Growth in technology aided psychological services: Telepsychology
Presumably, crises have always occurred and the outbreak of COVID-19 worldwide is a crisis too. Trademark of any crisis is its unpredictability: the crisis itself is unpredictable, and its ability to affect people is unpredictable as well. Individuals start perceiving this unpredictability as problems that cannot be solved. These irresolvable issues result in increase in tension, signs of anxiety, a subsequent state of emotional unrest and an inability to function for extended periods. Every crisis is different but all crises require immediate intervention to interrupt and reduce crisis reaction and restore affected individuals to pre-crisis functioning. Hence, crisis intervention surged as a specialized field of psychology that provide victims with emotional first aid targeting particular circumstances of the crisis can come handy.
With the government directives of social distancing, the practice preference of mental health professionals has seen an enormous shift towards increased usage of technology. Telepsychology emerges as highly effective crisis intervention aid to manage patient and community mental health issues. Social media is being used extensively to spread message of hope, webinars being hosted, sharing of tips to combat COVID-19 anxiety, videos on surviving pandemic, newspaper articles being published, task force created by various organizations providing tele-counselling as preventive measure. Academicians, organizations/mental health professionals are conducting online surveys to understand the psycho-social impact of the novel virus/lockdown experiences on human behavior. Although many of these surveys are ongoing but most of the surveys highlight the increase in mental health issues since the outbreak. Mental health professionals are noticing a hike in online consultations and are also hosting webinars. There is a shift in mode of help-seeking behavior. A recently published article published in The New Indian Express stated “There has been a 50% increase in those buying online packages from which offer 3-5 sessions. Of that percentage, about 60-80 percent are new clients. Seeking help of counsellors/ clinical psychologists/psychiatrists/psychiatric social worker is gaining acceptance. Psychological services gaining accessibility as most of these services are provided free of cost/ incurring a minimal charge. With the growth of usage of technology in practice it deems fit to acquaint ourselves with accurate understanding of telepsychology.
Telepsychology can be defined as the provision of behavioral and/or mental health care services using technological modalities in lieu of, or in addition to, traditional face-to-face methods (e.g., provision of therapy using the phone, diagnostic interviewing via video teleconferencing, use of applications to track mood states, consultations via email). Historically, telephone counselling evolved from psychiatric services and medical triage experiences. In the late 1950’s crisis, hotlines focusing on suicide prevention began to emerge in both Europe and the United States and rapidly expanded to Australia. These hotlines, despite lack of empirical evidence for their effectiveness, soon became part of community mental health services in many places around the world. The term commonly used is Telehealth or e-health. Telepsychology is one form of telehealth service that is related to remote psychological services. Other terms also commonly used are e-psychology, e-counselling, web-counselling, telephone counselling or online counselling. Different technologies may be used in various combinations and for different purposes during the provision of telepsychology services. For example, videoconferencing and telephone may also be utilized for direct service while email and text is used for non-direct services (e.g. scheduling). Regardless of the purpose, psychologists strive to be aware of the potential benefits and limitations in their choices of technologies for particular clients in particular situations.
Telepsychology Vs Helpline
While it is easy to presume that telepsychology and helplines provide similar service, there are emerging differences in technology and case management practices. Helplines are community services where people call and talk to someone while remaining anonymous. Client chooses the conditions of interaction such as the time and length of the call. Volunteers with little formal qualifications commonly staff these services. Helplines are usually available to clients at extended hours, often 24 hours a day, free of cost. Telepsychology on the other hand, is a detailed sharing of information between the psychologist and the client. The psychologist is providing services over the telephone and/ or computer similarly to the type of service provided in face-to-face consultation.
Ethical Guidelines for Telepsychology Practice:
American Psychological Association (APA, 2013) proposed eight guidelines to be followed while opting for providing tele psychological services. These guidelines cannot be inclusive of all potential changes and cannot take precedence over clinical judgment
a) Competence of psychologist:
Psychologists who provide telepsychology services strive to take reasonable steps to ensure their competence with both the technologies used and the potential impact of the technologies on clients/patients, supervisees or other professionals.
b) Standards of care in the delivery of telepsychology services
Psychologists make every effort to ensure that ethical and professional standards of care and practice are met at the outset and throughout the duration of the telepsychology services they provide.
c) Informed consent
Psychologists strive to obtain and document informed consent that specifically addresses the unique concerns related to the telepsychology services they provide. When doing so, psychologists are cognizant of the applicable laws and regulations, as well as organizational requirements that govern informed consent in this area.
d) Confidentiality of data and information
Psychologists who provide telepsychology services make reasonable effort to protect and maintain the confidentiality of the data and information relating to their clients/patients and inform them of the potentially increased risks to loss of confidentiality inherent in the use of the telecommunication technologies, if any.
e) Security and transmission of data and information
Psychologists who provide telepsychology services take reasonable steps to ensure that security measures are in place to protect data and information related to their clients/patients from unintended access or disclosure.
f) Disposal of data and information and technologies
Psychologists who provide telepsychology services make reasonable efforts to dispose of data and information and the technologies used in a manner that facilitates protection from unauthorized access and accounts for safe and appropriate disposal.
g) Testing and assessment
Psychologists are encouraged to consider the unique issues that may arise with test instruments and assessment approaches designed for in-person implementation when providing telepsychology services.
h) Interjurisdictional practice
Psychologists are encouraged to be familiar with and comply with all relevant laws and regulations when providing telepsychology services to clients/patients across jurisdictional and international borders.
Since the spread of the corona virus worldwide it is indeed encouraging to see mental health professionals with the help of technology offering their services. Telepsychology emerges as a specialized service with the potential to broaden the reach of psychology. During these difficult times it is commonly observed that motivation for doing crisis work, whether a person is a trained professional or a volunteer, is the need to help and care for others. Unfortunately, the altruistic motivation is not enough. Appropriate training is crucial and it can determine whether a crisis worker becomes a source of help or hindrance to a community in crisis. It is of utmost importance that crisis workers acquaint themselves with the importance of informed consent, the limits of confidentiality, and the risks involved, remain well informed about the best uses of technology and what technologies are more facilitative of the provision of psychological services. It is a call for the field of mental health/policy makers/ academic institutions to include innovations in graduate training; continuing education; formulating guidelines for professional associations; regulation of professional activity and applicable law to enhance effectiveness of technology aided psychological services. Let us be reminded of the primary ethical principle of practice being 'Beneficence' and 'Nonmaleficence'. i.e. strive to benefit those with whom we work and take care to do no harm.