Telemental health is a process by which a mental health provider can provide services to a client utilizing a secure and confidential HIPPA compliant platform on a computer, tablet or smartphone. It’s got many names such as telemed, telehealth, virtual counseling, virtual therapy, distance counseling, and more. And, with the onset of the pandemic, more mental health providers have shifted to offering this virtual option for services or exclusively utilize it.

The National Institute of Mental Health (NIMH) offered up these advantages and disadvantages to Virtual Counseling:

  Potential Advantages:

• Convenience: Telemental health appointments don’t require travel and often mean less time off work and smoother logistics coordination for things like transportation or childcare. Clients also can schedule appointments with less advance notice and at more flexible hours.
• Broader reach: The technology is available to people who may not have had access to mental health services previously, including those in remote areas and emergency care situations.
• Fewer barriers: For those who may have been hesitant to look for mental health care in the past, telemental health services might be an easier first step than traditional in-person mental health services.
• Advances in technology: As telemental health services have increased, providers have become more familiar with evolving videoconferencing technology, with some switching to entirely virtual practices.

Potential Drawbacks:

• Access to technology: Services may be limited by lack of internet connection and devices.
• Quality issues: Varying levels of technological quality can affect how services are provided and received.
• Cost: Evolving technology means updating equipment, platforms, and networks for clients.
• Privacy: Cameras in users’ homes and virtual online platforms pose privacy considerations. Individuals also might be more hesitant to share sensitive personal information with a provider in a situation where they think others might hear.
• Insurance coverage: The rise in telehealth during the COVID-19 pandemic has led to policy changes to make services accessible to more people. However, it is not known how long such flexibilities will stay in place, and understanding what services are available can be complicated. Coverage and provider licensure requirements vary from state to state.

Even if all technologies are top notch, there still may be clients who are not appropriate for telemental health. Individuals who have hearing impairments or voice impairments may not be able to adequately hear or make themselves heard over a telehealth platform. It is vital that the practitioner is able to hear what the client is saying as clearly as possible and to ensure that the client can adequately hear the practitioner in response.

Persons who have certain psychotic disorders may be “triggered” by the use of technology. There are some actively psychotic people who hear voices and sometimes believe the voices are coming from a radio or television.

Individuals who are actively suicidal need to be seen in person so that the practitioner can assess the full demeanor of the person which may not be accessible via telemental health. The practitioner also needs to be able to act swiftly if there is a need for emergency services such as hospitalization. With the client face to face with the practitioner, it is more conducive to ensuring safety until emergency services personnel arrive.

Small children may not be good candidates for telemental health due to their distractibility. Couples who are in a contentious relationship may not be able to sit together before a camera and express themselves appropriately due to their close proximity. Screen sharing using two different computers or smartphones may be one possible remedy to this.

Researchers Brittany Lazur, Lily Sobolik, and Valerie King in their 2020 article “Telebehavioral Health: An Effective Alternative to In-Person Care” reported the following:

Studies indicate that there are largely no significant differences between telehealth and in-person care for adults with anxiety, depression, substance use disorder, and post-traumatic stress disorder for the following outcomes: Symptom improvement, patient satisfaction, quality of life, and medication and treatment adherence.

Patients have reported that behavioral health treatment delivered by synchronous telehealth was convenient and reduced barriers to accessing treatment.

Therapists at Lutheran Family Service have been actively utilizing telemental health for nearly two years, in addition to in-office settings. Clients who utilize the virtual option for therapy do so for varied reasons. Some related to social distancing, others related to lack of transportation, and some related to wanting to work with a counselor with a focus on faith but there are none in their geographical areas.

To date, Lutheran Family Service counselors have obtained professional licenses to be able to provide services to clients in Iowa, Nebraska and South Dakota. It is necessary for the counselor to be licensed in the state where the telemental health video session originates in order to provide service according to state laws.

As in any change in traditional modes of service delivery, there is a certain degree of skepticism. More needs to be and will be learned about the delivery of mental health services via telemental health, but preliminary studies indicate that for many clients it can be a viable alternative to office visits and remove barriers that can impede accessing services in the traditional manner.

Does telemental health sound like something you’d like to try? Reach out today via web form HERE, email [email protected] or call 515-573-3138.

Did you know that the licensed, Christian mental health and marriage counselors at Lutheran Family Service provide free pastoral counseling consultation to LCMS Pastors who are working with individuals and couples in their congregations? If you find yourself in a situation outside your level of comfort or training, reach out to us via web form HERE, email [email protected] or call 515-573-3138.

Toni Larson, LISW
Director of Church Worker Wellness
Lutheran Family Service