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As the Lindsay Clancy murder trial spotlights the psychiatric care she received before the killings of her three children, the case has raised broader questions about the growing reliance on telehealth for mental health conditions.
Nearly half (48.3%) of American adults with serious mental illness now receive some type of mental health treatment via telehealth, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
Clancy reportedly had 14 virtual visits with her primary psychiatrist, Dr. Jennifer Tufts, over a five-month period, from September 2022 through Jan. 23, 2023, according to testimony reported by The Associated Press. The final appointment was on Jan. 23, the day before the killings. The two never met in person.
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During cross-examination, Clancy’s defense attorney, Kevin Reddington, questioned Tufts about her reliance on virtual appointments, per AP.
“Did you ever suggest to her that ‘maybe you should come in and see me, rather than on the computer?'” Reddington asked.
“Talking to her over the video didn’t seem like an issue,” Tufts responded. “It didn’t seem like there was something I was missing.”
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Jonathan Alpert, Ph.D., a New York psychotherapist — who was not involved in Clancy’s care and was speaking generally about telehealth rather than the specifics of her treatment — said virtual care can work very well, but that “there comes a point where a screen may not be enough.”
“The sicker and more unstable someone becomes, the less comfortable I’d be relying exclusively on a screen.”
“If someone is becoming suicidal, psychotic, manic, unstable or unable to function, the clinician has to consider whether that person needs to be seen in person or needs a higher level of care,” Alpert, author of “Therapy Nation: How America Got Hooked on Therapy and Why It’s Left Us More Anxious and Divided,” told Fox News Digital.
“The priority has to be getting an accurate picture of what’s going on and keeping the patient safe.”
Benefits and drawbacks of virtual care
Telehealth plays an important function in mental healthcare and offers many benefits, Alpert noted.
“As a provider, I can see far more people in a day doing virtual therapy than I could if I were doing in-office treatment,” he told Fox News Digital.
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For the patient, it eliminates the commute to the therapist’s office, which could be a limitation for those with busy schedules.
“So it does allow more and better access to care in many cases, but it does have its limitations if someone has a severe psychiatric disorder,” Alpert said.
There are certain things about a patient’s appearance — such as hygiene, movements, agitation, intoxication or general behavior — that aren’t as obvious on Zoom, he noted.
“Someone can pull themselves together for an appointment and look relatively fine for 30 minutes even though they’re falling apart outside of it,” he said.
Signs that in-person is best
If the patient keeps getting worse despite frequent appointments, that’s a big warning sign, according to Alpert.
“More appointments aren’t necessarily more treatment,” he told Fox News Digital. “If someone is becoming more suicidal, paranoid, manic, disorganized, aggressive or simply unable to function, you can’t just keep scheduling another video call and assume that’s enough.”
“At some point, the treatment plan has to change, whether that means seeing the person in person, getting an emergency evaluation or moving them to a higher level of care.”
“It’s helped a lot of people get care who otherwise might not.”
In cases where there is any concern about suicide or violence, Alpert said it’s important for the therapist to be direct and to ask the following questions.
- Are they having thoughts of hurting themselves or someone else?
- Do they have a plan?
- Do they have access to weapons or other lethal means?
- Have they done anything recently that suggests the risk is escalating?
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“If someone says they just want to die, that’s one thing, and it’s very concerning, but if they have a plan, say a weapon or pills, that brings it to the next level and would certainly warrant intervention, whether it’s through the police or emergency services,” he said.
If you or someone you know is having thoughts of suicide, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
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It’s also important for the therapist to know where the patient is located during the appointment so that if there is an emergency, they can take action, Alpert advised.
“And sometimes you need information from family or other people in the patient’s life, because the patient may not be giving you the whole picture.”
The expert also emphasized the distinction between postpartum depression and postpartum psychosis.
“With postpartum psychosis … there may be delusions, disorganized thinking, hallucinations — and if that’s what’s going on, that definitely warrants inpatient treatment.”
Overall, Alpert said, telehealth itself is not the problem.
“It’s helped a lot of people get care who otherwise might not,” he said. “The bigger issue is whether the clinician is doing a thorough assessment and whether the level of care still fits the patient’s condition.”
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A good clinician can identify serious risk over video, he noted — but at the same time, someone can miss serious risk sitting across from a patient in an office.
“The sicker and more unstable someone becomes, the less comfortable I’d be relying exclusively on a screen,” he added.
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