Long-Distance Psychiatry/Therapy
November 4, 2016 1:00 PM   Subscribe

Is there such a thing as a psychiatrist/therapist who could diagnose and treat (and maybe prescribe) via Skype or another remote mechanism?

I have a dear, close friend who is struggling with serious mental health issues. I want to assist her/him by identifying some treatment options.

Problem: she/he is a Mexican living in Mexico with little money and terrible experiences - and no relief - with the three therapists available to them.

I feel like this is a unicorn of a provider - but while I'm imagining...something like:
- US trained
- experienced with depersonalization/derealization
- fluent spanish
- woman
- will work remote via the web

Additional Info:
- the friend could probably make a one-time trip to the US for two weeks for initial consultation.
- the provider could also be a LNP-therapist with extensive psych experience and prescribing power.

Please give me better ideas if you have them.
posted by j_curiouser to Health & Fitness (7 answers total)
I know there are telemedicine practitioners, but, realistically, does the friend have money to pay American rates for something like this? US insurance? Any other ideas for how they would like to pay for it?
posted by brainmouse at 1:23 PM on November 4, 2016

Response by poster: I'm paying.
posted by j_curiouser at 1:28 PM on November 4, 2016

Literally checked Metafilter while writing an article on tech-enhanced delivery of mental health treatment. It's a little tough to do this because licensing/credentialing laws cover providers on a state-by-state basis, so telemental health that crosses state lines requires a license in both states. I'm not sure what the situation is like for Mexico, but it will probably make it impossible to get remote services from a provider in the US because their license will not cover them to practice there. The typical setup is to get these services within the context of a local clinic that has secure videoconferencing and on-site providers in case of a suicidal emergency, although it can be delivered to the home assuming the patient has fast enough internet and secure videoconferencing software (Skype is a no-go for that). It also can be tough to get insurance coverage for telemental health to the home depending on the insurance carrier, although again, not sure about the insurance situation in Mexico.

The depersonalization/derealization bit will also make things tough. Assuming this is the right diagnosis (and not something like PTSD or borderline personality disorder), this is a very rare condition that most providers have not have explicit training in or extensive experience treating- and if they say they have extensive experience, I'd be concerned that they're overdiagnosing. It's always worth it to get a high-quality diagnostic interview before deciding what kind of treatment is needed, but particularly worth it in a case like this where the symptoms could be something unusual.

I'll keep thinking and dig around a bit in my resources.
posted by quiet coyote at 1:31 PM on November 4, 2016 [2 favorites]

Response by poster: wow, thanks q.c.

Do you see any value in travelling to the US for consult/diagnoses? I know it's a rare condition - maybe they could course-correct.
posted by j_curiouser at 1:40 PM on November 4, 2016

Just found this: "There is a difference between practicing in other states within the US and practicing in other countries. In most general terms psychotherapists can treat clients in other countries if these countries do not regulate "counseling", "psychotherapy", "marriage and family therapy", etc. Some argue that even if a foreign country regulate the practice of psychology but not of Marriage and Family Therapy", MFT can practice treat people remotely in this country. If this is true, as a result of this lack of regulations LPCCs and MFTs have far more leeway when practicing with clients in other countries for the reason that they are not violating those countries' laws because they have no laws governing the practice of LPC or MFT. This argument is similar to the argument used, so far successfully, by coaches all over the world."

This is more optimistic in terms of getting access to a provider in the US (assuming that Mexico doesn't regulate these things). My guess is that it will still be hard, though, because providers might be nervous about getting into murky legal territory. One way to go about this might be to contact psychiatry departments in academic medical centers on the Southern border to ask if they have any ideas.

On preview: If you're concerned about the quality of diagnosis in Mexico, maybe. Psychotherapists won't have a go-to, standard therapy for treating it if it's really depersonalization/derealization, but it's pretty simple and quick to treat using widely-available treatment manuals if it's PTSD. It's somewhat less simple/quick to treat BPD, but there's an effective and widely-used treatment. If it was me or one of my loved ones, I would want a workup by a PhD-level psychologist (but I'm biased). I don't do any prescribing but I assume that this would affect diagnosis and you'd want to have a good one. It's just hard to say how helpful it will be- there are a lot of crappy diagnosticians in the US, too. I would also hate for you to spend a lot of money and then not be able to find a good psychotherapist who can treat whatever you identify.
posted by quiet coyote at 1:48 PM on November 4, 2016 [1 favorite]

Keep in mind that finding someone who can prescribe medication (which an MFT cannot do; you'd need an MD psychiatrist or a psychiatric NP) in a country where they'll legally allowed to do so will add another layer of complications.
posted by lazuli at 7:38 AM on November 5, 2016

I reached out to a Mexican colleague living in the US who said that it IS possible to do telehealth from the US to Mexico because therapy is not very regulated in Mexico. She knows a psychotherapist in Mexico who works with a nonprofit in New York that does telemental health to Mexico using Zoom teleconferencing software. I asked her for the name of the nonprofit and I'll memail you when she gets back to me.
posted by quiet coyote at 10:29 AM on November 5, 2016 [1 favorite]

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