Virtual Reality and Telemedicine/Telemental Health: Reaching Remote Populations and Opening New Avenues of Treatment

The information age is here, whether we like it or not; goods, services, marketing, shopping, and now even medicine, and mental health are either online or including more online options. As with any new technology, there are pros and cons. There are concerns over privacy and efficacy, however, there are also many benefits to the tele-health option. There are now populations of people that have access to certain types of care that have never been available to them before.

Privacy Concerns with Telemedicine/Telemental Health

One of the biggest ethical concerns with modern communication is privacy. In truth, no information is safe from determined hackers or cyber-criminals. We can look at somewhat recent events like the stealing of millions of people’s credit card information from Target, and realize that criminals evolve faster than our ability to protect ourselves from them.

With privacy, we are never completely safe, but there are two factors that protect those of us in mental health and medicine from being hit often by hackers. The first is that cyber security has gotten better. It is much more difficult for cyber criminals to access an individual’s data. It can take hours, days, months, and even years, to successfully execute certain cybercrimes. Taking this into consideration, the data we hold is just not that valuable. There are some exceptions, but with as secure as most Electronic Health Records (EHRs) are, it would take a criminal far too long to access the data for the value they would get.

Efficacy Concerns in Telemedicine/Telemental Health

Another major ethical concern is the efficacy of digital vs. in person treatment. I don’t know many mental health clinicians that would tell you that digital treatment, via some video conferencing software is better than in person treatment. It is important to know what treatments are effective digitally and what are not.

There are also limitations on exactly what the clinician can and cannot observe in the client. If there is only a standard computer monitor and video chat, then usually you are only seeing the head and shoulders of the client, and vice versa, this eliminates much of the body language information both given and received by the client. It makes it harder for the therapist to “lean in” when necessary, and offer some calming techniques that therapists are trained in teaching.

It is still far better than a simple phone call, but nowhere near as good as in person. The advent of AR/VR (augmented reality/virtual reality) has eliminated some of these concerns, and will only increase the efficacy and availability of treatments. This could change as AR/VR becomes more common and affordable, but it is still a concern that needs to be addressed by clinicians wanting to utilize Telemedicine/Telemental Health in their practice.

Habits of Easy Treatment

I have heard a number of people say that we shouldn’t use telemedicine to replace in person medicine and I agree. One of the concerns that gets raised is that some people will then not leave their house or go out into the world if they can just see their therapist digitally, or that people will use the convenience of digital to replace the efficacy of in person treatment. Given enough time it could erode the demand for in person services, until digital becomes the norm instead of, an addition to. This argument has some merit, however, if we think about other digital platforms for other services, like customer service, or even banking, people still tend to prefer to interact in person, if possible.

I personally don’t believe that it will replace in-person medicine. Instead, this kind of technology and medicine is more about increasing the reach of certain services, or continuation of a therapeutic relationship, when it is not feasible to meet in person. Remote populations, soldiers on deployment, people on vacation, these are the times when telemedicine and mental health becomes most appropriate. Unfortunately, there are insufficient guidelines on how exactly this should be used. It is a conversation we need to continue to have to truly tease out what are the best practices in telemedicine. In moving forward, we must listen to those we are treating through telemedicine. Learning from them, what is working, what is valuable, and what is not.

Reaching Remote Populations

There are many groups and areas that have little to no access to mental health or modern medicine. People living in highly rural areas or third world countries often have no mental health professionals within a reasonable distance and as such have minimal access to treatment for issues that may arise. With the increasing access to the internet, and telecommunications worldwide, these remote populations can potentially get care they would otherwise have no access to.

Remote populations are not just groups who live in areas with no access. It can also include first responders or military members deployed somewhere in the world where there is no professional available. If a service member is deployed overseas, telemental health could allow them to continue their therapy even while deployed. Again, ideally, people will be able to see a professional in person, but this technology provides access when such help is unavailable.

Responding to Crisis

Post-Traumatic Stress Disorder (or PTSD) is a major topic of conversation these days. From soldiers coming back from war zones, to first responders who see tragic things on a day-to-day basis, to victims of crime; all are at risk for developing PTSD and other traumatic stress disorders. While there are a number of very effective treatments for trauma, prevention is a far better and achievable goal.

Numerous studies have shown that immediate debriefing of traumatic incidents, along with well-defined support networks can significantly reduce the risk of developing traumatic stress disorder. The better trained a professional is on psychological first aide, and critical incident debriefing, the more they can help people to reduce this risk. The problem with this arises when a firefighter is fighting a brush fire and their team comes upon a traumatic scene, or a soldier gets back from a traumatic mission, often there are no professionals close by to debrief them. Cue telemental health.

Telemental health provides an opportunity for professionals to debrief these soldiers, first responders, crime victims, and many others, immediately and effectively, and can massively reduce the development of traumatic stress disorders.

New Avenues of Treatment

The last area I want to touch on is the new avenues for treatment that telemental health and telemedicine are opening up. One of the newest is the use of virtual reality for the overcoming of severe phobias. Sometimes phobias are too severe for the individual to actually partake in exposure therapy. Using VR, it is possible to slowly build up resilience to the stressor, and allow the person to eventually be able to do the full exposure therapy.

Another way that using telemedicine and technology is opening up new avenues of treatment is in the world of apps and client/clinician connectivity. There are now more and more apps and pieces of software that are being used to connect clinicians to their clients and provide tools for clients to manage their own symptoms. These can be mood tracking apps, food tracking, or any other thing that needs to be tracked, and this can be synced directly to the clinician, so that you have more accurate and current self-reports made by the clients.

Add in the ability to video chat, or ask questions of professionals, this can be a lower level of care for some people who either cannot afford full outpatient treatment, or are at a lower level of care that doesn’t necessarily need continuing in-person sessions. It can also provide an excellent follow up to increase the continuum of care and extend and enhance the availability of aftercare.

When I worked in a residential program, we tried to get patients to have their initial session with their outpatient therapist referral electronically, before they discharged from treatment. This drastically increased the likelihood of following up on their aftercare program as they already had a connection to their outpatient clinician.

Telemedicine is here to stay, what we need to do now is figure out how to best use it, with an eye towards what is best for our clients. It is easy to think that now we can use this to make our own lives easier, and we can, but we have to remember that all of this is not about us, it is about our clients.

This is just an overview of some of my experiences with telemedicine. If you have other experiences, ideas, comments, or questions, I would love to hear them. Either comment below, or email us at info@coherenceassociates.com. If you would like to talk to a clinician about what your options are, call us at (760) 942–8663.

Jeremy Larsen
Business Development and Practice Manager
Coherence Associates Inc.
www.coherenceassociates.com