When Madison Maroney (name changed for privacy) moved from Boston to Wisconsin, there was one thing the 40-year-old east-coaster couldn’t leave behind: Her weekly therapy sessions. So now, two years later, in her Midwestern home, she pops open her laptop every week, logs on, and via live-streaming video, talks through her highs and lows with a therapist on the other side of the country.
Sure, she could have found someone new. But she had been seeing her psychotherapist for about two years and the idea of starting over felt counter-productive. “We had an immensely personal relationship, and this made it possible for me to continue that relationship and our work together,” Maroney says.
Therapists are reporting a rise in the number of patients requesting video sessions, says Marlene M. Maheu, Ph.D., executive director of TeleMental Health Institute. Like Maroney, many people continue video sessions with their therapists after a long-distance move—or while traveling for business. However, others just find them more attractive than in-office visits.
“Telemental health breaks down many of the accesses barriers that currently exist between people and the care they need,” Maheu says. More than 80 million Americans live in mental health professional shortage areas, according to the U.S. Health and Human Services Health Resources and Services Administration. Meanwhile, even in urban settings where mental health professionals abound, time and money can be a deterrent for people seeking professional help. Telemental health services—such as online chat and video streaming—squash them all.
HOW DOES IT WORK?
“Video therapy is not all that different from in-person therapy,” Maheu says. “It’s talking.” Together, the patient and practitioner determine the length and frequency of their appointment, and the conversation depends on both on the patient’s needs as well as the mental health expert’s training. Telemental health professionals can be licensed in counseling, therapy, psychology, and psychiatry, and each individual will have a slightly different approach.
Typically, sessions with a trained expert begin with a code designed to determine if the patient has privacy, which can be of concern for patients taking their calls from home, she says. (For example, saying a red car is parked outside might mean that a family member is in earshot, while a green car means that no topic is off limits.) Also, Maroney sets a white-noise machine outside the door where she takes the call to guarantee privacy amid a busy household. After confidentiality is ensured, the time proceeds like any other in-person session.
The benefits are tangible: Research has shown that virtual visits can be effective in dealing with stress, anger management, social anxiety, smoking cessation, pain, depression, and obsessive behavior. And published this year in Psychiatric Services, the first large-scale study of telemental health services found that virtual visits slash mental health patients’ hospitalization time by 25 percent.
WILL IT WORK FOR YOU? POTENTIAL PROBLEMS (AND POSSIBLE SOLUTIONS)
PROBLEM #1: YOUR WIRELESS STINKS
Technical difficulties can complicate sessions. Dropped connections, frozen pictures, and poor resolution are all possibilities that can encroach on appointment time and efficiency. “You have to expect that technology will get in the way from time to time,” says Maroney.
FIX IT: Before you get started with a provider, come up with a plan in case any technical snafus arise, Maheu says. Will you be charged for time lost due to a dropped connection? Who will call the other back? It’s much easier to address these issues ahead of time. Plus, if you aren’t worried about missing out on your session—or your money—any hiccups will cause you far less stress.
PROBLEM #2: YOU CAN’T FIND A TELE-THERAPIST
Any guy in his garage can build a website and take your money, and a great therapist might not be schooled in virtual services. Without proper training, a qualified in-person psychologist might not be able accurately evaluate if web therapy can be effective for you, administer services, or identify non-verbal forms of communication on a little screen, Maheu says.
FIX IT: Start by performing a Google search for telemental health or distance counseling, she suggests. Or, if you have a therapist or counselor with whom you’ve begun in-person work and would like to continue online, ask if he or she is trained in telemental health.
Also, ask for your practitioner’s licensing number and verify it through your state’s board of mental health practitioners, Maheu says. If you are in—or move to—a different state from your provider, make sure he or she is licensed where you are. It’s illegal in many states for a provider to treat a patient who lives in a state in which he or she is not licensed. What’s more, if you have any complaints down the road, your state’s board of mental health practitioners can only help you if the provider is licensed there, she says.
PROBLEM #3: YOUR HEALTH INSURANCE DOESN’T COVER IT
Health insurance is increasingly seeing that covering online therapy sessions can save them money in the long run, and more and more companies are covering virtual care, Maheu says. Currently, state law requires health insurance companies to cover telemental health services in 16 states, she says. While it’s an improvement, it means that health insurers don’t have to cover the services in 34 states.
FIX IT: If your health insurance plan includes mental health benefits, they could extend to services provided online or over the phone, Maheu says. You may need to make a case for why they cannot happen in person. If you live in a mental health professional shortage area, move away from your provider, or are unable to travel due to a medical condition or procedure, you may qualify.
If your health insurer still says your plan does not cover online therapy, don’t despair. That’s where sites such as CopeToday.com, TherapyLiveCare.com, and eCounseling.com come in. They allow patients to schedule a session, or even talk immediately, to a licensed therapist in their state—often for a fraction of the price of an in-office visit without going through insurance.
These sites work with licensed and local mental health experts, most of whom are also in private practice. CopeToday, for instance, is the virtual home to about 250 professionals, according to Tania S. Malik, the company’s CEO. And as each provider sets his or her own schedule, often at diverse hours, people are able to receive care around the clock. After the initial visit, the client and provider are able to set their own schedule for continued sessions.
Still, it’s important to confirm that any provider you work with through such sites are both licensed in your state and obtain your personal and medical information. While staying anonymous can sound appealing to many patients, it’s not safe or fully legal, Maheu says. Mental health professionals are required by law to report any cases of abuse, and need to be able let family members know if a client is a danger to him or herself.
PROBLEM #4: YOUR THERAPIST MIGHT BE BREAKING THE LAW
And while many well-meaning therapists use Skype for online sessions, it’s not compliant with the Health Insurance Portability and Accountability Act (HIPAA), a federal law that ensures your personal details stay safe, Maheu says. “On Skype, anyone can listen in without you knowing it.” Apart from that, however, there are very few risks for you as a patient. Mahoney even prefers to use Skype with her therapist, after having one too many technical difficulties on other platforms. Still, if any healthcare provider—therapist included—is reported for a HIPAA violation, fines could range from $100 to $1.5 million.
FIX IT: The TeleMental Health Institute has identified more than 50 HIPAA-compliant video teleconferencing companies. To comply, video platforms must comply with both HIPAA’s Security Rule and Privacy Rule, which include specifications on administrative safeguards, equipment, and disclosure. If you do not see your therapist’s video service on the list, give the office a call and ask for the name of its video platform. You can then go to the platform’s website and look for the words “HIPAA compliant” or “HIPAA compatible,” Maheu suggests. “The fact that a company has met these standards is a selling point, so they openly advertise their compliance,” she says.