Before deciding to provide a clinical intervention utilizing tele mental health, it is important to carefully consider the patient’s clinical needs and the potential benefits and costs. As with other remote services, it is important to consider what clinical support is available at the patient’s site, and what availability there may be for follow-up care. A thorough evaluation of needs at a particular site is the first step.
Using tele mental health to provide PTSD treatment can significantly reduce the costs, both in time and money, of having patients or clinicians travel to in-person sessions.
Tele mental health allows a small community clinic to offer access to specialized interventions and specialists in PTSD, which the clinic would normally not be able to provide. Home-based tele mental health has become a way for housebound patients to get the help that they need.
However, tele mental health is not without its drawbacks. The equipment, maintenance, and fees for VTC, for example, can be costly. The quality of the equipment ranges widely, with lower-end equipment being quite unreliable. Clinicians need to be properly trained so that they can maximize the benefits of the technology and minimize technical malfunctions. Some technical malfunctions will inevitably occur, so it is recommended that the clinician have a backup technician available. There are significant clinical challenges when using tele mental health for PTSD. Perhaps the biggest clinical challenge is that the clinician is not physically present to address crises such as suicidal thoughts and aggression, which are commonly associated with chronic PTSD. Having a backup clinician on-site with the patient is strongly suggested.
Although quality VTC equipment and connections can render extremely clear images, clinicians may find it somewhat challenging to pick up on nonverbal cues such as psychomotor agitation or poor hygiene. There is also a risk that the patient will not pick up on the clinician’s warmth and empathy and will perceive the interaction as impersonal.
Because tele mental health is still a relatively new phenomenon, it has not been thoroughly empirically validated. Ethical, clinical, and insurance-reimbursement guidelines are still in development.
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