Tele mental health

Definition and history of Tele mental health, Tele counselling, tele behavioural health, e-
counselling, e-therapy, online therapy, cyber counselling or online counselling.

Types of online counselling: Telephone Counselling, App-based Counselling, Email

counselling, Web-based counselling and other modalities. Ethical Issues in Online
Counselling,
Tele mental health: Definitions
• National Institute of Mental Health: Telemental health is the use of
telecommunications or videoconferencing technology to provide mental health
services. It is sometimes referred to as telepsychiatry or telepsychology.
• Research suggests that telemental health services can be effective for many
people, including, but not limited to those with attention-deficit/hyperactivity
disorder (ADHD), post-traumatic stress disorder (PTSD), depression, and
anxiety.
• As the need for providing virtual mental health care services has increased,
providers are finding ways to use phone and videoconferencing technology to
bring therapy, evaluations, interventions, and medication management to
individuals where they are.
 Tele mental health: Definitions
• Telehealth has also been referred to as Telemedicine, TeleMental Health or E-Health.
It refers to the general term of delivery of medicine via digital means in a non in-
person situation.
• TeleMental Health Activities May Include using the telephone, text, e-mail, or
interactive tele-video-conferencing
• The use of the telephone, e-mail, chat rooms, and other Internet and satellite-based
technologies to provide direct clinical services.
• In most general terms, telehealth is defined as the use of technology to provide clinical
services.
• Tele Mental Health (TMH) can be provided from larger hospitals to smaller clinics
lacking mental health services, as well as to nonclinical locations such as prisons,
schools, community centers, and increasingly, directly to patients’ homes. Patients and
providers can connect via a variety of video-enabled devices, including smartphones,
tablets, and desktop or laptop computers.
 History of Tele Mental Health
• The first documented use of telecommunications technology to provide health
care at a distance occurred in 1920 at Haukeland Hospital in Norway, where
radio links were established to provide health care support services to ships at
sea. It wasn’t until the 1950s, however, under the pioneering efforts of Dr. Cecil
Wittson and his staff at the Nebraska Psychiatric Institute (NPI), that
telemedicine was used in the field of mental health.
• The technology used by these early projects would be considered primitive by
today’s standards. The University of Nebraska designed a simple one-way
closed circuit system using small black and white televisions for lectures and
instructional purposes. More than 1,000 students at the Medical College of
Nebraska received instruction via this network in the 1954-55 academic year.
 History of Mental Health
• With continued Federal funding, the University of Nebraska program expanded
throughout the late 1950s and 1960s. Milestones included the first audio-visual
interactive system in 1959, and the use of microwave technology to open a link in
1964 with Norfolk State Hospital, which was 112 miles away. This latter
development meant that picture and sound could originate from multiple locations at
either site. In the late 1960s, the Nebraska project linked the Veteran’s
Administration hospitals in Omaha, Lincoln, and Grand Island into the existing
network.
• In 1968, NIMH funded a project to develop a closed circuit link using two
microwave relay stations between the Department of Psychiatry at Dartmouth
Medical School and a rural hospital in Claremont, New Hampshire. The technology
allowed for timely mental health consultation without moving the patient from his
or her home environment. Also, for the first time highly trained technicians were not
needed. Program staff, with limited technical training, could now operate these more
“user-friendly” systems, eliminating the problem of down time due to technical
difficulties.
• In 1968, Dr. Thomas Dwyer expanded an existing telemedicine project at
Massachusetts General Hospital to provide emergency psychiatric consults
to staff at Logan Airport Medical Station in Boston, some 2.7 miles away.
This project used a bi-directional television transmission system equipped
with remote camera control that allowed the consulting psychiatrist at the
hospital to pan, zoom, and focus the camera located at the remote site.
• This capability helped psychiatrists observe physical and emotional
nuances without invading an individiual’s personal space (Baer, Cukor and
Coyle, 1997). In particular, doctors reported that communication with
adolescents, children, and certain patients with schizophrenia was easier
than the conventional face-to-face interview process. For the first time, the
technology was said to be more effective with these groups than the
established “best practice” model.
• Benefits of Tele mental health counselling:
• Convenience: No travel requirement, lesss time, easy access.
• Broader reach: The technology is available to people who may not have
had access to mental health services previously, including those in
remote areas and emergency care situations.
• Fewer barrier: For those who may have been hesitant to look for mental
health care in the past, telemental health services might be an easier
first step than traditional mental health services.
• Advances in Technology: As telemental health services have increased,
providers have become more familiar with evolving videoconferencing
technology, with some switching to entirely virtual practices.
• Social stigma; Anonymity;
• Drawbacks
• Access to technology: Services may be limited by lack of internet
connection and devices.
• Quality issues: Varying levels of technological quality can affect how
services are provided and received.
• Cost: Evolving technology means updating equipment, platforms,
and networks for patients.
• Privacy: Cameras in users’ homes and virtual online platforms pose
privacy considerations.
• Insurance coverage: The rise in telehealth during the COVID-19
pandemic has led to policy changes to make services accessible to
more people.
Tele Counselling
• Tele-counselling is a service that provides telephone-based mental health
support by a trained counsellor. Callers can use this service to access
individual support, remotely.
• Telephone counseling refers to any type of psychological service
performed over the telephone.
• Telephone counseling ranges from individual, couple or group
psychotherapy with a professional therapist to psychological first aid
provided by para-professional counsellors.
• Telephone counseling is also provided by crisis hotlines, quitlines, and
child helplines.
• How to access our tele-counselling helpline?
Telebehavioral Health
• Telebehavioral health, also known as telemental health, is broadly defined as
any telehealth services delivered by behavioral health professionals, such as
psychiatrists, psychologists, and social workers.
• Examples of behavioral health services delivered via telehealth include
cognitive behavioral therapy, general psychotherapy, behavioral activation,
problem-solving therapy, medication management, and training for parents of
children with attention-deficit hyperactivity disorder.
• the purposes of this brief, telebehavioral health services are limited to live
audio-video connections (synchronous) in which patients receive health care
at an originating site (e.g., clinical or home setting) from providers located at
a distant site.
• There are minimal differences between in-person and remotely delivered
services, regardless of modality or separate benefit designation
 E-counselling (Online Counselling)
• Online therapy is growing rapidly. The Internet is not just for chatting with friends
and relatives anymore. World Wide Web is now helpful in obtaining information
about mental health, including specifics on disorders, medication, and treatment.
• E-counseling or online counseling is a controversial form of psychological
counseling that uses distance communication technologies to deliver a variety of
mental health services, including therapy, consultation or psycho-education. These
services are provided by a certified specialist and can take place via telephone, e-
mail, chat or videoconferencing.
• E-counseling is suitable for people who are looking for guidance in solving
everyday problems. For more severe conditions, specialists strongly recommend
patients to seek conventional face-to-face therapy.
• Goal: The goal is to empower the client by finding areas he can control and
successfully manage. The emphasis lies on the client’s strengths rather than
behavioral short-comings.
E-counselling
When is E-counseling Used
• Research so far suggests that e-counseling may benefit clients that don’t have
access to face-to-face therapy, for instance people living in rural areas. The
advantage of easy access can also prove useful for providing mental health
services for people with disabilities or inmates who can’t leave the
correctional facilities.
• Another advantage of e-counseling is that it can offer support at the right
moment. The patient can seek help exactly when he feels he needs
professional counseling without having to wait for an appointment.
• This form of counseling has been used in treating symptoms of depression,
anxiety, panic, stress as well as relationship difficulties or academic concerns.
E-counselling
How e-counseling Works
• Online therapy has widely spread through various services on the Internet. E-
counseling can be conducted on multiple platforms that can suit their needs.
• Some psychotherapy clients can be more receptive to communicating with
therapists via e-mail, especially when addressing issues that may be difficult
to discuss face-to-face. People dealing with issues that have an element of risk
such as addictions or phobias might find it more comforting to express their
issues in writing[2].
• “Online counseling helps to clarify my own thought process. I can rethink and
rewrite my comments. I couldn’t do that in face-to-face counselling, says
Kathy.
• People who prefer more interactive sessions can use videoconferencing
e-therapy
• E-therapy potentially offers all the benefits of conventional face-to-face
counseling at a fraction of the cost.
• It’s convenient, widely available, and advancing along with technology.
• As internet-based therapy becomes more popular and widespread in its
practice, we look at what it is, what’s involved, and the research findings on
its efficacy.
• E-therapy has become the official term for ongoing online interactions
between a therapist and client. In e-therapy (Bloom, 1998; Ainsworth, 2000 in
Manhal-Baugus, 2001: 4): …client and counselor are in separate or remote
locations and utilize electronic means to communicate with each other.
e-therapy
• Sucula and colleagues (2012) give a similar definition: E-therapy is defined as
a licensed mental health care professional providing mental health services via
e-mail, video conferencing, virtual reality technology, chat technology, or any
combination of these.
• Other terms that are often used interchangeably with e-therapy are
telepsychology or teletherapy.
• e-therapy is designed to help a client deal with specific, well-defined
challenges with a certified mental healthcare professional’s support primarily
through digital communication modes (Manhal-Baugus, 2001).
• Examples of such challenges are anxiety-related disorders, post-traumatic
stress disorder (PTSD), and social and specific phobias (Olthuis, Watt, Bailey,
Hayden, & Stewart, 2016), which may be treated using similar interventions as
those used in a face-to-face context.
 Online Therapy
• Online therapy is the provision of professional mental health counseling via the internet,
usually through live video chat, messaging app, email, or over the phone.
• Also known as teletherapy, telemental health, e-therapy, or online counseling, the practice
has grown rapidly in popularity since the start of the COVID-19 pandemic, allowing a
patient to connect with a qualified therapist from the safety—and comfort—of their own
home.
• Traditional, in-person therapy usually takes place in a therapist’s office, and has long
been used as an effective treatment for many different mental and emotional health
problems. Talking to a professional can help you overcome obstacles in your life, gain
awareness of the root cause of your problems, manage symptoms, and heal.
• As an example, studies have shown that cognitive behavioral therapy (CBT) can be as
effective as antidepressants in treating moderate to severe depression—but without the
risk of harmful or unpleasant side effects.
• You don’t have to be dealing with a
• If you’re going through a difficult time in your life, such as a bereavement,
divorce, or unemployment, therapy can help. Even if you’re facing everyday
concerns like overwhelming stress, low self-esteem, or trouble sleeping, the
right therapist can provide expert support and guidance and help you make
positive changes.
• online therapy is a much newer form of therapy, current evidence suggests
that for many people it can be just as effective as in-person therapy
 cyber counselling or online counselling
• Online counseling is a form of professional mental health counseling that is
generally performed through the internet.
• Computer aided technologies are used by the trained professional counsellors
and individuals seeking counselling services to communicate rather than
conventional face-to-face interactions.
• Online counseling is an alternative to traditional face to face counseling,
wherein, professional counseling services are provided through the use of
Internet. These services are mainly offered via email, real-time chat, and
video conferencing. It is however, becoming a popular model for support for
young people, with key national services such as Lifeline, Kids Helpline,
Suicide Call Back Service and Headspace adding online counseling to their
service provision.
 Types of online counselling
1.Telephone Counselling,
2. App-based Counselling: Mobile apps to improve
emotional well-being, becoming more mindful; addressing
common mental health issues.
3. Email counselling,
4. Web-based counselling and other modalities.
5. Ethical Issues in Online Counselling
• Online therapy options have become an effective and convenient alternative
to in-person treatment. New types of online counseling are emerging each
day. Teletherapy, text-based chats, videoconferencing and other forms
of virtual therapy are changing the way people receive mental health services
. Because treatments in this field are constantly evolving, people may not be
aware of the available online options for treating addiction and co-
occurring mental health conditions.
 Common Types of Online Therapies

• Mental health and drug addiction therapy may involve one or many types of
therapeutic approaches. Numerous styles of therapy and therapeutic
orientations can help a person explore their motivations, adjust their behaviors
and improve their feelings.
Cognitive behavioral therapy (CBT) is one of the most frequently used styles
of mental health treatment, so there is a high likelihood someone could
engage in cognitive behavioral therapy online. Like face-to-face
sessions, online CBT therapy will address:
• The connection between thoughts, feelings and behaviors
• Distorted beliefs and the negative impact they have on mood
• More beneficial behavior patterns that improve symptoms
• CBT is effective for numerous mental health issues, including depression,
anxiety, addictions, behavior compulsions and many others.
Dialectical Behavior Therapy
• A specific version of CBT, dialectical behavioral therapy (DBT) can be an
effective treatment style for a variety of symptoms and conditions like:
-Suicidal thoughts
-Self-injury
- Borderline personality disorder
- Eating disorder like anorexia and bulimia
Post- traumatic stress disorder
Online DBT helps build new skills related to regulating emotions, tolerating
stress and improving relationships. Often, DBT involves both individual and
group therapy sessions to help create the desired change.
Family Therapy
• People may think online therapy only offers one-on-one phone calls or video
chats with a professional. In reality, online family therapy is a helpful
approach that includes an identified client and one or more loved ones.
• Online family counseling services are based on the notion that the family
system affects and is affected by each person. Ideally, online counseling will
improve communication skills and routines to create a more peaceful and
rewarding family setting.
EMDR Therapy
• Eye movement desensitization and reprocessing (EMDR) is a helpful
treatment that minimizes the unwanted impacts of past traumatic events,
depression, anxiety and addictions. A therapist can accomplish EMDR
online with a few modifications to fit the virtual space. An online EMDR
therapy session may help achieve desired results from the comfort of the
person’s home.
 Ethical Issues in Online Counselling
• To maintain quality of service, avoid potential complications, and serve the
community safely, professionals who practice online should know the limits of
online consults and understand various ethical as well as legal considerations
that apply to this type of work.
• Clients safety and identity of the clients are important.
1. Understanding and informing:
(a) Online clinicians educate themselves about the uses and limits of online care,
they advise potential clients about them in accordance with current research and
practice.
(b) Online practitioners inform potential clients of any relevant research and
available data about online therapy, including the potential effectiveness or
limits for a specific problem.
2. Online and in-office service arrangements:
• Online clinicians assess the suitability of potential clients for online care.
Online care may be insufficient for clients in crisis or life threatening
situations, where in-person assessment and care is the better
alternative. If an online practitioner foresees that a potential client may
require in-office care at some point, the practitioner informs the client of
such an eventuality. The clinician accepts the client into his/her care
only if:
(a) both parties agree that the therapist is within a reasonable
geographical distance of the client and can thus provide in-office care if
such is needed; or
(b) a contingency referral arrangement for such cases is mutually
agreed upon by the clinician and client.
3. Emergency contact:
• Online clinicians verify the client's identity to the extent possible and establish some
means, other than e-mail, of communicating both with clients and emergency
contacts.
4. Limits of license and insurance:
• Online clinicians provide professional care only to those clients who reside in the
state or province in which the practitioner is licensed or certified. Online clinicians
explain the limits of out-of-state practice and lack of insurance coverage in such
cases to clients who must always sign an Informed Consent form.
5. Understanding confidentiality and security online:
• Online clinicians educate themselves about, and advise clients of, the potential risks
to confidentiality in regard to Internet transmissions.
6. Privacy measures:
• Online clinicians provide care only through "secure" web sites, using
current protective procedures.
7. Reimbursement and payment for services:
• Online clinicians advise potential clients of the current limitations of
online care with regard to third-party involvement, payments or
reimbursement for online professional services.
8. Regulating and supervising entities:
• Online clinicians provide links to information web sites of those bodies
that license, certify or supervise the practitioner, and to whom clients
have recourse in case a dispute arises between the therapist and client.
9. Professional standards:
• Online clinicians safeguard the privacy of client records using
standard office procedures, e.g., of such level and detail as are
required and kept in the non-virtual office.
10. Mastery of the modality:
• Online clinicians seek technical consultation, or other means of
understanding technical issues, prior to providing online
professional services.