The potential of digital, mobile, and connected technologies to advance mental health, and especially psychiatric rehabilitation, continues to rapidly evolve. An increasing number of people are relying on the internet to obtain health related information. Many of these individuals use social media – such as blogs, social networks sites, micro blogs and content communities – particularly to access mental health information. In addition, mental health providers are increasingly depending on the internet to give information to patients, to seek advice about patients, communicate with colleagues and to provide mental health counseling and treatment. Connecting with a therapist online only is often referred to as online counseling, online therapy, e-therapy, web counseling, and cyber therapy. According to a journal published on the US National Library of Medicine National Institutes of Health, “the use of information and communications technology, especially the Internet, to improve or enable health and health care is defined as eHealth.
Considerations for using Online Counseling
In spite of the enormous opportunities presented by eHealth; there are significant ethical and legal concerns associated with the use of internet and social media in mental health practice. Ethical issues related to lack of warning to the patient of the risks and limitations in the use of online counseling, potential breaches of confidentiality, and limited capacity to manage crisis interventions and emergencies. Legal issues arise when a social worker is practicing via internet in a jurisdiction in which he or she is not licensed. In this aspect, a PubMed publication acknowledged that the use of technology is neither a cure nor a replacement for personal care. An article published by Revista Romaneasca Pentru Educatie Multidimensionala emphasized that online counseling can be used effectively with individuals seeking continuous care, personal growth and fulfillment. Then again, crisis interventions should not be treated online; these include situations involving suicide ideation, disordered thinking, and borderline personality disorder. Furthermore, an additional PubMed research stated that another matter of concern is the risk of rapid response expectations from the patient. It was found that those patients had high expectations in terms of response time to messages and expressed their fears about not being able to get help when needed, especially in situation where patients may wish to indicate thoughts of imminent desire for self-harm or even suicide attempts.
The WHO Global eHealth Evaluation Meeting’s Call to Action consensus statement declared that ‘to improve health and reduce health inequalities, rigorous evaluation of eHealth is necessary to generate evidence and promote the appropriate integration and use of technologies’. According to an Epidemiology and Psychiatric Sciences journal, the enthusiasm for mental health reform in the social media era must be driven and guided by evidence. This will reduce the risk of commercialization and marketing of interventions that have not been validated. In a Journal of Medical Internet Research, the authors also stated that the eHealth field needs to create standards that not only meet such requirements, but provide the highest standards of health and mental health intervention as well. Useful standards that have a high applicability to the challenges of eHealth and e-mental health interventions can only be created through collaborative exploration and debate by those involved in the provision of these programs. Moreover, future research must explore these opportunities to support and empower people with serious mental health disorders through online counseling while carefully considering potential risks that may arise. A significant challenge will be to conclude whether skills learned or help received from online counseling translate into concrete and consequential enhancement in the recovery of the individuals in need of these services.
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