Additionally, practitioners can still generally only see patients who live in the state in which they are licensed. Efforts by multiple professional boards are underway to make interstate licensure reciprocity easier for clinicians who could be filling serious gaps in mental health care, according to Dr Alvord.
Even if the perceived advantages of telemental health seem to outweigh the drawbacks, experts warn against its premature adoption without appropriate training. “Therapists absolutely must obtain adequate training because it’s a mistake to believe that just because you know how to use a computer that you are prepared to offer these services,” Lynn Louise Wonders, LPC, psychotherapist and director of services at Wonders Counseling Services, LLC, told Psychiatry Advisor.
“There are so many issues that must be considered before offering these services,” she added. Wonders conducts continuing education courses on ethical and legal issues pertaining to telemental health and says there are many high-quality trainings available both online and in person.
There are multiple areas of competency required for delivering mental healthcare services via video — and for knowing when it might not be appropriate. “Clinical skills for the most part are the same in person as they are on video, but if someone is an alcoholic or substance abuser or psychotic you can’t assess enough online — you can’t smell them, you can’t check their gait,” said Dr Alvord. She agrees that “you can’t just go do it.”
In 2009, the American Telemedicine Association published Practice Guidelines for Video-Conferencing-Based Telemental Health11 that highlights necessary clinical and technological competencies, and the American Psychological Association released guidelines in 2013.12