If you’ve ever spoken to a counseller over the phone, had a video conference with your GP, or received prescriptions online, you’ve participated in telehealth.
Telehealth is the use of digital technology for remote healthcare consultations and treatment. It is a relatively new phenomenon and an excellent way to connect with a health professional when an in-person appointment isn’t possible or necessary.
But does it have a role to play in mental health? Can it be useful for young people in a psychological setting?
This is a question the team at our Sydney-based mental health clinic get asked a lot, and here is our view on the role of telehealth in child and adolescent psychiatric care.
The history of telehealth in Australia
While radio and television have helped bring medical advice to rural households since the early 20th century, it’s only over the last couple of decades that telehealth has become widespread.
In Australia, telehealth has been on the rise since the 1990s, and what was initially aimed at remote communities has now spread to urban centres like Sydney, Melbourne, and Brisbane. In 2011, the Australian government’s new Medicare Benefits Schedule (MBS) included funding for access to doctors and specialists via videoconferencing.
The COVID-19 pandemic has seen the use of telehealth explode over the past few years, with patients and doctors both finding ways to work within the limitations of lockdowns, long wait times, and staff shortages.
The benefits of telehealth are far-reaching
As we come through the other side of the pandemic, telehealth clearly isn’t going anywhere. Patients have discovered there are many benefits to virtual healthcare, including…
Accessible healthcare
If you are unable to see your doctor, psychologist, or other health professional, telehealth can be hugely helpful.
When you are unwell with an infectious illness, telehealth lets you speak to a doctor without risking exposure to other patients. If you live remotely, you can access a routine appointment that you might otherwise put off. When you have a sick child, it offers you medical advice without leaving the house.
Convenience
For many of us in Sydney, life moves at a breakneck pace and taking time out of your busy day to sit in traffic on either side of your appointment can be off-putting. The result is that your health appointments might never reach the top of your priority list.
With telehealth, an appointment is quick and easy, and this convenience allows you to finally put your health first.
Privacy
If you feel nervous about an appointment or are discussing a sensitive topic, speaking to your doctor over the phone can be less embarrassing or anxiety-provoking than a face-to-face session. You can access telehealth appointments from the comfort of your own home, which offers an extra layer of confidentiality and privacy.
And any scripts you receive are safely encrypted, which can feel more secure than a hardcopy being kept in a physical location.
The trouble with telehealth in child psychiatry
While telehealth plays a valuable role in modern healthcare, in some settings it is far from ideal – and child psychiatry leads the pack when it comes to consultations that should be experienced in person.
Here’s why child and adolescent psychiatry and psychology appointments are not good candidates for telehealth.
Engaging sessions happen in person
Have you ever spoken to someone over a screen and noticed their eyes drift off to the side? Frustrating, right? You don’t know what they’re looking at, but you know they’ve lost interest.
Now, imagine this tell-tale sign of disengagement happens in the middle of a psychiatric appointment. More than frustrating, it’s ineffective. It’s a loss of progress. A waste of money.
A big part of the success of child psychiatry or child psychology is the relationship between therapist and patient. If you have children, you know how important physical closeness is to their relationships. It’s essential to creating and maintaining a connection, especially when delving into the complicated world of feelings, emotions, and behaviour.
Observing a child for assessment and diagnosis
Psychiatric and psychological treatment begins with a comprehensive assessment, and when it comes to children, physical examinations and in-person observations are needed to make accurate diagnoses. This simply can’t be done to the same extent over a video call.
From eye-contact to body language to facial expressions, a lot of subtle cues will be missed when an educational psychologist or child psychiatrist isn’t in the same room as the child they are assessing.
Slow internet connections are disruptive
When child psychiatrists or psychologists connect with their patients digitally, they have no control over internet speed, technical issues, and dropped calls. Lags are disruptive to the therapeutic space, leading to less effective treatment and care.
In child, adolescent, and perinatal psychiatry or psychology, therapists are trained to evaluate both verbal and non-verbal behaviour during an appointment. A stalled or blurry internet connection can mean important signs of distress get missed, leading to poorer outcomes for vulnerable patients.
Confidentiality concerns
While confidentiality can be heightened for some adult psychiatry or psychology appointments, it is quite the opposite for children. In face-to-face sessions, children can speak openly and honestly, without worrying about being overheard by a parent, sibling, or caregiver.
When these sessions are conducted virtually, the child does not get the same promise of privacy, and when a young person doesn’t feel they are in a safe space, they won’t open up.
Blurry boundaries
Boundaries within the psychiatry or psychology clinic play an important role in building the relationship between a child and their therapist. Creating boundaries leads to trust and respect, which leads to improved communication and better therapeutic outcomes.
On a telehealth appointment, these boundaries are not established, and the results of treatment are not as robust.
A hybrid approach to telehealth in child and adolescent psychiatry
Despite the drawbacks, there is a role for telehealth in child and adolescent psychiatry and psychology in Australia.
We know that in times of crisis – like we saw with the COVID-19 pandemic – telehealth plays an invaluable role keeping vulnerable patients connected to their healthcare providers. The accessibility that it offers cannot be underestimated – it provides mental healthcare to people who would otherwise have none.
But video appointments are not a replacement for face-to-face consultations when it comes to child and adolescent psychiatry or psychology. That’s why even during the COVID-19 pandemic our clinic has always been open for face-to-face consultations.
Going forward, we need a hybrid model of care where in-person appointments are upheld at the gold standard of care, with telehealth offering complementary care, available when necessary and appropriate.
How we use telehealth at Dolphin Tribe
At Dolphin Tribe, we are more than happy to work with adult patients via telehealth, but for children and adolescents, we will take it on a case-by-case basis, always encouraging in-person consultations as the preferred method.
When we do use telehealth, we use state of the art secure technology for video consultations, secure messaging, and eScripts for safe delivery of prescriptions.
If you have questions about how telehealth can play a role in your care or the care of your child, contact us today.
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