April 10, 2020
If you are coping with behavioral health problems, finding a good mental health clinician is essential to getting help. Finding the right help at the right time can be the difference between prolonged suffering and having practical skills to manage symptoms. Many fire service personnel seeking help are reluctant to see a clinician face-to-face. Others struggle to find appointment times between shifts and busy schedules.
For a growing number of healthcare services, telehealth is emerging as an excellent alternative to office-based care. Behavioral and mental health care services are no exception. During the COVID-19 global pandemic, telemental health services offer a unique opportunity to receive critical support while observing social distancing. If you are a fire fighter or emergency medical services professional and are considering telemental health services for yourself, someone else or as resource for your fire department or peer team, consider the following:
- What are telemental health services? Telemental health services are mental health services provided over the phone, a mobile app or an interactive website
- Why would I choose telemental health services over office-based services? Amidst the COVID-19 pandemic, telemental health services allow you to participate in counseling or psychotherapy while following social distancing guidelines. Some people prefer telemental health because it is more convenient and more private than driving to an office to receive services. Others are more comfortable discussing difficult topics over the phone or computer versus face-to-face. While telehealth services are typically best suited for clients who are psychiatrically stable with non-acute symptoms, providers are adapting to treat a broader range of patients via telehealth due to current social distancing guidelines and restrictions on hospital-based outpatient services. During your initial assessment, the clinician will advise you if telehealth services are appropriate for your needs or if you need a higher level of in-person care.
- How do I know if a mental health clinician is qualified to provide telehealth services? Prior to the COVID-19 outbreak, clinicians were required to be licensed in the state in which patients plan to participate. While this is still the case in some places, other states have temporarily relaxed restrictions to meet the current demand for providers. It is the clinician’s job – not yours – to verify with the respective state licensing board if he or she is permitted to provide telemental health services to you. Clinicians should have completed specific telemental health competency training that addresses unique ethical, logistical, clinical and privacy considerations of providing mental health services over the phone or internet.
- How do I know if my information will be kept private? Confidentiality is the cornerstone of counseling and psychotherapy. Licensed mental health clinicians are strictly required by federal law (Health Insurance Portability and Accountability Act – HIPAA) to keep your information private, except under rare exceptions due to imminent threats to safety. Prior to the COVID-19 outbreak, a mental health clinician providing services through a phone-based app or website was required to use a HIPAA-compliant platform that verifies the identity of both the clinician and the client. While HIPAA-compliant platforms remain best practice, the Department of Health and Human Services (DHHS) has temporarily relaxed this requirement while the United States remains in a state of public emergency.
- How can I find a telemental health clinician who understands the culture and daily operations of the fire service? Start by asking your crew or department if anyone has a family member who is a mental health clinician or if anyone has had a positive experience with a local mental health clinician and is willing to share the referral. When researching clinicians, directly ask, “Do you have experience working with fire fighters or other emergency responders, including EMS, police or military populations? Tell me about it.” If your peer team or department plans to maintain a long-term relationship with a clinician, ask if he or she is willing to participate in ride-alongs or a FIRE OPS 101 to get a better understanding of the fire service. While these types of activities may not be possible during the COVID-19 outbreak, cultural awareness training for your clinician is important to keep in mind for the future.
- How are telemental health services paid for? Many insurance companies cover office, clinic and hospital-based treatment of mental health and substance use disorders. However, since teletherapy is an emerging practice, don’t assume your insurance plan will cover it. Call the member services number on the back of your insurance card and ask if your provider covers teletherapy services. Next, ask your telemental health clinician if he/she accepts your insurance. While some clinicians who provide teletherapy do not accept insurance, many offer significantly discounted rates compared to office-based services.
- How can I determine if a telemental health clinician is qualified to treat post-traumatic stress disorder (PTSD), depression, anxiety and co-occurring substance use? Directly ask the clinician, “What evidence-based practices do you use to treat post-traumatic stress disorder, depression, anxiety and co-occurring substance use?” Research supports the efficacy of standardized, time-limited interventions to treat PTSD and other acute mental health problems. Ask the clinician if he/she typically assigns homework between sessions. Clinician-assigned homework between sessions not only maximizes session time but allows you to assume an active role in your recovery during the week. Lastly, be wary of clinicians who describe themselves as a generalist, eclectic or claim to treat everything.
- What can I expect from the first one or two telemental health appointments? Before or during your first appointment, you should receive a brief overview of the therapy process, sign consent forms and review how to use the telehealth platform. Then, an initial diagnostic assessment of your presenting concerns should begin. If a provider takes more than two sessions to conduct an initial assessment and construct a treatment plan, this may reflect a non-directive, open-ended approach to therapy that is generally not suited for someone coping with moderate-to-severe symptoms. After the assessment is completed in the first one or two visits, the therapy process should begin.
- What if I am in crisis and need to reach my clinician outside of our scheduled teletherapy appointment? How to reach your clinician in the event of crisis or emergency should be clearly addressed during your first session. The clinician may have an on-call number or crisis hotline or direct you to your local emergency room. For better coordination of care, your clinician may prefer you use a specific emergency room.
- Can my telemental health clinician prescribe medication if I need it? Psychiatric medication should only be prescribed by a psychiatrist or a physician’s assistant or nurse practitioner who is supervised by a psychiatrist. Ask your clinician for a psychiatrist referral or visit your primary care doctor for a referral. In communities with provider shortages, a primary care physician may prescribe psychiatric medication. Look for a prescriber who has prior experience working with first responders and is knowledgeable about medications that can impact clearance to work. Lastly, it is critical that your mental health clinician and prescriber coordinate your care
If you are interested in finding a telemental health provider, see page two of the IAFF Telemental Health Guide for a checklist of specific questions to ask the clinician during your first call.
The IAFF Is Here for You
The IAFF Center of Excellence for Behavioral Health Treatment and Recovery is a residential treatment center for IAFF members struggling with addiction, post-traumatic stress disorder (PTSD) and other co-occurring mental health problems. The Center remains open and willing to serve IAFF members while continuously adapting patient screening, contact precautions and isolation protocols as recommended by the Centers for Disease Control and Prevention (CDC). For the latest updates, behavioral health resources and IAFF guidelines for responding to COVID-19, visit www.iaff.org/coronavirus.
Lauren Kosc, M.A., LCPC is a behavioral health specialist, clinician and blog writer for the International Association of Fire Fighters.