For all of its shortcomings, virtual communication does play a vital role in democratizing interactions and relationships. This has been accomplished through different modalities: e-mail, social media, live chat, FaceTime, and others. In behavioral healthcare, this democratization has facilitated the movement toward self-direction of care and self-determination of life activities, both of which are key elements of personal recovery.
Here, I would like to explore several evolving applications of virtual communication in behavioral healthcare. The purpose is to show the possibilities, as well as the ways these new communication modalities can address some of our current problems in the field.
Virtual care integration: Envision a consumer in a meeting with a primary care practitioner, while, at the same time, a behavioral health practitioner and a peer are virtually present through a video conferencing application. Obviously, the roles could be reversed, so that any one of the three could actually be present with the consumer, while the other two are virtually present. Also consider several very important potential consequences: Virtuality can permit care integration to occur without much of the trauma of organizational integration; a peer can be present at every interaction where support is needed; and behavioral health expertise can be available to primary care on demand, and vice versa.
Virtual care sessions: It is a simple step from partial to fully virtual sessions. Envision a behavioral health provider interacting with a consumer in an online video conferencing session. Or, envision the same provider interacting online with a group of consumers through video conference platform, much as virtual education is conducted today. Or consider several different providers interacting with a single consumer. Such interactions don’t require travel for any party, and they can be conducted with great scheduling flexibility. The sessions also can be recorded for later review by a provider or by a consumer.
Provider-free virtual care: Envision a consumer interacting with an online application that provides guidance in setting care or life goals. Or, envision a consumer working through an online care task with an online virtual assistant specifically designed for that purpose. Such approaches not only would promote greater self-direction and autonomy, but also extend provider capability greatly at a time when we have a human resource crisis in behavioral healthcare.
Self-directed virtual care via artificial intelligence: As artificial intelligence—AI—improves over the next several years, it is likely that such systems will become very useful in supporting self-directed care. These systems could not only help consumers or providers chart the future course of care, but also assess progress and offer alternative courses of action for consideration. They also could be used for improving self-determination in life choices. AI systems are very compatible with avatars, thus permitting each of these steps to be personalized through consumer-avatar interaction designed by the consumer.
Almost needless to say, a blizzard of outmoded laws and regulations would need to be modified to encourage the development of applications such as those described above. In these transitions, we will want to preserve consumer privacy of the online experience and any derivative recordings or records.
As we move forward, it will be important for the federal government to exert a key leadership role in the development and monitoring of these new applications. This is needed because the IT industry as a whole lacks a hierarchal structure to monitor for quality assurance and appropriate consumer protections. Such work could be envisioned on the model employed by the US Food and Drug Administration (FDA).
Several years ago, a recommendation was made to the U.S. Department of Health and Human Services to create an Office of Digital Health to lead all coordination and monitoring activities around applications designed to deliver healthcare. This role would be differentiated from that of the current HHS Office of the National Coordinator, which monitors electronic health records and their standards.
Going forward, behavioral health will need to remain competitive in healthcare and social contexts that are ever more reliant on communication technology. To do this, careful discussion and strategy formulation will be needed in the short term within the field, especially with consumers and providers, followed by outreach and dialogue with virtual communication entities.