Implementation Considerations for Teletherapy for Behavioral Health

TELETHERAPY FOR BEHAVIORAL HEALTH

Teletherapy for Behavioral Health

Provision of behavioral health services has moved from therapy to teletherapy. The use of telehealth, which is a form of online psychotherapy, has increased widely especially during the pandemic. Essentially, physical distancing measures that were imposed during COVID-19 necessitated the inclusion of telehealth services such as teletherapy for behavioral health problems. Despite its continued use, Sauter (2022) points out that policymakers and providers continue weigh its advantages and disadvantages in treatment of conditions such as substance use and mental illness. This is more so the case given that use of technology in psychotherapy happens to have some inherent benefits and risks. Dr. Joe Markowits, a research psychiatrist and a professor of clinical psychiatry, states that despite the fact that many patients feel that teletherapy is good, therapists tend to feel otherwise - indicating that the said therapy cannot be compared to personal therapy (Sauter, 2022). In addition, Markowits also indicates that despite the fact that teletherapy increases accessibility of behavioral health services, the said accessibility is economically unfair to individuals who lack good insurance. Indeed, Markowits referred to the said unfairness as a disgrace especially to a country that is advanced on the insurance services front. Failing to provide telehealth services to patients who lack insurance is unethical. Essentially, the said doctor argues that a country that is rich in insurance companies ought to help all its citizens. With regard to what Markowits states, there exists various ethical considerations against or for the use of teletherapy in behavioral health.

There are a number ethical considerations that are in favor of the use of teletherapy. The first ethical consideration is the fact that teletherapy increases accessibility to psychotherapy as well as flexibility and availability of service (Stoll et al, 2020). According to the authors, online psychotherapy enhances and improves access to evidence-based care and healthcare services especially to underserved populations and those living in remote or rural areas. In addition, services provided through teletherapy have greater flexibility in that they can be accesses at any time and place. This happens to align with the rights of patients, i.e. in relation to the receipt of compassionate and respectful treatment without being discriminated against in terms of disability, national origin, identity, gender, age, religion, and race (Lemberg, 2019). The author further suggests that failing to provide care to mental health and physical needs is a form of neglect. Apart from flexibility and easy access to care, online psychotherapy facilitates more frequent engagements between therapists and patients (Stoll et al, 2020). This ensures that patients with behavioral health problems can easily access special care since therapists are readily available. It is also important to note that easier access to care ensures that patients are able to receive emergency care when required (Lemberg, 2019).

Second, teletherapy enhances communication while ensuring that therapy benefits patients. For instance, teletherapy can include the use of other online materials such as videos and websites by integrating them in therapy. In addition, documentation and data recording processes are easier and can be revisited by patients and therapists when needed. According to Lemberg (2019), this ensures that patients can access their medical records as well as add information to the said records when need be. Third, Stoll et al (2020) make a finding to the effect that online psychotherapy is a cost-effective form of therapy compared to in-person therapy. In addition to being cost-effective, teletherapy helps in reducing waiting lists that are accelerated by staff shortage in mental health care. Fourth, Stoll et al (2020) points out that teletherapy can enhance privacy and anonymity in the sense that a patient may not be seen entering a psychiatric institution. As a result, more persons may be more willing to seek the relevant services.

On the other hand, there is need to explore certain ethical considerations relating to online therapy. The first disadvantage against the use of teletherapy relates to issues of security, confidentiality, and privacy. According to Stoll et al (2020), some communication tools that are used in tehetherapy may be unencrypted while other websites may be unsecured. Such websites may be prone to hacking thus compromising security of data. According to Lemberg (2019), a healthcare provider is required to disclose the risks of a proposed treatment methodology and/or approach. Essentially, Liem et al (2020) indicate that behavioral health providers should discuss issues related to confidentiality by describing limits related to confidentiality in the informed consent. The second disadvantage of teletherapy is that the said therapy requires special training and therapist competence. Stoll et al (2020) suggest that therapists are required to have knowledge on specific policies and legal requirements as well as ethical guidelines and approaches. According to Lemberg (2019), therapists should be familiar with international laws such as tort law - which helps ensure that healthcare providers perform their duty without being exposed to the risk of prosecution for neglect or failings on multiple front. There is especially need for therapists to ensure that they comply with policies and regulations that are related to teletherapy so that they can be able to prevent negligent and unintentional failings.

Third, there are those who are against the use of teletherapy in behavioral health owing to the negative issues related to effective communication. For instance, Stoll et al (2020) point out that teletherapy - especially in the use of telephone and text-based media - for therapeutic interactions lacks non-verbal cues. As a consequence, therapists may lack important information which would then impair psychological assessment and diagnosis. Thus, therapists may cause unintentional harm to the patient by providing interventions that were based on wrong diagnosis and assessment. Further, teletherapy use in behavioral health may lack proper informed consent which is a requirement in engagements of this nature. According to Liem et al (2020), a therapist is required to collect a consent that is signed by the patient. Lemberg (2019) suggests that before an informed consent is signed by the patient, the said patient should have the capacity to make sound judgments and reason rationally. In most cases, it may not be possible for the said therapists to collect a consent that meets the relevant standards or conditions. This is more so the case given that it may be difficult for therapists to determine whether patients has the capacity and is legally able to provide informed consent (Stoll et al, 2020).