Evidence-Based Practice for Telemental Health

Evidence-Based Practice for Telemental Health (July 2009)
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Published July 2009

Telemental health, like telemedicine, is an intentionally broad term referring to the provision of mental health care from a distance. The prefix “tele” can refer to geographical, time, or even circadian distance when providing care across time zones. Telemental health (TMH) includes mental health assessment, treatment, education, monitoring, and collaboration. Patients can be located in hospitals, clinics, schools, nursing facilities, prisons and homes. TMH providers and staff include psychiatrists, nurse practitioners, physician assistants, social workers, psychologists, counselors, primary care providers and nurses. Thousands of clients and patients have experienced access to mental health care via telemental health technologies. The goal of the telehealth provider is to eliminate disparities in patient access to quality, evidence-based, and emerging health care diagnostics and treatments. General information regarding telemental health can be found in review articles, practice parameters and textbooks. 

Mental health professionals and practitioners continue to develop new ways to leverage technology to provide services to those needing expert care. This best practice recommendation document focuses on two-way, interactive videoconferencing as an alternative medium for clients and patients to directly engage with their mental health providers. The use of other modern technologies such as virtual reality, electronic mail, remote monitoring devices, chat rooms, and web-based clients were considered but these technologies are not currently included. There was little published literature on asynchronous methods for providing telemental health services at the time the document was written. The primary goal of the guideline is to distill the evidence from the published literature on interactive videoconferencing into a pragmatic reference for those engaged or about to engage in providing interactive TMH care. A
secondary goal is to develop a clinical coding system for TMH clinical recommendations. Like other areas of telemedicine there is a growing, yet still limited amount of rigorous scientific research upon which to draw conclusions and set public policy for the use of telemental health. As the telemedicine field advances, researchers are striving to meet scientific standards and provide more guidance concerning evidence-based telemedicine practice in the future10,11 When guidelines, position statements, or standards exist from a professional organization or society such as (but not limited to) the American Psychiatric Association, American Psychological Association or National Association of Social Workers, the guidelines, position statements, or standards shall be reviewed and incorporated into practice.

In response to the needs and requests of providers, organizations and the ATA membership interested in or engaged in telemental health activities, the TMH SIG formed a committee to develop evidence based TMH guidelines. The broad nature of the mental health field along with an unlimited number of ways to use technology in mental health services led the committee to limit this guideline to interactive video conferencing applications.

Appreciating the broad range of providers and settings involved in TMH, a method for coding the literature upon which the practice recommendations in this document are based was developed. When feasible the relevant published data were organized by patient age, types of treatment, treatment setting and provider specialty. When reviewing the literature and formulating the recommendations, the following confidence ratings were used: considerable confidence, reasonable confidence, and limited confidence based on a specific application [for more detail see next section, clinical coding methodology]. The use of the rating scale is in line with the confidence rating structures used by other organizations (e.g., the American Psychiatric Association) and is familiar to mental health clinicians. However, in order to allow for the broad range of videoconferencing equipment used and disparities in bandwidth availability, the recommendations are subject to specific application situations. Thus a second coding variable was introduced to identify the technology used. The purpose of the second coding variable was to be inclusive and appreciative of the technical and social performance of all interactive videoconferencing technologies currently in use and to not exclude niche populations or applications. It is anticipated and hoped that the coding system will encourage more specific descriptions of the technology used for future TMH interactive videoconferencing research and methods publication.