Telemental health for clinical assessment and treatment

Abstract

Telemental health—the use of videoconferencing or audio only (telephone) in mental health care—has accelerated tremendously since the start of the covid-19 pandemic. Meta-analyses have examined the reliability (ie, concordance) of assessment and the efficacy/effectiveness of telemental health compared with in-person care. Results indicate that telemental health assessment and clinical outcomes are similar compared with in-person care but there is much unexplained variability, as well as evidence that patient clinical and demographic characteristics can influence these findings. Further, gaps exist in the literature regarding specific patient populations (eg, psychotic disorders, children/adolescents), treatment modalities (eg, group therapy), audio only telemedicine, and hybrid care that mixes in-person with telemental health care. These gaps provide important directions for the next generation of telemental health research. Comprehensive clinical guidelines from mental health organizations are available to telemental health practitioners and focus on five content themes: legal and regulatory issues, clinical considerations, standard operating procedures and protocols, technical requirements, and considerations of specific populations and settings.

Introduction

Before the covid-19 pandemic, the use of telemedicine (ie, care delivered via videoconferencing or phone/audio only) had been increasing in mental healthcare but was not prevalent.123 The pandemic, with its pressure to enact social distancing when possible and a concomitant relaxation of healthcare payment and regulatory policies to facilitate rapid adoption of telemedicine, vastly accelerated its use, particularly for the care of mental health conditions.45678 Several terms have been used to describe the delivery of mental healthcare via telemedicine, including telemental health, telepsychology, telepsychiatry, and teletherapy. These terms can encompass a variety of different technology based modalities such as videoconferencing, telephone, mobile applications (apps), websites, and text messaging. In this review, we focus on synchronous interactions (ie, videoconferencing and telephone). We use the term “telemental health” as defined by the United States’ National Institute on Mental Health as the “use of telecommunications or videoconferencing technology to provide mental health services.”9

Source: BMJ