Our New Experts in Telemental Health

Amber Eckert, Vice President of Student Affairs, Alliant International University

During our University’s recent commencement ceremony one of our student speakers, a doctoral graduate in Clinical Psychology, remarked that she became an immediate expert in the once obscure specialty of delivering services via Telemental Health.  That remark stuck with me as I shook the hands (or fist bumped, pandemic style) of our hundreds of graduates.  Over the last two years, we have witnessed one of the largest industrial retooling efforts since WWII, when our assembly plants converted overnight to war production.  The entire outpatient mental health system along with dozens of other medical specialties went almost exclusively to Telemental Health over the course of a weekend in March 2020.  In addition to being an educator, I am also a practitioner and turned my school-based mental health practice over to telehealth along with everyone else. 

What struck me about the speaker’s comment most was that while I—a licensed psychologist for 20 years— adapted , albeit clumsily at times, to doing what I was trained to do in a different modality, my students and a generation of clinical practitioners over the past two years were trained exclusively in this Telemental Health modality.  We have embarked on a vast international experiment in which mental health practitioners have learned to assess, diagnose, and deliver therapy interventions to their clients remotely.  Those students, now graduates, have now had to learn to adapt to live, in-person clients and they, like me, will do so; but the larger question is how do we harness their familiarity, skill and willingness to deliver services by Telemental Health to help address the mental health crisis that grips us worldwide?  Surely, we cannot simply revert to training mental health professionals to treat people almost exclusively in-person, in clinics with all of the attendant barriers to accessibility including transportation, child-care, fixed hours, etc.? 

While the global transition to Telemental Health was unplanned, the transition to a new hybrid delivery model can be planned carefully and is already well underway in many sectors.  I posit that the unique cohort of pandemic-trained-clinicians must be instrumental in this development.  I believe that there are five key questions administrators, researchers, policymakers, and educators should ask ourselves and this cohort of pandemic-trained clinicians.

​1. What technology do you wish you had?

We mostly relied on various video conferencing platforms during the pandemic. None designed from the ground up for mental health treatment and certainly not for activities like psychological assessment, play therapy, or other uniquely interactive processes.  Our trained students will have lots of ideas of what types of audio/visual technology would have helped them learn these practices and, by extension, will be useful to practicing clinicians who wish to deliver a range of services remotely other than simple face-to-face talk therapy.

"While the global transition to Telemental Health was unplanned, the transition to a new hybrid delivery model can be planned carefully and is already well underway in many sectors"

2. How did you learn to manage privacy for both you and your clients?

Telemental Health allows for incredible flexibility in delivering services at convenient locations.As a clinician, I was pleased that in my school-based clinic, where I had always been limited to seeing my clients who actually came to school, I was able to see my frequently truant teens much more frequently because they could connect from wherever they were. But this led to the tricky prospect of attending to their privacy during the therapy session.Were they alone in a room with a door, at the kitchen table, at a coffee shop?I had to learn to assess for privacy, session by session.Our students who learned remote modalities exclusively not only had to manage their client’s privacy but also their own, these same circumstances applied to them.We need to incorporate their experiences into our assessment of privacy.

3. What clinical skills did you develop in Telemental Health without being taught?

Most training programs had few, if any, Telemental Health experts in the Spring of 2020. While we all went online simultaneously, few were prepared.  Our experience has been that our newly graduated clinicians are highly competent practitioners, they have passed our exams and completed their training rotations with flying colors. This means they learned to adapt what we were teaching them from our “in person” perspective to a remote perspective. They must surely have learned from experience what we couldn’t teach them and are likely to have great insight into some of the nuance of their clinical work. “How do you manage to note the body language of one family member in a session while the other is talking?” “How do you assess sobriety in your frequently relapsing substance use disorder client via camera?”  There are countless therapeutic techniques that we take for granted that we need to learn to teach for Telemental Health.  

​​​​​4. What is the difference?

I mentioned earlier that we are in the midst of a worldwide natural experiment.We had a two-year period of training most mental health practitioners almost exclusively by remote Telemental Health.There are various cohorts in this experiment.Those who spent their entire two years of clinical training remotely and those who spent one year of clinical training, either first or last in clinical training straddling the pandemic.We, of course, have the just pre-pandemic and just post-pandemic cohorts who are adjacent.We should be enlisting these groups in large studies of clinical proficiency, job satisfaction, attitudes, and cognitive approaches to mental health treatment and I am certain that my academic colleagues are planning, undertaking, or even analyzing results of these studies.Each individual also has a natural experiment underway and will be reflecting on their own insights of what was different when they went from exclusive Telemental Health training to on-ground practice.What were the gaps in their training?What did they have to learn anew?

5. How would you propose we teach Telemental Health going forward?

While this is not an exhaustive list of questions, I believe that if we harness the experience of those we trained during the pandemic to be qualified, competent, and compassionate mental health professionals we can develop training programs of the future that both harness the technology of Telemental Health but also provide an excellent user experience, capture the nuance of remote clinical practice, and prepare students for a career where physical access to services are no longer a barrier.  I look forward to learning from these new experts.

Cognitive