Expert Interview Series: Dr. Marlene Mahea of TeleMental Health Institute
Marlene M. Maheu, PhD is the founder and Executive Director of the TeleMental Health Institute, where she oversees the development and delivery of professional training to behavioral health practitioners from around the world through their online training platform at www.telehealth.org.
We recently checked in with Marlene to learn about what Telemental Health is, as well as the benefits and drawbacks for patients. Here’s what she had to say:
Tell us about Telemental Health. What is it?
Telemental health refers to the delivery of behavioral services across geographical distance via a wide variety of technologies (telephone, video, email, test messaging, apps) for a wide variety of services (e.g., clinical care, education, billing, consultation).
How did you become interested in Telemental Health? How has the field evolved since you got your start?
Drawn to technology in 1994 to explore how to reach many more people than prior, I started an online magazine that further opened my eyes to how health consumers from around the world clamored for information. I began asking questions about legal and ethical issues, and soon learned that very few of my colleagues in the large professional associations had begun to consider the realities of practicing via technology. That sparked my interest further, and has since led me to be a worldwide leader in legal and ethical issues (best practices) for the spectrum of behavioral professionals, from psychiatry, psychology, counseling, social works, marriage and family therapy, substance use and behavior analysis.
What do you think is the future for how providers offer behavioral health services?
We are just seeing the tip of the iceberg. Within a decade, using technology in routine medical and behavioral care will be the norm. We will interact regularly with our smart phone, tablets and other mobile devices to not only communicate with each other and our treating clinicians and their staff, but also with ourselves. Many of us will be wearing sensors that communicate much more about ourselves than most people can imagine today.
Much of that information will be stripped of identifying elements, and fed up to large cloud-based systems that will give us (and those with whom we choose to share) regular feedback about how we are doing with respect to the goals we have set for ourselves; our physical and emotional states; how we are sleeping; the medication or supplements we take; the food we eat; the water we drink; our exercise; our interactions with others, etc.
What are the benefits of telemental health to patients?
The largest benefit is related to access. That is, access to practitioners, to information, to other people who share our interests and concerns about healthcare, to other resources that can help us.
What about the potential drawbacks for patients?
Patients can be easily misled by uninformed practitioners who haven’t taken the time and energy that is ethically mandated to learn what they should about technology before they offer it to their patients. For example, practitioners have made their services available through technology that does not meet federal requirements for privacy and security, leaving their patients vulnerable to hacking and other violations. These practitioners are unwittingly acting as if they know wheat they are doing, when they frankly, have been cavalier about technology.
What considerations should patients make when using telemental health providers versus more traditional mental health providers?
Just as it is wise to ask a surgeon how many surgeries they have performed of the specific type being recommended, it is wise to ask clinicians how many hours of formal legal and ethical training they have received before jumping aboard with any technology they recommend.
In today’s day and age, a clinician’s knowing how to turn on a video system is simply not enough. All responsible clinicians have taken several hours of legal and ethical professional training to know how to protect their patient’s privacy, security and other issues when working across distance with whatever they choose for technology. For instance, many clinicians are practicing over state lines without a license, leaving the patient vulnerable if they ever feel the need to file a malpractice complaint against the professional involved. Others readily sign on with “life coaches” who practice worldwide, but are completely unregulated, meaning they never have to prove their credentials to a government entity, and cannot be held to professional standards by any law.
Patients then, ought to thoroughly inquire about any clinician’s legal and ethical as well as technical training with regard to any technology they are directed to use.
Is telemental health typically covered by insurance? How can patients find providers that will be covered by insurance?
In many states, TMH is covered by insurance. Consumers can inquire with their insurance plans to find approved providers. Many will also find some online, but I would caution against approaching services that hire unwitting, uneducated licensed professionals to do things such as offer anonymous care, which is illegal when offered by licensed professionals because those professionals cannot engage in a number of mandated services. Another example where licensed professionals are asked by some online companies to engage in illegal activities is when they practice over state and national borders.
What advice can you offer patients on shopping for insurance that will cover telemental options?
This really isn’t complicated. Ask your insurer if they cover telemental health, and if not, ask if they are required to do so by state law. That ought to get an interesting answer … The majority of states do require coverage by insurers on par with in-person benefits for insurance carriers.
If you can’t get a straight answer, go to the American Telemedicine Association’s website and look for their “report card” of states and how well they are doing with telemental health.
What trends or innovations in healthcare are you following right now for how they’ll benefit patients?
- -Patient engagement tools
- -Video-based tools
- -Apps that are evidence-based (most are not)
- -Technology platforms that offer a wide range of educational and clinical services for specialized populations, such as seniors, drug and alcohol patients, minorities
What health insurance headlines are you following right now? Why?
We are tracking legislative news related to state adoption and dissemination of telemental health services. We also track grants that will help our colleagues get funded for specialized service development.
We also are keenly interested in how the professional licensing boards are beginning to address telemental health with their licensees. We regularly get asked to consult or deliver professional training in conjunction with these regulatory boards to help them understand the scientific literature, the emerging technology and how other boards are dealing with the challenges of practitioners who are not bothering to educate themselves before delivering technology-based care to the clients and patients they serve.
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