Is Your Online Therapy Safe?

Asian Scientist Magazine (8 Nov 2022) — Mental Health consultations are just one of the many aspects of our lives, including remote work and fitness classes, that have been heavily digitized since the start of the COVID-19 pandemic. Therapists and clinical psychiatrists are increasingly using apps or video conferencing platforms like Zoom and even WhatsApp to conduct remote consultations and therapy sessions with clients looking for support in a safe space. Widespread use of such platforms has made it possible for people to easily seek mental health care online.

“There are more people who are interested in having online sessions because it is easier for them,” said Mimie Rahman, a counselor based in Petaling Jaya, Malaysia. Asian Scientist Magazine.

Lower costs compared to in-person sessions combined with the ability to have the sessions anytime and anywhere is a major factor behind this increased demand for online teletherapy.

“In a month, I usually see about 20-30 customers. About 60 percent of them are online. Only 40 percent are face-to-face,” Mimie said.

She also noted a significant increase in the number of clients since the start of her practice in 2021 during the height of Malaysia’s third wave of COVID-19. At one point, she received almost a hundred customer requests in a month. However, as the popularity of online counseling increases, there is a growing concern about data privacy and patient safety. Zoom had previously come under fire for its poor end-to-end encryption in 2020, leading to situations where meetings were hijacked by malicious users playing or sending shocking material as a prank. User emails and passwords were also leaked.

Data security and protection is extremely important in the healthcare sector and particularly for mental health services. A client’s family history, medical records, and in some cases intimate details of their trauma and self-harm are important information a therapist needs to understand and help their client manage their mental well-being. Sharing this information involves a tremendous level of trust, which is integral to a mutually beneficial outcome for the client and the therapist.

With this in mind, institutions such as the American Psychological Association (APA) have updated their Code of Ethics to include guidelines for psychologists and therapists in selecting and using appropriate digital platforms to ensure patient confidentiality and data protection. In a section outlining data and information privacy, the APA suggests consulting with technology experts before beginning online teletherapy sessions to establish and apply safeguards, along with suggested criteria for finding applications or methods that ensure a minimal chance of breakup.

In Malaysia, however, the absence of clear guidelines leaves mental health providers themselves to figure out the rules and regulations needed to protect patient data during teletherapy sessions. For mental health workers like Mimie, it has been a complicated situation to navigate. According to her, the situation has become confusing due to the lack of clear communication from Malaysia’s Ministry of Health regarding any updates to telemedicine guidelines in the country. Asian Scientist Magazine contacted the ministry seeking an interview to understand its plans to make online mental health services safer, but received no response.

The doctor will see you online

Telehealth care has been around since the 1920s. Doctors and specialists sent clinical information to each other using telephone lines and radio. Closed-circuit television and eventually videoconferencing technology in the 1970s led to the development of remote health care monitoring and delivery to rural patients. With today’s technology, doctors and patients can contact each other through a simple swipe of a smartphone.

In Malaysia, the Telemedicine Act has been in place since 1997 as part of the country’s national plan to strengthen the delivery of health services in the public sector through telecommunications and information technology. However, the law itself has not been updated since then, with many of the clauses reflecting an old understanding of the technology available at the time. The law is a short, three-page document that describes how the patient’s consent must be obtained and how physical files and images must be stored securely by doctors and nurses. The law does not specifically address mental health professionals such as therapists and clinical psychologists, nor does it describe how to protect sensitive patient data using digital communication services, including video conferencing apps.

In a paper published in 2020 reviewing telemedicine guidelines in Southeast Asia, lead author Dr. Intan Sabrina Mohammad that a majority of guidelines in the region, including Malaysia, do not directly govern the technology or platforms used for telemedicine or telehealth care. Intan is a rehabilitation doctor at Hospital Rehabilitasi Cheras in Kuala Lumpur. In mid-2020, Malaysia’s Ministry of Health published a ‘virtual clinic’ guideline for doctors to conduct consultations, make diagnoses and perform preventive treatment using video conferencing apps remotely. However, the guideline did not provide clear examples of video conferencing platforms that were approved, nor did it provide explicit instructions on how best to handle patient data. And again, the document did not include therapists, clinical psychologists and other health workers.

Convenience over privacy

Fiqa Abdul Fata, a wellness coach and clinical psychologist conducted physical hospital rotations in the northern peninsular state of Perak and the east coast peninsular state of Kelantan from the beginning of the pandemic until September 2021. According to her, there were no concrete guidelines set by the psychiatric ward she was placed in regarding suitable platforms for conducting online teletherapy sessions.

“For video sessions, I would say there was no specific guideline, to be honest. We went into it blindly,” Fiqa shared Asian Scientist Magazine.

Patients under her care would sometimes struggle to use video conferencing apps like Zoom due to poor internet connectivity or a lack of understanding of how such platforms worked. Cycling through different platforms and apps in the hope that something would stick, they finally settled on an app that was “most convenient for the patient to use.” When Mimie began her training, she also chose to use the most convenient app or platform for her online sessions. But apps that are easy to use may not always be the most secure.

Now Mimie uses dedicated teletherapy apps approved by the health centers where she works. After using these platforms with end-to-end encryption to conduct her therapy sessions, Mimie said she is more aware of the risks associated with public apps and unsecured platforms.

Mimie and Fiqa hope Malaysia’s Ministry of Health will look at providing clearer guidelines for virtual health clinics that emphasize safety for both patients and service providers. Protection of patient data is essential for trust to develop between a patient and the healthcare staff. Without trust, mental health practitioners cannot help the patient navigate their way in learning about and managing their mental health.

This article was first published in the print version of Asian Scientist Magazine, July 2022.
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Copyright: Asian Scientist Magazine. Illustration: Ajun Chuah / Asian Scientist Magazine

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