Informed Consent for Telemental Health

This is an addendum to the Mental Health Therapies Policies and does not replace them. All aspects of those Policies apply to telemental health (TMH) treatment. TMH refers to counseling sessions that occur via phone or videoconferencing using a variety of technologies. TMH is offered to improve access to counseling services to UK employees when significant barriers of travel to campus for counseling services exist. However, the results of TMH cannot be guaranteed or assured. You are not required to use TMH and have the right to request other service options or withdraw this consent at any time without affecting your right to future care or treatment. TMH services may not be appropriate, or the best choice of services, for reasons including, but not limited to heightened risk of harm to oneself or others; lack of access to, or difficulty with, communications technology; significant communications service disruptions; or need for more intensive services. In these cases, your therapist will help you establish referrals to other appropriate services.

TMH services are conducted and documented in a confidential manner according to applicable laws in similar ways as in- person services. There are, however, additional risks including:
  • Sessions could be disrupted, delayed, or communications distorted due to technical failures.
  • TMH may reduce visual and auditory cues and increase the likelihood of misunderstanding one another.
  • In rare cases security protocols could fail and your confidential information could be accessed by unauthorized persons.
  • Your therapist may determine TMH is not an appropriate treatment option or stop TMH treatment at any time if your condition changes or TMH presents barriers to treatment.
The mental health therapists work to reduce these risks by only using secure videoconferencing software and these policies and procedures:
  • Due to board licensure requirements, all telehealth appointments must occur in the state of Kentucky. With this, you may only engage in sessions when you are physically in Kentucky. Your therapist will confirm this for each session.
  • You and your therapist will engage in sessions only from a private location where you will not be overheard or interrupted.
  • You will use your own computer or device, or one owned by UK but that is not publicly accessible.
  • You will ensure that the computer or device you use has updated operating and anti-virus software.
  • You will not record any sessions, nor will your mental health therapist record your sessions without your written consent.
  • You will provide contact information for at least one emergency contact in your location who we may contact if you are in crisis and your therapist is unable to reach you.
Should there be technical problems with video conferencing, the most reliable backup plan is contact by phone. Make sure that your mental health therapist has a correct phone number at  which you can be reached and have your phone with you at session times. If you are unable to connect, or get disconnected, please try to connect again and if problems continue, call 859-257- 9355 (option 1).

Email is not a confidential method of communication, and your therapist may not access or respond to emails quickly. If you choose to contact your therapist by email, do not include private information, and do not expect a prompt response. If you need to reach your therapist between sessions, you may call the main office during business hours (859-257-9355, option 1) or email  employeementalhealth@uky.edu.

E-mail communications will be stored electronically as treatment records. If we believe you are in crisis and we are unable to contact you, we may call your emergency contact or local emergency services providers. Our main office is open 8am-5pm, Monday - Friday except for holidays and University closures. Our office cannot provide 24-hour emergency management, particularly to those using services at a distance.

If you are in crisis outside of normal hours, you agree to:
  • Call 911 or the National Suicide Prevention Life (988) to speak with a counselor.
  • Go to the nearest emergency room or crisis mental health agency:
Emergency or Crisis Agency Information
 For the location you will typically be, that is:






I have read and understand this information and all my questions have been answered. I hereby give informed consent to use Telemental Health in my care. I understand I must be physically in the state of Kentucky during my therapy session.

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