Legal and Ethical Challenges in Telepsychiatry

Abstract

Telepsychiatry in the 21st century poses a wide range of legal and ethical challenges. The authors review issues related to licensure, credentialing, privacy, security, confidentiality, informed consent, and professional liability in the use of telepsychiatry services and illustrate the discussion with hypothetical clinical vignettes. It is clear that there will be a need in the immediate future to create legal instruments as well as formal professional ethical guidelines for the practice of telepsychiatry.

Forensic Assessment via Videoconferencing: Issues and Practice Considerations

“…While privacy relates to the client's control of disclosure of personal information (Hyler & Gangure, 2004), confidentiality on the other hand requires the forensic practitioner to protect a client's privacy (Knapp & VandeCreek, 2006). As technology advances, the risk imposed by these same technologies in maintaining privacy and confidentiality during assessment also increases.…”

“…Interstate, intercountry, or cross-border assessment using VC can also be maximized provided alternative licensure arrangements could be made. To illustrate, by adopting a licensure by reciprocity system, licensing authorities in different states or countries could enter agreements to recognize licenses issued by each authoritative body, while licensure by mutual recognition system enables different licensing authorities to enter an agreement to legally accept each other's policies and processes (Hyler & Gangure, 2004). Other potentially viable licensing agreements include license by endorsement system, license by registration, and limited licensure system (see Hyler & Gangure, 2004, for further discussions).…”

“…To illustrate, by adopting a licensure by reciprocity system, licensing authorities in different states or countries could enter agreements to recognize licenses issued by each authoritative body, while licensure by mutual recognition system enables different licensing authorities to enter an agreement to legally accept each other's policies and processes (Hyler & Gangure, 2004). Other potentially viable licensing agreements include license by endorsement system, license by registration, and limited licensure system (see Hyler & Gangure, 2004, for further discussions). In countries (e.g., United Kingdom) where the practice of psychology is regulated by a single regulatory body, making it easier for practitioners to provide their expertise everywhere in the country, licensure issues are generally not a problem Miller et al, 2005;Saleem et al, 2008).…”

Forensic telepsychiatry in the United Kingdom

“…The scenario of a doctor potentially having to be credentialed and licensed in two different states, if the doctor and the patient are in different parts of the country (Hayler & Gangure, 2004) does not arise within the United Kingdom. This is because physicians' practice throughout the U.K. is regulated by a single body, the General Medical Council (GMC).…”

Telepsychiatry in Juvenile Justice Settings

“…12,13 Courts have consistently held that youths held in correctional facilities have the right to assessment and treatment, yet the degree of mental health care sufficient to meet legal standards is a complex question. Dilemmas regarding dual agency is a prominent concern.…”