Pros & Cons for Telepsych for PMHNP’s

the pros and cons of telepsych for PMHNPs

Why is TelePsych so Important for PMHNPs? Pros & Cons.

The benefits of telepsych are overall straightforward but sometimes people may continue to say it’s inadequate care due to not being “in-person”. In some circumstances, telepsych may be inappropriate but patients knows what they think is best and most of the time, patients don’t refuse mental health services regardless of the methods.

If the patient do becomes feel apprehensive, it’s primarily related to not feeling tech savvy. However, with educating and various approaches, telepsych will continue to provide and assist in delivering quality services. I’ve made the benefits simple because it’s mainly straightforward whereas the risks are a few of my own personal experiences:

A Few Pros of Telepsych 

  • Finances: tax deductions, saving the costs of driving, more affordable than a standard office.
  • Professional: networking/increasing collaboration due to convenience, advocacy, connection with the community, expanding technology, promotes autonomy. 
  • Practice: helpful especially in the winter months or difficult times, easier to expand to rural areas, and to those who have disabilities or an inability to drive.   
  • Mental Health Services: easier and quicker to diagnose/treat, comparable to in-person services at times, treatment is quicker and usually don’t have the backlogs as traditional clinics.
  • Clients: increases privacy and reduces the stigma, flexibility with scheduling, reduces anxiety with patients being able to stay in the comfort of their own environment, easier to adjust medication changes instead of waiting weeks-months.

Some Cons & Risks of Telepsych

  • Everyone does not have the right personality: if the provider does not have an outgoing, motivating demeanor or does not believe in telemedicine, then the client may also adapt that attitude. If the patient already feel apprehensive and vulnerable then not having the right temperament can make the situation worse. If the NP does not feel comfortable, neither would the patient. 
  • Not knowing local information: there are times when you need to know local information about the patient such as the weather, news, or events. For example, there could be a storm that may affect internet connections. I had a patient who was very anxious that he couldn’t leave the house because of the Covid-19 restrictions and suggested he may get arrested if he broke the curfew. Whether it’s true or not, it made me think about how local information may affect the patient’s mood and way of life. Like the weather, technology and events can be unpredictable and could be a factor in telepsych visits. 
  • The patient is unknowingly psychotic: I think we’ve all been in situations when you thought the patient sounded okay until he starts telling you about the time they got abducted by aliens… The patient was alertx3, nicely groomed, and was in college. I simply asked about the first hospitalization and that’s when everything got extra colorful. An actively psychotic patient does not qualify for telepsych but those symptoms need to be ruled out and sometimes it’s not so obvious. 
  • Seeing is believing: when a patient is doing better, sometimes the provider wants to see the proof or confirm how effective the treatment is going…NOT with telepsych. Sometimes the visuals are unavailable or simply consist of a phone call, which is okay. If the patient is motivated and has their faculties, you can still provide treatment. You can also use screening tools and rating systems to provide more accuracy. The main point is to continue aiming for realistic goals, improving their mental well-being and charting as much as you can to provide that proof.   
  • You need a break from the house: working from home is self-explanatory but sometimes you get more than you bargain for… Your home should be a place for refuge and peace and sometimes the telepsych conversations can get graphic. For example, if someone is detailing a traumatic incident, it can become triggering and difficult to remain objective. To be frank, sometimes I will head to an office because I don’t always want to think about other people problems at home. I read somewhere that people will schedule difficult clients on a Friday, instead of a Monday to have a better week yet that’s not always possible. I personally just try to set boundaries but if it’s still overwhelming, leaving the house, doing some stress management and decompressing becomes very essential.

Lastly, the most important way to minimize harm is to keep learning and staying updated with practice. Another issue is how a lot of facilities are new to telepsych as well, and may be winging it. It’s okay. Rule out the major red flags, maintain safe practices/standards, and document (just like you would in a clinic).

American Telemedicine (ATA) have some case studies about how other places practice telemedicine. The RAND corporation has many articles focused on telepsych as well. American Medical Association (AMA) provides some insight on how to limit risks by using a client who has harmed himself (a fictional case study):

How to Mitigate Limitations 

Current research shows that telepsychiatry offers a viable alternative to in-person mental health care, one that expands access to care and improves outcomes. Potential limitations of telepsychiatry can be mitigated by adherence to ATA guidelines and the employment of a collaborative approach, particularly one involving the patient’s primary care physician. We offer the following specific recommendations:

  • Telepsychiatry professionals must ensure that the standard of care delivered via telemedicine is equivalent to any other type of care that can be delivered to the client and should follow the ATA guidelines.
  • Active collaboration with primary care physicians is strongly recommended.
  • All practitioners should make themselves familiar with the services and resources nearest to the patient.
  • Where there are safety issues, telepsychiatry visits should be arranged, if possible, at the patient’s primary care clinic. If this is not possible or practical, a “patient support person” should be designated close to the patient for assistance in the case of emergencies.

–AMA

Additional Links 

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