It was 2010 I believe, when I first read the very few articles that had been published on the subject of e-therapy in mental health practice. I remember thinking how neat and cool it could be to interface with a client in real time via e-mail or videoconferencing. After these initial thoughts though, I dismissed it as something way off in the future, given the possible glitches that could easily arise, as well as the legal and ethical issues associated with HIPPA compliance and other privacy concerns.
Well, what strides we’ve made over the last 5 years! Technology has literally exploded in practically every area of our personal, social and professional lives. Facebook and Twitter dominate social media and tele-treatment is gaining momentum across all mental health disciplines.
The reasons for the proliferation of e-treatment are becoming clearer and clearer. Mental health professionals are increasingly in short supply. Simply, there are not enough of us to meet the growing demand for mental health services — particularly in rural settings across our country. Also, potential patients are becoming more aware of the time demands associated with trudging from appointment to appointment, with 30 percent of their time devoted to travel alone. And since our assessments and treatment plans don’t entail physical contact with patients, tele-treatment is looking quite viable as an alternative to the traditional office visit.
So if you’re contemplating starting up a tele-practice of some sort, here are some basic guidelines to get started:
- Decide on your method of communication.
- – E-mail: Virtual private networks (VPNs) like Hot Spot Shield and Cloak facilitate your Internet traffic through an off-site private server. Cost is $3.00 per month and up depending upon choice.
- – Texting: Apple iMessaging communications are encrypted if both parties exchanging messages are using an iPhone. Whats App is another option whereby both parties must download the app.
- – Video: Your free options here are Skype, Google Hangouts and Apple FaceTime. These 3 are HIPPA compatible “enough,” easy to use and protect well from data breaches. If you want even more protection, you can purchase a fully HIPPA-compatible system beginning at $30 per month and ranging up to $300 or more per month. Reputable choices include Cloudvisit and Secure Telehealth.
- Check with you malpractice carrier. Most, but not all policies will cover you for tele-treatment, so verify of course.
- Call your state board. A general rule of thumb is that you must be licensed in the state in which your potential patient resides. Some states with severe shortages of mental health clinicians have been known to grant special dispensations for e-treatment to out-of-state practitioners. And some state boards have not yet clarified their position on e-practice, so as with your malpractice insurance, find out how your state is handling this.
- Make your current patients aware of this treatment option. This entails informing them that you’re now offering tele-treatment as an alternative option, having them sign a tele-medicine consent document and providing them the requisite instructions for downloading or utilizing whatever platform you’ve agreed upon.
- Insurance. Medicaid pays for electronic health services in most every state. Medicare reimburses if you are positioned in designated underserved areas of the country. As for private insurance, over 30 states reimburse somewhat. Call your patient’s insurance company for parameters regarding payment.
- Maintain integrity. Common sense and proper decorum would dictate the following: No shorts, tee shirts, and tank tops. Shoes required. And be aware of what’s in your background, that is, what might the patient be seeing besides you that might not be appropriate or shouldn’t be viewable.
Technology is here to stay and will become more and more refined, while marching relentlessly toward expansion into our personal and professional lives. Obviously some patients will eschew tele-health treatment in favor of a physical presence with their provider, while others, given the acuity of their presenting condition or circumstances, wouldn’t be suitable candidates for e-services.
Nevertheless, these technologies help us to expand our reach to acquire and service clients we might not have otherwise ever encountered.
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.