To use or not to use: Clinicians' perceptions of telemental health.

Equal access to mental health services is necessary for healthy individuals and communities. However, due to geographical distances and other barriers, some clients cannot easily access mental health professionals. Technologies such as videoconferencing for clinical purposes (i.e., telemental health) may help to bridge these gaps to connect clients and clinicians at geographically diverse locations. However, despite its potential utility, telemental health has not been widely adopted in Canada. This study is an exploratory investigation into mental health professionals' attitudes toward telemental health, factors that affect the frequency with which they use this technology, and their perceptions of individual characteristics that make clients more or less suitable candidates for telemental health. This study has a particular focus on remote and rural and Operational Stress Injury (OSI) contexts. One hundred sixty mental health workers across Canada participated in an online survey, and 25 mental health workers from Operational Stress Injury clinics across Canada participated in in-person interviews. The data were examined using qualitative and quantitative analysis methods. Findings suggest that mental health workers have overall positive attitudes toward the use of telemental health-particularly for clients in remote and rural locations. Additionally, receiving training in telemental health, being in the mental health field for longer, and perceiving the technology as easy to use are associated with more frequent use of telemental health. Finally, clinicians reported specific client characteristics that they perceive to make some clients unsuitable candidates for telemental health. Implications of these findings and directions for future research are discussed. Keywords: telemental health, technology, attitudes, client characteristics, videoconferencing There is a high demand for mental health services across Canada - particularly for those living in remote and rural locations (Barbopoulos & Clark, 2003). The 2006 Canadian census (Statistics Canada, 2006) classified more than six million people as living in rural locations. Literature suggests that rural residents demonstrate a need for mental health services equal to, or greater than, their urban counterparts. Indeed, some authors suggest that rural settings are comparatively more stressful than urban ones as a result of unique factors such as higher levels of unemployment, poverty, accidents, and natural disasters (Barbopoulos & Clark, 2002). Despite these needs, there are fewer services available to those in rural settings. For example, in remote and rural communities, mental health workers may only make in-person visits a limited number of times annually. Further, these communities may have access to few resources for mental health treatment due to limited funding, community remoteness, and lack of infrastructure. These challenges may be particularly acute for remote First Nations communities (KO, 2006). Alternatively, individuals seeking treatment may have to travel to urban locations to receive treatment, which may result in additional costs associated with travelling, lost work hours, and time away from family (Simpson, 2009). In addition, when individuals from rural and remote locations leave their communities for treatment, the new environment can pose many threats in terms of lack of familial support, exposure to substance use, and other difficulties (Gibson, Kakepetum-Schultz, Coulson, & O'Donnell, 2009). For many, travel is simply not an option, and so having very limited access to services, or no service, can sometimes be a reality. In other cases, even when the community is not as isolated, other factors may contribute to difficulties in acquiring mental health services. For example, certain psychological stressors - such as social anxiety, agoraphobia, or even physical challenges such as chronic pain or limited mobility - may make accessing services in the traditional face-to-face environment nearly impossible (and, at the least, very uncomfortable) for some clients. …