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· Internationale Science Digests · 3 Min. · Von Mia Yang [Qualitätssicherung Dr. K. Loboiko]

Video Consultations in Youth Mental Health: Revolution or Risk?

Telemental health has rapidly transformed adolescent mental health care, especially during the pandemic. Video consultations can make therapy more accessible and private, sparing young people the need to physically attend a clinic. Yet key questions remain: are these virtual sessions truly as effective as traditional face-to-face therapy — and where might their limitations lie?

The Evolution of Telemental Health

Telemental health has undergone significant evolution since the 1960s, when Joseph Weizenbaum’s pioneering chatbot Eliza demonstrated that people were willing to disclose personal thoughts to a digital entity [1]. Today, a broad range of digital applications and remote services reflects the willingness of both professionals and patients to integrate new tools into mental health care. The breakthrough came during the COVID-19 pandemic, when video consultations (VCs) established themselves as a vital channel for care delivery under lockdown conditions, providing access even in the absence of physical attendance [1, 2].

Yet, despite their rapid success, the effectiveness of VCs is highly dependent on context and patient group. In mental health care, their potential is particularly striking: unlike many somatic treatments, mental health consultations often do not require physical examination, making remote care more feasible. The approach appears especially promising for young people, a group that is both highly vulnerable and in urgent need of timely, accessible support [3]. Adolescents and young adults are also digital natives, accustomed to using online tools in everyday life, a factor that may enhance acceptance and usability of video-based therapy. However, the rapid adoption of VCs has declined in the post-pandemic period [1, 4]. To understand this change, we need to think further about the following questions: How do young patients experience therapy via a screen? From the perspective of youth, how do VCs differ from face-to-face consultations? Understanding these issues and dynamics is essential for ensuring the long-term success and sustainability of telemental health.

The Role of VCs in Youth Mental Health

A study in Norway (2024) explored how VCs affect youths‘ self-presentation and interactions with therapists [1]. This investigation, grounded in sociological theories such as Erving Goffman’s concepts of frontstage and backstage behavior, aimed to illuminate the benefits and challenges of telemental health. The researchers adopted a qualitative approach, conducting 33 interviews with individuals aged 16 to 23. Through analysis of the interviews, the study offered a nuanced understanding of youths‘ lived experiences with VCs.

Figure 1: The study at a glance

Key Findings: Themes in Youth Telepsychiatry

The study identified two primary themes: the comparison between screen-based therapy and face-to-face (F2F) interactions, and the influence of physical context on the therapeutic process.

Therapeutic interaction: Participants found it harder to express feelings via VC, with limited body language cues and altered eye contact dynamics. The screen’s impersonal nature sometimes hindered emotional openness, while others felt more comfortable due to reduced social pressure.

Physical context: Context also played a significant role. Home sessions provided comfort but raised privacy concerns when family members could overhear. School-based sessions posed even greater challenges, with potential interruptions and privacy breaches impacting communication.

Overall, the findings of this study highlight the importance of adopting flexible, context-sensitive approaches in digital mental health services. A promising strategy is the implementation of a blended care model, which integrates video consultations with traditional in-person therapy. This hybrid model empowers patients with the flexibility to choose the most suitable modality for their needs while ensuring the continuity and quality of care.

Conclusion

The transition to telemental health has brought both opportunities and challenges to youth mental health care. Video consultations have improved accessibility, convenience, and flexibility [1–4]; however, their success hinges on thoughtful and deliberate implementation. Therapists require specialized training to accurately interpret nonverbal cues in a virtual setting, as these cues play a crucial role in understanding patients‘ emotional states [5, 6]. Additionally, creating secure, private spaces for virtual sessions is essential to protect patient confidentiality and foster a safe therapeutic environment [7, 8].

Looking ahead, the development of telemental health must prioritize patient-centered care by leveraging the strengths of both digital and in-person therapy [9, 10]. A collaborative approach that accommodates individual preferences will enhance therapeutic outcomes and overall service effectiveness. Furthermore, continuous research is essential to refine these practices, ensuring that telemental health remains a reliable, effective, and accessible tool for mental health care in the future.

References

  1. Gullslett MK, Larsen F, Nybakke HL. Digital mental health: locations and contexts in youths’ presentation of self in video consultations— a qualitative study. BMC Digit Health 2024. doi:10.1186/s44247-024-00139-z.
  2. Gullslett MK, Kristiansen E, Nilsen ER. Therapists‘ Experience of Video Consultation in Specialized Mental Health Services During the COVID-19 Pandemic: Qualitative Interview Study. JMIR Hum Factors. 2021;8:e23150. doi:10.2196/23150.
  3. Mseke EP, Jessup B, Barnett T. A systematic review of the preferences of rural and remote youth for mental health service access: Telehealth versus face-to-face consultation. Aust J Rural Health. 2023;31:346–60. doi:10.1111/ajr.12961.
  4. Nicholas J, Bell IH, Thompson A, Valentine L, Simsir P, Sheppard H, Adams S. Implementation lessons from the transition to telehealth during COVID-19: a survey of clinicians and young people from youth mental health services. Psychiatry Res. 2021;299:113848. doi:10.1016/j.psychres.2021.113848.
  5. Lin T, Anderson T. Reduced therapeutic skill in teletherapy versus in‐person therapy: The role of non‐verbal communication. Couns and Psychother Res. 2024;24:317–27. doi:10.1002/capr.12666.
  6. Marcoux A, Tessier M-H, Jackson PL. Nonverbal behaviors perceived as most empathic in a simulated medical context. Computers in Human Behavior. 2024;157:108268. doi:10.1016/j.chb.2024.108268.
  7. Gulliver A, Bennett K, Bennett A, Farrer LM, Reynolds J, Griffiths KM. Privacy Issues in the Development of a Virtual Mental Health Clinic for University Students: A Qualitative Study. JMIR Ment Health. 2015;2:e9. doi:10.2196/mental.4294.
  8. Drum KB, Littleton HL. Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations. Prof Psychol Res Pr. 2014;45:309–15. doi:10.1037/a0036127.
  9. Chiauzzi E, Clayton A, Huh-Yoo J. Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era From Clinical and Patient-Centered Perspectives. JMIR Ment Health. 2020;7:e24021. doi:10.2196/24021.
  10. Talal AH, Sofikitou EM, Jaanimägi U, Zeremski M, Tobin JN, Markatou M. A framework for patient-centered telemedicine: Application and lessons learned from vulnerable populations. J Biomed Inform. 2020;112:103622. doi:10.1016/j.jbi.2020.103622.

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