Remote Mental Healthcare Facing Ethical, Legal Pushback
March 1, 2023 2 minutes read
Remote mental health assessments “can be very effective, and can increase access to care,” says John Torous, MD, MBI, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston.
However, there are multiple ethical considerations regarding mental health evaluations conducted via telehealth. “Who’s on the other end of the screen? Often times, it is not a licensed or qualified clinician,” Torous notes.
Patients might assume they are talking with a licensed therapist, but it actually is an unlicensed therapist or a mental health coach. That is a clear ethical violation, Torous warns.
Another concern is the fragmentation of mental healthcare that happens when someone engages with digital mental healthcare services. “That happens when telehealth providers do not coordinate with the patient’s medical team or share records and information with the primary care team,” Torous explains.
It is ethically problematic if patients are directed to remote or self-help programs instead of receiving in-person access to a trained clinician. “This is 'gating' access to care. For example, some employee mental health programs first force a patient to use such a program before being able to meet [a professional in person],” Torous says.
There are some pending developments on the legal and regulatory fronts that will affect the future of remote mental healthcare. In 2022, the federal government sued a digital mental health company, which has faced questions about its practices for prescribing medications used to treat attention deficit hyperactivity disorder for possible violations of The Controlled Substances Act.1 “While there is much we still do not know, there are allegations of inappropriate and unsafe prescriptions,” Torous notes.
On May 11, 2023, the Ryan Haight Act, which requires at least one in-person evaluation before a provider can prescribe a controlled substance through telehealth, will go back into effect.2 “The era of online prescribing without any in-person visit will come to an end — for now, at least,” Torous adds.
REFERENCES
1. Winkler R, Safdar R. Mental-health startup Cerebral investigated by FTC. The Wall Street Journal. June 14, 2022.
2. New York Office of Mental Health. Informational bulletin from OMH chief medical officer. Prescription of controlled substances after the federal public health emergency for COVID-19.
Patients might assume they are talking with a licensed therapist, when they actually are speaking with an unlicensed therapist or a mental health coach. That is an ethical violation.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content