Tag Archives: Mental Health

Interdisciplinary Collaboration in Rural Mental Health

by Deborah Meyer

This module was developed by Deborah Meyer, Ph.D., RN, College of Osteopathic Medicine. The course, however, was developed and is team taught by faculty from several disciplines. They are: Kathleen Rose-Grippa, PhD, RN, Nursing; Karen Carlsen, Ph.D., Department of Social Work; Jane Hamel-Lambert, PhD, MBA, clinical psychologist, College of Osteopathic Medicine.

Course Overview:

This is a Tier III course, “Interdisciplinary Collaboration in Rural Mental Health.” The course combines lectures, team projects, problem-based learning, readings, and observation of interprofessional teams. The course objectives are:

1.     enhance interdisciplinary team skills,

2.     employ technology as a tool for mental health practitioners, and

3.     enhance student understanding of Appalachian culture and rural mental health.

This module occurs near the end of the quarter after students have covered team development, professional roles, culture, mental health issues in rural areas, and ethical theory as it relates to mental health practice including:

  1. Professional beneficence: defining one’s professional duties, the extent of the duty to care, duty of non-abandonment of patients in need.
  2. Professional autonomy: defining the limits of acceding to a patient’s wishes.
  3. Principle of justice: is anything useful being achieved in the relationship? Is the  relationship therapeutic?
  4. Patient autonomy: the right to choose a physician, the extent of the right to define the nature of the relationship.
  5. Confidentiality and privacy.

This module expands on the theoretical framework by applying the concepts to technology-mediated health care (telehealth, telecounseling, etc.).

Module Overview:

The growing use of  technologies in the delivery of health care services has led to far-ranging discussions concerning their uses and potential roles in the health care system. Although these technologies can improve access, they can also lead to a number ethical concerns. This 2-hour module addresses those concerns using both lecture and case-based methods.

Learning Outcomes:

?    Students will apply professional ethical guidelines a technology-mediated scenario;

?   Students will discuss teleheheath guidelines found in the literature and apply them to various technology-mediated scenarios;

?   Students will apply ethical theories learned in an earlier class to a scenario where there is technology-mediated health care;

?   Students will discuss situations in which the use of technology is appropriate and those in which it is inappropriate?


A 21 year old male with schizophrenia, who resides in the rural town of 2,400 where he grew, would like to join a support group, but has had trouble finding one. He did attend a meeting at a local church that included other individuals with a wide range of disorders, but was uncomfortable when he realized that he knew two of them: one was two years ahead of him and high school and had dated his sister; the other was a local dentist that worked on his teeth several years ago. He refuses to return.

You find an online support group that is just for individuals dealing with schizophrenia. He was reluctant at first because he had delusions that electronic appliances were implanting messages into his brain and he now avoids electronic devices. Also, your supervisor, who doesn’t use email, is opposed. She says that the clinic does not have policies in place to deal with those types of support groups and that you should stick with “what you know”. Yet, you believe that he would really benefit. You move ahead with investigating the various groups online.

1.     What ethical issues are involved?

2.     What other issues should you consider?

You have a choice of two online support groups. One is a text-based asynchronous group that does not have a facilitator/therapist running the group. The other uses CUCMe technology and is facilitated by a therapist in another state. He seems more comfortable with the idea of using the CUCMe because he can type well. You have found funds to purchase the necessary equipment and proudly hand him the check to cover the costs. You see him about a month after he joins the online support group and ask him how it is going. He says fine except that his 12 and 16 year old siblings keep coming into the room and listening in to the meetings.

1.     What ethical issues are involved?

2.     How would the issues differ if his only access is a public library?

Now that he has become comfortable with using the internet for support groups, he also wants to begin using email to contact you between sessions.

1.     What issues are involved? Ethical? Legal?

2.     What can you do ahead of time to minimize these?

3.     What other issues would arise if you were a counselor who was out of state using email to work with an established client? A new client?

4.     What if you could also use video conferencing to “meet”?

Six months after you begin using email with him you notice that he is beginning to skip his appointments. When you ask him why, he states that he can keep in touch just fine with you via email. His writing, however, has become more disorganized and incoherent and you are concerned that he has quit taking his medications. The last time he was off his medications he was admitted to the psychiatric hospital after threatening a neighbor with a machete. At his last session, he complained about this same neighbor, saying that the neighbor played loud music that bothered him when he was trying to relax.

1.     What issues are involved? Ethical? Legal?

2.     What ethical duties are involved?

Additional Discussion Questions:

?   What ethical issues arise in technology-mediated health care that don’t exist in face-to-face?

?   Why is privacy and confidentiality important?

?   What constitutes privacy?

?   When does harm occur?

?   Why is privacy and confidentiality important?

?   What stigma and privacy are issues in a rural areas, might technology-mediated counseling actually provide greater privacy?

?   What do you do when clients/patients come in with information found on the internet and demand specific treatment or medication?

?   Should you have a list of websites that you provide clients/patients?

?   Who should determine the guidelines and rules? Federal government? State governments? Professional Boards? Citizen groups? International boards?

?   Use with individuals with disabilities.


?   The Practice of Internet Counseling: National Board for Certified Counselors, Inc.http://www.nbcc.org/ethics/webethics.htm

?   Ecode of Health Ethics: http://www.ihealthcoalition.org/ethics/ehealthcode0524.html

?   Clinical Applications of Telehealth in Mental Health Care, Hudnall Stamm, December 1998 Vol. 29, No. 6, 536-542:http://www.apa.org/journals/pro/pro296536.html

?   Loane M. & Wootton R. (2002). “A review of guidelines and standards for telemedicine.” Journal of Telemedicine and Telecare8: 63ń71.

?   Collste G. (2002). “The internet doctor and medical ethics. Ethical implications of the introduction of the Internet into medical encounters.” Med Health Care Philosophy; 5 (2), pp. 121-125.

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