, there is still much more that needs to be done both in terms of developing new applications and providing proper training in their use.

And new developments can go further still according to Maheu and her fellow authors. Cloud-based applications allowing therapists and patients to access the Internet from anywhere in the world, for instance. For health care professionals, that could mean Bayesian-level diagnostic tools, online sessions with patients and family members, and direct access allowing therapists to link with patients wherever they happen to be. Along with new applications can come better security measures including biometric scanning and better encryption schemes to make sure that confidential information stays safe. Whether this will be enough to satisfy professional licensing bodies and the skeptics preferring to stick with the traditional treatment approach is another question entirely, though.

Over the next few years, even more radical mental health treatment options might become available. Virtual worlds, virtual reality, and online gaming are already transforming how people interact with their computers. Second Life is just one example of a virtual community with millions of regular users for everything from game playing to scientific applications and, yes, psychologists are already staking a claim by offering avatar therapy. As online avatars become more realistic, group and individual therapy might seem perfectly normal for the next generation of therapists and patients.

New technology also means new challenges as well. Once psychotechnologies enter the mainstream, how will professional licensing cope with the disappearance of national, or even international, boundaries? Would someone licensed to practice in California be able to provide services to someone in Maine? Or even Finland for that matter? Though the Association of State and Provincial Psychology Board allows for license portability between states and provinces, will it be able to keep up with the new challenges posed by psychotechnologies? And would licensing standards between states (or countries) make sure that the same quality of services are available for patients? Dealing with remote patients means that teleprofessionals will need to know about local resources they might need that will not be available online. The possibility of malpractice might become more critical than ever and professional insurance will need to take psychotechnologies into account as well.

In concluding their article, Marlene Maheu and her co-authors point out that psychologists are at a crossroads now. “Their future depends on the speed with which they organize to make themselves more relevant in the current technological marketplace”, they add. Mental health professionals have already fallen behind other health professions in developing new ways of exploiting online services and other possible developments in future. With each new development in IT and cloud applications, the challenge of catching up with the demand is something that all mental health professionals and the professional licensing bodies will have to face.