A couple years ago, I had a patient who lives about an hour from my office ask if we could do our sessions over video. With traffic, coming to see me in my office would take almost half a day and even though he really needed help, he just couldn’t make it into my office on a regular basis. Since he has diabetes, and my practice focuses exclusively on the mental health needs of people with diabetes, he didn’t feel like he had anywhere else to turn. I’ll be honest, I was pretty skeptical about seeing a patient online. I had never done anything like that before and I had no idea what to expect. But my goal has always been to expand mental health treatment for people with diabetes and this was one tangible way to do it.

Now I see patients online every week and I am a big believer that tele-mental health treatment can help meet many of the mental health needs of people with diabetes. When I first started, I was worried that doing therapy online would be awkward. I’ll be honest, with each new patient it usually is awkward…. for about 2 minutes – and the people I see online tell me they have the same experience. After a couple minutes of getting used to it, talking over video becomes normal, and it feels no different than an in-person session. I’ve actually seen a lot of people over video that I’ve never met in person, and I’m confident that their outcomes have been just as good, and sometimes better, than the people I see in person.

My goal is to make diabetes related mental health services available to as many people as possible no matter where they live and I’ve found that telemental health is an ideal way to expand my reach to areas where these specialized services aren’t available. I do my best to limit my online practice only to people who have specific mental health challenges related to living with diabetes for a couple reasons. First, I’ve found that telemental health is most effective for people who come to treatment for a specific reason and with measurable goals and this is often the case for people with diabetes-specific issues. For example, I’ve had a lot of success with online treatment for fear of hypoglycemia and diabetes burnout – issues that have targeted treatments and measurable goals. The second reason is simply time. There are only so many patients I can see in a week, and if someone can get high quality treatment (in-person or online) from someone without expertise in diabetes, that is usually a better option for them, and lets me  focus my time working with patients who need very specialized treatment they can’t get from someone else.

Tele-mental health is not without challenges. One of the most common symptoms for anyone dealing with mental health challenges, diabetes-related or not, is avoidance. And avoidance rears its head in a lot of different ways like not showing up to appointments, avoiding certain topics or not talking at all. Avoidance is difficult to work with when someone is in the room with you and it’s even more challenging when working with someone over video. In fact, seeing a therapist over video can be an avoidance strategy – you can tell yourself you’re checking the box of getting treatment while using video as a way to avoid the hard work that therapy requires. These challenges tend to be amplified when the patient and therapist aren’t sitting in the same room.

There are some interventions that I’m hesitant to do over video. For example, when I treat people with a fear of hypoglycemia, sometimes I do a type of exposure therapy where I have them take insulin to make their blood sugar go low to show them that they have the ability handle and treat low blood sugar. It’s really difficult to do this type of exposure over video.

I am a licensed psychologist in California, so I can only see patients who are physically located in California. Most insurance policies cover telemental health, but each plan is different so if you are interested in getting tele-mental health treatment, you’ll want to check your policy to be sure that these services are covered.

Telemental health has been a great way for me to increase access to specialized services to people who really need them and I’m always looking for ways to keep expanding. In the near future, I plan on offering group therapy online. If you are interested in talking more about diabetes-specific telemental health for yourself or someone you know, please give me a call at 858-461-9295 or send me an email (mark@cdmh.org). If I am not the best therapist for you, or if you don’t live in California, I would be happy to help you find a provider who can help you.

3 replies on “Telemental Health”

I do not think I could ever advise intentionally going low. But I get the reason and the need. I think tele-health would be great for any mental health therapy I could do tele-counseling and save myself and my therapist time.

My daughter was diagnosed with type 1 the week before she started high school. SHe is now finishing up her sophomore year. It has been very difficult for her, and for our relationship. She is very healthy. She participated in many sports, always made straight As and has always been very happy. Since her diagnosis (and paired with being a teen) she has had a lot of anxiety and a little bit of depression. She doesn’t want to deal with it. SHe doesn’t like for anyone to know and will not wear a pump or a monitor. We fight constantly and it is a constant struggle to get her to check her levels and remember her insulin. I wish there was a counselor in our area (southern Alabama) but I have not had any luck finding someone. It is such a battle and has put a huge strain on our relationship. Her grades have slipped and she has become very lazy. I wish I could take this disease for her. DO you know of anyone in our area?

My grandson is type 1 diabetic and has been for years since 8 or 9 years old. He is 20 years old and very non compliance has been hospitalized 28 times with DKA in 4 years. I love him dearly and want to help him. He says I dont know DM he does not have to follow portion control or diet plan, or his sliding scale he can take his Lantus and double his dose and eat whatever he wants so he does not need to check his blood sugar 2 hours after a meal. I am a Hospice Nurse and do love him but I feel he is killing himself and we dont know where to turn. Every thing is “you dont know Diabetes, you dont talk to my doctors, I can eat what I want so long as I watch my carbs and protein , I dont think that sounds right. But dont know where to turn. As we speak he iis in the hospital. I would appreciate any help or resources I. Can get. Thank you
In His Grace

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