There are just about as many ways to get help, as there are methods of help. All of these are need based, and the need is determined at the hands of someone else. Author Todd Essig’s article “Help for Consumers Shopping the Confusing Online Mental Health Marketplace” written for forbes.com, discusses the complications with relying on online help. The two issues raised in this article are: “There is neither adequate assessment nor professional accountability.” These issues are not only present in the online help platforms available, but also in real life, as people who face mental illness inadvertently stand in their own way.

When it comes to online help, there is no limitation to where a therapist can hold their practice. Without respective boarders, any insurance or protective measures cannot be controlled. Essig illustrates this point in saying “But for now, adequate professional accountability for potentially unethical actions is lacking.” While a therapist may carry good insurance, the insurance is typically only regionally applicable. While regulations and requirements for online treatment are being developed as the process becomes more commonly practiced, there are far too many holes and gray areas to fully ensure that a therapist will be held accountable through a broadly applied online platform.

Unethical action can sometimes be intentional, although it can also be the result of error. In the case of virtual treatment; it may be as simple as a misunderstanding of the patient’s symptoms, or worse, a result of the fact that people can easily edit themselves. Author Joe Madden hits the nail on the head in his article “I tried to Fix my Mental Health on the Internet” when saying “The fact that you can edit messages before sending them means you’re unlikely to blurt out something unguarded and revealing in the heat of the moment.” While online, the editing is in the form of messages, in person, the editing is in the form of personal character. This “editing” is what often makes people their own roadblock from getting adequate help.

When someone decompensates, or has a complete breakdown and loses the ability to control their psychological and physical functions, it is an ultimate low point. They are most certainly not themselves. The typical process is for them to go to the local ER and be assessed. Upon completion of an assessment, they are either sent away with a suggestion to see an outpatient psychiatrist, or admitted to the hospital’s psychiatric department. It is a very different situation if the person does not want help, and a friend, family member, or someone nearby calls 911 for help. The police can utilize a law referred to as 5150 to bring the unstable person to certain psychiatric facilities that have a license for evaluations.  Once a doctor has assessed the patient, they can be admitted with or without their consent on a 72-hour hold. During that time, they are monitored by trained staff, medications may be administered to assist them in regaining stability, and ultimately a plan is put into motion for what will happen after their time in the hospital is up. This is a process that is evidence based and  has been vetted over years of law and regulation development.

With online treatment the person is self determining the severity of their situation, and making decisions on how to be assessed and treated. The instability of an emergency situation can be very dangerous time for self-assessment as perception of reality is very skewed, and clear thinking is essentially impossible. If one is not facing an emergency when seeking online help, they still have the  capability to edit themselves. Editing means censoring their actions and mannerisms before they respond to the online service. The virtual treatment censorship is a two way street, in that the doctor can also sensor themselves and act outside their scope of knowledge. An online atmosphere removes the in person capacity to monitor the patient in real time, and treat them with adaptable evidence based skills.

On one hand, the problem of professional accountability lies more in the hands of virtual treatment that can be complicated waters to navigate on the internet. Debates on regulation and licensing for online services are being developed. On the other hand, the problem of continual assessment applies to both virtual and in person treatment. Self editing and censorship of one’s behaviors presents a huge problem, when the resulting treatment becomes based upon the façade, rather that true reality. Skewed treatment may result in the person being denied access to evidence based programs designed to help them get stable and have long term success in their life.

The above referenced articles evaluate the advantages and dis-advantages of online treatment, while acknowledging that rules and regulations for online help are being developed currently. This presents a buyer beware market. The person seeking help would be wise to explore in person treatment as well online treatment. The severity of their condition should be one of the final determinants of the type of treatment to seek out. It is essential to remember that mental illness is not a one size fits all.The goal should always be to make sure every person who faces a mental illness receives the best possible care for their specific situation.