BY JENNIFER CORREA-ELKINS, LCSW-C
The COVID-19 pandemic required technological modernization that changed the direction of mental healthcare. In a whirlwind of fear of the unknown about the transmission of this illness, physical distancing measures were swiftly implemented in both inpatient and outpatient settings. There was an increase in isolation, grief, loss of lives, lack of resources for basic needs, loss of employment and decreased support from loved ones. The combination of these factors contributed to making depression one of the most widespread illnesses worldwide. Before this world event, direct patient care was the standard in mental health. While hospitals had greater resources to handle an increased reliance on technology, many outpatient locations were not equipped to immediately go online and address the growing need for mental healthcare. According to Mental Health During the Covid-19 Pandemic, from 2020 to 2021, telehealth visits for mental health and substance use disorders accounted for almost half of the total visits for behavioral health.
The 21st century has been thriving for technology companies and their innovations. The expansion has stimulated new ways of thinking and the development of different approaches in the psychiatric field. There are undeniable benefits to telehealth forums. Patients can take more responsibility for arranging their mental healthcare. Individuals can actively use the online platform to engage with their providers because they may feel more comfortable asking questions or expressing concerns in familiar settings. The ease of attending sessions from a webcam or phone becomes alluring due to the simplicity of the process. Also, practitioners can accommodate more patients that they can treat with online therapeutic methods to enhance the patient’s quality of life. Virtual modalities can offer additional materials, such as websites and videos. Studies found this more efficient than self-guided therapeutic interventions (Fadipe et al., 2023).
When managing increased access to healthcare, greater autonomy eliminates certain factors. Traveling to in-person appointments used to require taking into consideration aspects such as childcare, coordinating coverage at work, arranging transportation to the facility and, most importantly, additional time. An individual is no longer forced to direct professional, familial, socioeconomic and personal commitments to the extent previously required pre-pandemic. Telehealth services even allow underserved populations living in remote areas, those with physical disabilities and those dealing with transportation problems to improve accessibility. Patients now have self-sufficiency that allows them to take control of their healthcare. Telehealth can create continuity of care and immediacy within the boundaries of everyday life.
However, technological advancement also entails consequences and risks for patients. When facing the increased need for technology, most practitioners had no virtual experience. There are limited opportunities for education or guidelines of how to render services. The numerous technologies involved in mental health services entail emails, text messaging, electronic medical records, cloud-based storage and apps. These virtual tools open the patient up to unintended risks to confidentiality. Media platforms that offer telehealth services like Zoom, SimplePractice, RingCentral, and Doxy.me attempt to remain HIPAA compliant because it enables practitioners to communicate, save information and rely on computer software and hardware (Lustgarten et al., 2020). However, technological delays from unreliable internet or faulty equipment can create confusion. If providers choose non-compliant software with inadequate firewalls and protection against adware and malware, then potential dangers like hackers accessing private information are a threat. It is important to maintain and safeguard ethical practices in mental healthcare to protect patient confidentiality.
Practitioners must determine the appropriate level of care when creating a treatment plan for their patients. The suitable level of care can be more challenging to evaluate when patients are in a different location from their practitioners. There may be a loss of collateral reporting from the patient’s known contacts, forcing situations like inaccessible family members and absentee parents. Providers are working with individuals in different stages of their readiness for treatment. Patients may be in an acute episode of mania, psychosis or are a threat to themselves or others. Practitioners may be ill-equipped to coordinate appropriate courses of action when emergencies require inpatient and outpatient programs, hospitalizations or other crisis resources. Technological communication breakdowns cannot stand in the way of acquiring speedy and accurate information. The provider connecting with their patient to retrieve crucial information may help provide life-saving services.
When mental health sessions went online, meaningful interaction between the patient and provider became more challenging. Practitioners no longer have something as simple as an office to create a safe, therapeutic environment that encourages honest exchanges from the patient. Nuances in nonverbal cues, like gaze patterns, eye contact and human spontaneity, are hard to replicate when not in face-to-face situations. The interruption in the communication process “may modify the therapeutic relationship in terms of its structural asymmetry, its fragility, and the interaction patterns” (Garcia & DePaolo, 2022). Staring at a screen the size of the patient’s face impacts therapeutic bonding because it becomes easier for the provider not to dig further for answers. Thus, those interruptions in nonverbal communication can negatively impact the efficacy of the practitioner. Mental health providers want to keep options open for virtual treatment as long as it is not at the expense of quality care.
Sometimes, an individual can have difficulty being mentally focused and present during sessions. Perhaps the absence of a mental healthcare facility from inpatient and outpatient settings may be one factor that affects the level of active commitment to the treatment process. I have often tried to conduct sessions with patients who decide to do so in front of family and friends or while doing some innocuous activity. The potential trouble that may arise when there is a lack of privacy is that patients filter their thoughts to keep certain information confidential from specific audiences like friends and family. Patients may also become distracted during sessions when rolling out of bed, getting ready to leave their homes, dealing with pets, children, spouses, and relatives, or transporting themselves to another location in their car. However, studies show that patients’ personalities and opinions towards the practitioner’s treatment approach precede their diagnosis and treatment goals (Barker & Barker, 2022). Regardless of dynamics like lack of privacy or various distractions, the person’s mindset ultimately plays a more significant role when determining the value of mental health services.
In the face of the pandemic, technology had allowed providers to continue treatment when in-person meetings were not possible. The federal Public Health Emergency for COVID-19 expired on May 11, 2023. Practitioners are managing treatment for the higher rates of mental health disorders, especially depression, anxiety, post-traumatic stress disorder and substance abuse. It is crucial to keep the integrity of mental health services, including precise assessments, comprehensive treatment plans and accurate record keeping. Despite concerns over dependable technology, the utilization of different technological communication through email, text messaging, electronic medical records, cloud-based storage and apps have helped providers give efficient and effective care.
The mental health world was adaptable and flexible toward unprecedented circumstances. Mental healthcare providers face ongoing obstacles when combining ethical, legal and training development when dealing with technological advancements. It would be advantageous if providers tracked their own psychiatric information and relevant literature, attended continuing education opportunities and solicited colleagues to discuss effective treatment modalities. Although the strength of face-to-face connection with patients cannot be duplicated virtually, the power of mental health treatment in any form is beneficial for the general population. When dealing with technology problems, online therapy permits judgment lapses that might not happen in person. Regardless, it is up to the practitioner to gather pertinent information for monitoring illnesses and adjust treatment plans as needed. The convenience and affordability of telehealth are ultimately vital tools to provide mental healthcare for all.
References
Barker, G. & Barker, E. (2022). Online therapy: lessons learned from the COVID-19 health crisis, British Journal of Guidance & Counselling, 50:1, 66-81, https://doi.org/10.1080/03069885.2021.1889462.
Fadipe, M., Aggarwal, S., Johnson, C., & Beauchamp, J. (2023). Effectiveness of online cognitive behavioural therapy on quality of life in adults with depression: A systematic review. Journal of Psychiatric and Mental Health Nursing, 00, 1– 14. https://doi.org/10.1111/jpm.12924.
García, E., Di Paolo, E. A., & Jaegher, H. D. (2022). Embodiment in online psychotherapy: A qualitative study. Psychology and Psychotherapy: Theory, Research and Practice, 95(1), 191-211. https://doi.org/10.1111/papt.12359.
Lustgarten, S., Garrison, Y., Sinnard, M., & Flynn, A. (2020). Digital privacy in mental healthcare: Current issues and recommendations for technology use. Current Opinion in Psychology, 36, 25-31. https://doi.org/10.1016/j.copsyc.2020.03.012.
Mental Health During the Covid-19 Pandemic (2023, March 20). Retrieved on April 23, 2023 from https://covid19.nih.gov/covid-19-topics/mental-health.
Jennifer Correa-Elkins, LCSW-C, earned her dual bachelor’s degree in communication studies & political science at Towson University. She earned her master’s degree from the University of Maryland School of Social Work with a concentration in mental health. During her clinicals, she was educated in the Baltimore City school system and Johns Hopkins Psychiatric Unit. She has been in private practice since 2010, working with an interdisciplinary medical team. Her theoretical orientation combines a behaviorist and cognitive approach. She has been trained in cognitive behavioral therapy, acceptance and commitment therapy and solution-focused therapy. In addition, she has extensive training and experience working with and evaluating adolescents and adults. She has been a clinical supervisor for the Maryland Board of Social Work Examiners and is a clinical preceptor for doctorate-level mental health nurse practitioner students at the University of Maryland School of Nursing. She currently offers outpatient psychotherapeutic services for individuals and couples.
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