The pandemic has prompted a swift move to video conferencing, telehealth, and telemedicine, opening new doors of possibilities when it comes to mental health care delivery. In some ways, it’s proven to be a more efficient form of care – but it doesn’t come without its limitations. Here are some to be aware of…
The technical aspects of telehealth limitations are at the forefront of challenges, as it’s the initial barrier to access care. It requires the client to have a device to communicate, reliable internet service, and the know-how to access a particular platform. This limitation rides a socio-economic line, meaning certain populations are predisposed to limited access (Austin Anxiety).
Over time, affordability and access to technology will likely become less of a barrier to telehealth, should the limitation be recognized. Click here to learn more about the technological limitations of telehealth and privacy & security issues.
Younger generations are pushing toward telehealth. Having grown up with technology, they find it is easy to navigate and utilize. Older generations, however, may not know how to use technology, don’t want to, or distrust it. This population demographic may be less likely to seek follow-up care or other services via telehealth (Etactics).
Assessment and Treatment Limitations
What you see is what you get in the case of an assessment via telehealth. With video-conferencing, your vision of the client is limited to a fixed setting, and a provider may not be able physically examine a client or administer certain tests.
Therapies or treatment where a larger picture of what is going on with a patient – and/or control over a safe environment – is required may not be as effective or desirable via telehealth (Good Therapy).
Eye Movement Desensitization and Reprocessing (EMDR), for example, is used to treat trauma and requires a provider to see a client’s entire body to determine if they are becoming overwhelmed.
EMDR is best done in-person so a provider has control over the environment and client’s safety, as this therapy can trigger trauma responses and crisis-level reactions. As previously mentioned, a provider will also want to note other physical responses but may be unable to due to the fixed chest-up nature of a virtual conference (Good Therapy).
In regards to hyperactive / impulsive behavior, at an in-person session, providers have control over the environment that a client is in. They can eliminate distractions, offer meaningful distractions such as props or toys, and can generally maintain the stimuli of the setting. Virtually, clients can have other computer screens open or may be stressed by household situations, resulting in a lack of engagement (Austin Anxiety).
SMI & Telehealth Limitations
Telehealth or telemedicine may not be the best option for some mental health disorder treatments, especially severe mental illness (SMI). SMI is “defined by the presence of persistent and extensive functional disability and includes psychotic disorder, schizophrenia, schizoaffective disorder, major depressive disorder, and bipolar disorder” (Campellone and Torous).
In a study of the application and effectiveness of telehealth for severe mental health disorders, it was found that some aspects of telehealth were less desirable for clients, such as computer use, but telephone and remote monitoring led to increased user engagement. In regards to schizophrenia and behavioral outcomes, access to educational websites was not found to be an effective form of providing information, while interactive websites with peer support or, CBT based self-management techniques, improved mood.
Furthermore, telephone support was found to reduce the severity of depressive symptoms; and telemonitoring was found to improve symptoms via pill counting. Additionally, telephone support was found to be effective for improving medication adherence, reducing the severity of symptoms, and reducing the amount of inpatient days. Using a telephone also improved patients’ attitudes toward their quality of life (Campellone and Torous).
Click here to learn more about facts vs myths about SMIs and telehealth.
When it comes to the effectiveness of various avenues of telehealth, such as patient apps, telephone calls, virtual conference sessions, websites, etc, patient preferences should first be assessed, as to best accommodate them, and jump the first limitation hurdle. Clinicians who treat SMI may want to hold a practice session with their clients to help familiarize them with the technology, go over the strengths & weaknesses of telehealth together, and replace some in-person sessions with shorter virtual meetings to ease into telehealth (American Psychological Association).
American Psychological Association: Serious mental illness and COVID-19: How to help your patients right now
Austin Anxiety: When Telehealth Works and When it Doesn’t
Etactics: The Enormous List of Telehealth Pros and Cons
Good Therapy: EMDR and Telehealth
JMIR Mental Health (Campellone and Torous) Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review