Telemental Health the Dilemma Over

Telemental Health

The Dilemma Over Adoption Telemental Health Services

Technology innovation can have a transformative effect on our shared way of life. Though we typically reserve our enthusiasm for those technologies which improve our recreation, which stimulate our imagination and which provide us with happy distraction, it is also true that technology in the best of hands can be used to improve the quality of human life altogether. So is this the case in such fields as healthcare and mental health support. Fundamental to the functionality of modern society and yet both plagued by critical needs and problematic realities, these are areas in which emerging technologies already coming into market readiness may be pushed into practice by virtue of their paired economic viability and social responsibility. So is this the case with telehealth in general and telemental health in more specific terms. The case scenario is framed within the state of Utah, where this new technology is enabling us increasingly to access those who have otherwise been isolated by health issues, geographical obstacles or financial limitations. Moreover, this technology has the capacity to reduce the expenditure of resource and labor during the counseling process. These features make telemental health service integration a rational and recommended course of action for our facilities. The discussion hereafter will provide a background, literature review and research proposal designed to support the hypothesis that telemental health services will both improve the reach of our facilities and reduce waste costs. As we attempt with this account to resolve concerns cited by my colleagues such as liability and viability, we will explore the implications of this new technology to the field of mental health services in a more general sense as well.

Background:

The discussion here will first present the technological developments taking place in the area of telehealth by virtue of proliferating broadband technology. Subsequently, observations will be offered on the business implications of telemedicine and the socio-cultural implications of its increased use in the mental health services context. Telemedicine may offer a partial solution to the problems of our healthcare industry by arming healthcare providers, businesses and individual laborers with the opportunity to access medical attention at a mere fraction of its traditional costs. (Sahadi, 1) A strategy which employs the telecommunication and information technology advances at our disposal to the benefit of the medical practice, telemedicine approaches suggest that treatment and consultation can actually be provided through the medium of the internet, arming providers with the relatively affordable few tools needed to add a new channel for healthcare access. This is promising because the healthcare industry is problematically unequal even as its practitioners and policy-makers seem to have spread it so thin by way of labor shortages. (Media Relations, 1)

The account herein will offer a discussion on emerging technologies which are inclining the further adoption of telemedicine strategies in the field of mental health services, resulting in a proliferation of evidence to suggest the practical benefits of mental health counseling through the online medium and helping to increase the clarity and consensus on questions of legal liability relating to the provision of mental health services through said medium. With the integration of internet technologies into everyday business functions, it seems an intuitive leap to consider the ways in which advancing communication and information tools might help to improve the quality and accessibility of mental healthcare which cutting down on the costs and labor imposed upon our therapy group by day-to-day operation.

This speaks to one of the core imperatives for the present research. Namely, in spite of the internal resistance which we have experienced in this scenario, it is clear that our facilities have clear limitations with respect to the ability to serve rural communities. This is especially true where counseling might concern the elderly, the enfeebled, those without the economic means to travel outside of their respective living contexts or those with psychological conditions which discourage them from leaving the house or traveling. In such contexts, telemental health services, as Smith (2001) characterizes them, should be seen as a particularly useful strategy for improving our outreach capabilities while simultaneously reducing labor demands on our personnel. Smith endorses this claim, indicating that "the provision of mental health services in America's rural and frontier areas remains a critical health services challenge. Telemental health - the provision of mental health services from a distance, using telecommunications technologies - is increasingly helping to surmount that challenge." (p. 1)

This will be a major preoccupation of the following account, which makes as one of its primary ambitions the demonstration that our counseling group could be servicing the needs of a wider spectrum of individuals including those with severely limited mobility and those isolated to remote rural regions.

Research Questions:

This discussion is structured around a number of key research questions, the answers to which should produce a satisfactory assessment of the major sticking points in our organization's dilemma. The following research questions have been essential to driving the focus of the literature review and establishing the structure of the research proposal thereafter:

-How would the implementation of a telemental health system impact our current client base?

-For whom would the implementation of telemental health be specifically amenable either within or beyond our existing client base?

-What are the social, cultural and ethical dimensions of the present dilemma?

Literature Review:

From a business perspective, the use of telemedicine or telehealth strategies represents a great opportunity to reduce inherent operational costs and to improve the cost implications of user access to the healthcare system. The potential represented by telemedicine, still modestly unexplored, bears a great deal of undiscovered opportunity for patients in need of access to mental health attention that is quick, cost effective and reliable. By placing live counseling and pertinent psychiatric care information at the computer user's fingertips, the process of telecommunication removes many of the fundamental obstacles to receiving mental health services. Among these, telemedicine eliminates the need for and cost of transportation, significantly diminishes the amount of time required by subjects to obtain the proper attention, compensates for any shortage of labor and, ultimately, reduces many of the inherent costs to the system in an office visit.

As a result of the relative cheapness of the basic required equipment for access to online healthcare, this has been widely touted as a sensible avenue for exploration as a means to advancing opportunities for healthcare to many venues and geographic locations where such had previously been unavailable. For our considerations here, the counseling group which shares our facility will serve as a hypothetical venue where, though, it has not been traditionally present, counseling access may through online strategies become a reality. According to available preliminary research, "the adoption of PC-based desktop medical teleconferencing is tracking closely after the more widespread use of desktop videoconferencing (DVC) for business" (B2B Media, 1) As this relates to telemental health, it seems apparent that very little physical adaptation needs to be made in order to participate in a growing network of online healthcare users, providers and counselors.

The abilities which it gives therapists to connect from remote locations by way of any modestly equipped PC terminal makes telemedicine a route to the expansion or supplement of our abilities to directly address the needs of subjects requiring immediate attention. Particularly in the area of treating existing clients, all evidence available suggests the opportunity to significantly broaden and improve our service capabilities. According to Grady et al. (2009), telemental health services help to eliminate many of the limitations to mental health service access created by time and space. Also of essential importance though is the essential finding that those groups constituting the presenting problem of lacking immediate access to such services are the inherent target of most pilot videoconferencing programs. Grady reports that he goal of the telehealth provider is to eliminate disparities in patient access to quality, evidence-based, and emerging health care diagnostics and treatments." (Grady et al., 6) Indeed, this concern over disparities drives much of our research, which is concerned with uncovering the ways that telemental health strategies help to overcome the types of barriers created by ethnic isolation, racial imbalance, socioeconomic inequality or age-based limtation.

Tyson (2010) describes some of the implications of the telemental health strategy as these concern reaching greater numbers of clients without the costs or impracticalities of travel. Tyson delineates a program in which a group of elderly military veterans have gathered for the past 15 years to engage in videoconferencing with a quality mental health professional. The article reports this as "an aftercare recovery group that meets weekly. The group is a mix of Veterans based in Helena, Missoula and Great Falls, where their psychiatrist is based. Group participants meet at their local medical center or outpatient clinic and gather in a room equipped with videoconferencing technology. VA technicians and nurses are on hand locally if any problem arises with the video connection, but the session is primarily run by the therapist tuned in on the video screen." (Tyson, 1)

The participants in the program has responded universally in favor of the program and have described it as a way of gaining access to critical support services which are inaccessible due to age, travel restriction and disability. Though the Tyson article denotes that many participants in the program do require some adjustment time to become comfortable with the flow of videoconferencing, most have ultimately reported that the reduction in travel time has been an enormous assistance in removing barriers to counseling. In this particular program, a focus on relieving alcohol and drug addiction symptoms following rehabilitation in the remote rural regions of Montana would demonstrate the importance of having a more accessible mode of gaining such support services. (Tyson, 1)

Indeed, the Tyson article suggests that the counterpoint to providing these opportunities is the danger that such individuals are likely to lapse back into addiction. This is a clear imperative for the ethical imperative to help improve outreach where it is likely to bear a positive impact. So denotes that text by Tschirch et al. (2006) which alternately examines the scenario for residents of a women's shelter who were reported as victims of domestic violence. The research here conducted would suggest that without the access to mental health support provided by telemental health technologies, most women demonstrated a higher likelihood of regressing back into an abuse relationship. Tschirch et al. indicate that "all of the women involved in the study had significant mental health issues and other health concerns that were not being addressed by the existing health care delivery system. Without the use of telehealth, these women would have had limited access to primary health care and virtually no access to mental health services. The East Texas Tele-Mental Health Network demonstrates the value of the clinical and organizational skills that nurses bring to innovative models of mental health service delivery." (Tshcirch et al., 1)

According to the Utah Division of Substance Abuse & Mental Health (2007), there is a social responsibility which is assumed by the mental health professional to serve those in need of mental health support when they present. This converges with the opportunity to meet a wider array of social demographics presented by the implementation of telehealth strategies. Accordingly, the UDSAMH indicates that "it is clear that mental illness crosses entire populations. Just like many disciplines are working together to study mental health and illness, all professional treatment providers -- public and private must come together in order to provide the most effective interventions on all levels -- from prevention to tertiary intervention." (Callister, 2)

This impetus as defined by the state of Utah implies something of the social imperative to not just improve services for our existing clients but to approach with greater dynamism though who reflect the problems dictating a need for telemental health services. As this relates to the legal liability of firms practicing telehealth strategies, the text by Godleski et al. (2008) is an appropriate source for consideration. This article employs consideration of the Department of Veteran Affairs approach to mental health video-conferencing, which it identifies as an essential tool in suicide prevention. However, it notes that in stating that goal, there are also certain legal liabilities for which an organization must take steps to protect itself. Accordingly, Godleski reports that "remote assessment of suicidality . . . involves complex legal issues: licensing requirements for remote delivery of care, legal procedures for involuntary detainment and commitment of potentially harmful patients, and liability questions related to the remote nature of the mental health service. VA best practices for remote suicide risk assessment include paradigms for establishing procedures in the context of legal challenges (licensing and involuntary detainment/commitment), for utilizing clinical assessment and triage decision protocols, and for contingency planning to optimize patient care and reduce liability." (Godleski et al., 271)

For our counseling firm, this would mean that adoption would involve the enlisting of legal services intended to provide inbuilt consideration of and protection from any such liability. This would also mean specialized training for all counselors such that legal considerations specific to telemental health conferencing could be imparted.

Methodology:

Most of the questions of legal liability about which our personnel have expressed concern will have been addressed by the review of sources cited here above. These provide a basis for the responsibilities and ethical demands which enter into the general counseling profession as this is practiced in the State of Utah and into the particulars of telemental health support. Before adopting the strategy for our group of practitioners, it would be appropriate to gather data from a sample population of counseling professionals who have already used telemental health services as part of their treatment strategy for a sustained period of time, which is identified hear as one year.

Research design:

For this research endeavor, it seems that the interview would be most appropriate. It is anticipated that there would be roughly one dozen participants in the survey-interview process. It is also expected that amongst the participants at the selected practices, a variance of internal cultural realities, responsibilities and pay scales would make it most efficient to garner information in each individual context by engaging practitioners one-on-one in their own practice facilities.

The sampling frame would be constituted of the head practitioner at each practice. This study would operate under the demand to isolate individual case causes of counselor perspectives from those which reflect more universal positions on telemental counseling. The interview design will allow us to take on the views of individual study subjects, using a framework that is guided by a line of questioning but which is also given over to a broad variance of possible data sets due to the open-ended nature of the approach.

Perhaps the most distinct advantage to conducting research with an interview questionnaire acting as the prime tool for data gathering is its capacity to yield first-hand accounts which may be protected by anonymity and which enable researchers to formulate data analyses that are not influenced by their personal perceptions of subjects. This benefit is supplemented by the ability which the interview offers researchers to craft data-gathering questions according to the needs of the study. With this method of qualitative data accumulation, questions can be shaped to cast a broad reach in terms of that which can be utilized to formulate conclusions. This means that the questionnaire can not only help to acquire data but can be instrumental in determining that data which is most useful or applicable

The methodological interest in provoking detailed insight into the benefits of employing telemental health strategies through the perspective of individual practitioners denotes a need for a form which is inherently structured to allow for unpredictable extrapolation within gathered data. This is a necessary aspect of the case study methodology and thus provides researchers with a degree of confidence in the balance offered by the interview.

Data Collection Process:

The interview will be formed as a questionnaire but will be applied differently. This is to say that its use as an instrument for collecting data will not necessitate that the subject actually fills out a survey form his or herself. Instead, the researcher is intended to proctor the interview verbally in a one-on-one session with the respondent. This means that the instrument will be an interview guide, rather than a hard and fast set of questions demanding rigid response parameters. The limitations of a survey are, instead, here at the discretion of the researcher(s) administering the interview. This means that a broad and far-reaching set of questionnaire questions will serve as directives for the overarching discussion.

To the aid (and also to the discretion) of the researcher, each of the broad questions, of which there will be 12 in this study concerning the relationship between telemental health services, operational costs and demographic reach, may be accompanied by any number of subquestions, notes and comments which are designed to facilitate further discussion where needed in the context of any one broader directive. These subquestions et al. may not be applied at all, or may be used selectively, with the primary intent of simply being available to the researcher for the purposes of accommodating more fluid discussion where such is needed. This can be a significant aid in exacting a sufficient enough data collection process. Additionally, we can see that this aspect of the instrument differentiates it in capability from the survey, which must naturally be significantly more rigid in terms of that which it includes. The absence of a mediator in its administration demands that specificity.

Ethical research practices:

Once an agreement to participate has been gained by telephone, subjects are mailed a statement of intent and a self-addressed stamped envelope. Respondents are simply required to review that statement of intent, sign and date the statement and return it in the envelope provided. The statement of intent would indicate the counseling group's dilemma, reiterating the concerns over the feasibility implications relating to implementation a telemental health program. Using some background information concerning the reigning debate on the subject, this statement would explain the purpose of the research without expressing the hypothesis. This is done to prevent the creation of bias in respondents who might then be encouraged to respond in such a matter as to please researchers.