Medical Legal Issues in Psychiatric Home Care and Telemental Health

Many elderly persons who reside in the community have the same degree of physical disability as those in nursing homes. Issues regarding autonomy and appropriateness of living independently, confidentiality, limitation of services provided, refusal of treatment, and physician safety often need to be addressed in home visits. Telemental health may help bridge the provider gap and is evolving as a service and field. Telemental health can take a variety of forms, including in-home monitoring, Internet and telephone psychotherapy, and videoconferencing. In telemental health there are ethical and forensic issues beyond those encountered in the home visit that clinicians may encounter. This chapter addresses these and medical-legal issues related to telemental health, including licensing and credentialing, malpractice and standard of care, informed consent, confidentiality, and the patient–physician relationship. Standards and guidelines have been established for telemedicine, including home healthcare and video-based online mental health services. These guidelines involve administrative core, technical core, clinical core, and implementation standards.