Digital technology has transformed the delivery of mental health services worldwide. Behavioural health professionals now have the option to provide remote and “distance” counselling services using a wide range of online tools, smartphone applications, video technology, and other technological innovations. This disruptive technology has enhanced consumers’ access to services. Yet, these impressive developments have ushered in a challenging array of ethical and risk-management challenges.
Since time immemorial, people have struggled with mental health challenges. Although formal diagnostic labels and nomenclature are of more recent origin, historical records are replete with accounts of what we now regard as major mental illness. The term psychosis is derived from the Greek psyche, meaning “soul,” “mind,” or “breath”. The ancient Greeks believed that breath was the animating force of life and that when it left the body, as happened in death, the soul left the body. A common belief in antiquity was that mental illness was bestowed by the gods. Many people sought cures via magical and religious rituals, including spending a night in a temple of the healing god Asclepius. Many historians believe that Socrates manifested symptoms of auditory hallucinations. Back then, the ancient Greek doctors did not have terms for what we now call schizophrenia.1
The concept of mental health counselling dates back to the nineteenth century, when the professions of psychiatry, psychology, and social work – what have become the principal behavioural health professions – were inaugurated. Since these professions’ creation, people who struggled with debilitating depression, anxiety, relationship conflict, addiction, and other mental health challenges typically have received in-person counselling and other assistance in inpatient psychiatric facilities and outpatient clinics or private offices. For more than a century, mental health counselling has entailed an essential feature: the client and behavioural health practitioner sit in a private room and engage in confidential discussions. For most, these services have been paid for by clients’ health insurers under their policies’ coverage or government-sponsored programmes. Some clients have chosen to pay for services out of pocket.
Fast forward. Today, many people who seek mental health counselling regard such face-to-face counselling sessions in brick-and-mortar clinics and offices as decidedly quaint. As with so many other areas of contemporary life, digital and other electronic technology has been transformative – and disruptive.
The Shifting Clinical and Ethical Landscape – Or “Webscape”
Behavioural health professionals’ use of digital and other technology to provide distance counselling services is proliferating.2 Increasing numbers of contemporary practitioners are using video counselling, email chat, social networking websites, text messaging (SMS), smartphone apps, avatar-based websites, self-guided web-based interventions, and other technology to provide clinical services to clients, some of whom they never meet in person. Digital technology has created unprecedented options for the delivery of mental health services. Increasing numbers of clinicians are relying fully or partially on various forms of digital and other technological options to serve people who are struggling with a wide range of mental health challenges. Clinical practice is no longer limited to office-based, in-person meetings with clients.
Some practitioners are using digital technology informally as a supplement to traditional face-to-face service delivery. Others have created formal “distance” clinical practices that depend entirely on digital technology. In addition, practitioners’ routine use of digital technology – especially social media and text (SMS) messaging – in their daily lives has created new ways to interact and communicate with clients.
About the Author
Frederic G. Reamer, Ph.D is Professor at the School of Social Work, Rhode Island College. He is the author of many books and articles on Professional Ethics, including Risk Management in Social Work: Preventing Professional Malpractice, Liability, and Disciplinary Action (New York: Columbia University Press). Reamer Chaired the National Task Force that wrote the Code of Ethics adopted by the National Association of Social Workers.
1. Harris, W.V., ed. (2013). Mental disorders in the classical world. Leiden, Netherlands: Brill.
2. Gupta, A. , & Agrawal, A. (2012). Internet counselling and psychological services. Social Science International, 28, 105-122; Zur, O. (2012). TelePsychology or TeleMentalHealth in the digital age: The future is here. California Psychologist, 45, 13-15.
3. Lamendola, W. (2010). Social work and social presence in an online world. Journal of Technology in the Human Services, 28, 108-119; Lannin, D.G., & Scott, N.A. (2013). Social networking ethics: Developing best practices for the new small world. Professional Psychology: Research and Practice, 44, 135-141.
4. Reamer, F.G. (2015). Clinical social work in a digital environment: Ethical and risk-management challenges. Clinical Social Work Journal, 43, 120-132.
5. See, for example, Association of Social Work Boards (2015). Model regulatory standards for technology and social work practice. Culpeper, VA: Author; Joint Task Force for the Development of Telepsychology Guidelines for Psychologists (2013). Guidelines for the practice of telepsychology. American Psychologist, 68. 791-800.