The multiple terms for telemental health can be confusing, especially when different professional groups use them in different ways. Mental health practitioners who provide traditional psychotherapy are required to have professional licenses regardless of the discipline. However, it is important for clinicians to know that state licensing boards use different terms for telemental health depending on the state. Ostrowski and Collins (2016) conducted a national survey of licensing boards and discovered that individual state boards use additional terms for telemental health services. These unique terms include d istance counseling, distance therapy, electronic-assisted counseling, electronic means, electronic practice, electronic telepractice, electronic transmission, Internet practice, online psychotherapy, remote psychotherapy, technology- assisted therapy, teleconferencing, telehealth, telepractice, and teletherapy. The plethora of terms used to refer to this specialized delivery of mental health services reflects emerging innovations in the field. In a telemental health setting, the practitioner located in the agency, also called the distant site, meets with a client who is at another site, called the originating site. The originating site, where the client is located, can be at another agency, at a different organization, or even at home. Although telemental health services have been used for quite some time (such as over the telephone), technological advances now allow providers to offer services in innovative ways and in a variety of settings (Lambert et al., 2016; Luxton, Pruitt, et al., 2016). Video capability allows practitioners to provide services in academic environments, medical centers, community mental health centers, acute care hospitals, private telehealth offices and healthcare centers, and rural healthcare centers (Lambert et al., 2016). In a survey of 150 telemental health programs, agency administrators reported that telemental health services were used in a multitude of ways (Lambert et al., 2016). The most common uses of telemental health services were as follows: Direct patient care (94%), consultation between providers (72%), case management and coordination (46%), staff supervision (36%), and quality assurance activities (32%). Direct patient services included medication management (82%), initial diagnostic evaluations (80%), psychotherapy (62%), crisis stabilization (44%), involuntary commitment assessment (28%), substance use treatment (26%), and crisis management (26%). Telemental health utilization has expanded since the COVID-19 pandemic began, growing from 17% of providers to 40% providing this service. Clients being assisted remotely grew from 9.1% prepandemic to 57.7% during the pandemic, with psychotherapists as well as all mental health practitioners in rural regions and those
working with out-of-pocket clients expecting high levels of telemental health to continue (Zhu et al., 2021). Clinicians provide telemental health services across a range of patient settings, including veteran and other military settings, mental health facilities, community health centers, primary care, emergency departments and acute care hospitals, specialized medical centers, primary and postsecondary schools, outpatient and inpatient settings, nursing homes, churches, and correctional facilities (Lauckner & Whitten, 2016; Lustgarten, 2017; Luxton, Nelson, & Maheu, 2016). Within these settings. they provide services to a wide array of consumers, including children, adults, couples, families, groups, veterans, military personnel, incarcerated individuals, people with chronic mental illness, individuals with disabilities, and senior citizens (Crowe, 2017a; Crowe et al., 2016; Lauckner & Whitten, 2016; Luxton, Pruitt, et al., 2016). Types of services vary as well. Using telemental health technology, clinicians can provide diagnostic sessions; individual, group, marital, and family therapy; assessment; case management; and psychoeducation (Lustgarten, 2017; Luxton, Nelson, & Maheu, 2016). The popularity of telemental health services has extended from individual practitioners to broader systems, including statewide use. Due to a short age of therapists, many school districts are having a difficult time finding therapists in their regions to provide services to students. A Baltimore- based teletherapy agency hired experienced therapists to provide clinical services remotely using a videoconferencing platform. The agency hires speech and language pathologists, mental health clinicians, and occupational therapists to address the unmet needs of students in the school sy stem (Goode, 2017). --------------------------------------------------------------------- A Minnesota-based community health center now offers a telemental health program that allows clients to have therapy in their homes. Many of its clients live in rural areas where transportation is lacking. The telemental health program helps to reduce the stigma of seeking mental health services by allowing people to have therapy at home. Clients for home- based therapy must be assessed to make sure that it is safe for them to receive therapy from home. In addition, they are required to have a private device, such as a computer or smartphone, that can access the Internet and is capable of video chat (Cummiskey, 2017).
EMERGING TELEMENTAL HEALTH PRACTICES
The emergence of telemental health practices is due to a variety of factors, including technological advancements and emerging applications. The remote provision of behavioral health care is a direct response to a shortage of mental health practitioners across the U.S. (Lustgarten, 2017; Luxton, Nelson, & Maheu, 2016; Luxton, Pruitt, et al., 2016 ; Ostrowski & Collins, 2016). The advantages of telemental health services are as follows: They improve access to healthcare, especially in rural settings where there is limited access; they are convenient for clients to use; and they offer flexibility in where, how often, and in what setting services are provided. There are potential cost savings for clients as well because the technologies used to provide services require less cost in transportation and time away from work (Luxton, Nelson, & Maheu, 2016; Luxton, Pruitt, et al., 2016). Telemental health services allow clinicians to easily connect with clients without required office visits. This can be
especially helpful for those who live in geographic areas where services are sparse; those who struggle with physical health restrictions; those who have particular behavioral health diagnoses that may inhibit them from using services, such as panic disorders, agoraphobia, and other anxiety disorders; and those who require specialist providers, such as those who are deaf (Crowe, 2017a; National Institute of Mental Health [NIMH] Advisory Board, 2017; Ostrowski & Collins, 2016). Further, telemental health services help to reduce barriers to access, such as the long distances that are required for clients who live in rural areas to travel to receive services. Clients who use telemental health services can also avoid the stigma that may be associated with going to mental health clinics (Lambert et al., 2016; Lustgarten, 2017; Luxton, Pruitt, et al., 2016). Telemental health can also be used to treat a disorder that may have symptoms or triggers associated with going to a specific clinic.
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