What is Telepsychiatry?: A Guide to Getting Started

In 2020, the Substance Abuse and Mental Health Administration (SAMHSA) conducted the National Survey on Drug Use in Health. The organization found that one in five Americans aged 18 and up experienced a mental illness, representing about 21% of all U.S. adults. Of these people, 46.2%, or less than half, sought mental health treatment or services for their condition.1 This means that about 10% of the U.S. population goes through life with an untreated mental health condition.

With 53 million people suffering from mental health disorders, the need for private, affordable, and accessible mental health care has never been higher.2 Telepsychiatry offers the option to seek help from the comfort of your home, your car on a lunch break, or wherever you feel most comfortable. This guide will break down all you need to know about the fast-growing field of telepsychiatry.

Telepsychiatry connects you with a licensed psychiatrist for psychiatric medication management (including getting new prescriptions, renewing previous prescriptions, and helping you come off of ones that don’t work anymore) over the Internet using video calls.

According to recent research, the U.S. has one of the highest rates of reported mental health conditions compared to other high-income countries. One contributing factor to poor mental health is unmet socioeconomic needs, such as access to adequate food, work, and shelter, which also makes it difficult to access mental health services.2 Other common barriers people experience when it comes to seeking psychiatric treatment include:3

• Having little to no faith in treatment
• Being concerned about cultural or social stigma
• Living in a rural or low healthcare access area4
• Not being able to afford treatment
• Having insufficient or no insurance
• Not having the time to seek treatment
• Having negative experiences with healthcare providers in the past

The burden of mental health on American society illustrates the need for increased access to mental health care. Although U.S. adults are more likely to seek help than adults in other high-income countries, one in six people are still unable to access or afford care.2

Telepsychiatry (also known as telemental health care, e-mental health, and telemental health) changes that by increasing access to care. Many telepsychiatry services offer appointments at a fraction of the cost of in-person visits and are more likely to take patients without health insurance without charging an arm and a leg.5 Because telepsychiatry is a remote service, all you need to participate is an Internet connection and private computer access. Having help with your mental health in the comfort and privacy of your home is an invaluable experience that bridges the disparities in-person therapies often create.

History

Though telepsychiatry seems new and even trendy, it began decades ago. In 1959, the Nebraska Psychiatric Institute took advantage of new technology and began using videoconferencing to conduct medical training, give lectures, and provide long-term and group therapy.4 In the decades following, telepsychiatry was practiced in many ways from remote psychiatric consultations at airports, prisons, and courts to being employed worldwide, particularly in Europe. Popularity and interest in telemedicine grew as research was done to determine its efficacy, giving rise to groups like the American Telemedicine Association in 1993.4

The COVID-19 pandemic transformed telepsychiatry from a convenient option to a necessary service overnight. Lockdowns and fear of a new deadly virus led to a 25% increase in mental health disorders worldwide. People turned to telepsychiatry to alleviate symptoms of anxiety, depression, and other conditions when it wasn’t safe to leave the house. Online psychiatry and mental health providers have remained more popular since 2020; you’ve probably heard of TalkSpace, Cerebral, or BetterHelp. The momentum started by the pandemic made telepsychiatry the second most practiced form of telemedicine.5

On paper, telepsychiatry has all the hallmarks of a successful alternative to in-person treatment. It’s convenient and affordable for many, and increases access to care. However, telepsychiatry has its own set of pros and cons beyond traditional psychiatry and may not be the right choice for everyone. Not everyone has access to high-quality Internet or the technological know-how to access the types of electronic devices capable of videoconferencing.

Understanding how insurance and prescription medications work in telepsychiatry is crucial before signing up for any e-mental health service. Teletherapy and telepsychiatry sound similar, but are two different fields: psychiatrists can prescribe medications, and some also perform therapy or offer therapy services within the same office or company. Therapists exclusively perform therapy and don’t have medical degrees, so they cannot prescribe medications. Your appointment costs will also vary depending on who you see and whether or not your insurance covers your visits.

Benefits & accessibility

The huge mental health burden in the U.S. is due in part to a disproportionate amount of mental healthcare professionals: there are only about 105 professionals per 100,000 people.2 Because psychiatrists must have an M.D. (with the exception of psychiatric nurse practitioners, who also need advanced training), there are even fewer practicing providers. This staggering difference could explain the difficulty in finding mental health services and obtaining an appointment, as only one-third of primary care practices provide mental health care, and it’s often very limited to mild symptoms and a handful of medications.2

Remote sessions are proven to be just as effective, if not more, than in-person mental health care.4 We’ve outlined the most important benefits of telepsychiatry below.

Outcomes & barriers

The benefits of telepsychiatry are enticing and hold a lot of promise for future practice. However, telepsychiatry is not for everyone. Some conditions can be exacerbated in a remote session or cause increased stress and frustration in some people. In-person meetings remain the most appropriate form of treatment for these individuals. Telepsychiatry has been especially beneficial for individuals with the following conditions:

Although research indicates higher satisfaction and better outcomes in patients who use telepsychiatry, it’s not for everyone. Some psychiatrists prefer in-person therapy for certain patients due to safety concerns.9 People who are likely to benefit more from an in-person therapy session include:11

• People at risk for exhibiting violent and self-harming behavior during a therapy session
• Older adults, children, and disabled patients who have difficulty operating an electronic device
• Elderly patients with dementia
• Patients with ADHD who may become distracted by technology and have trouble focusing
• Patients with paranoia about technology and recorded sessions
• Patients living in dangerous situations, such as victims of sex trafficking, domestic violence, and abuse, who may be at risk of being overheard by abusers.

To have a private telepsychiatry session, having access to high-quality Internet and devices capable of video conferencing is necessary. People living in rural areas and those with unmet socioeconomic needs face the reality of not being able to afford or access either in-person or remote treatment. Increasing access to computers and the Internet in these populations will be instrumental in increasing mental health services.

Telepsychiatry can encompass many different services: diagnosis of mental health conditions, prescription medication if necessary, and sometimes therapy for monitoring and managing your symptoms. These services will likely be covered, at least in part, by your health insurance. Although restrictions remain, particularly for Medicaid, the COVID-19 pandemic led to the development of new and improved insurance models for telepsychiatry.13 Some services don’t take any insurance, instead opting for a flat-rate payment per appointment subscription model; these are going to be your best option if you are uninsured but need support.

Don’t confuse popular online therapy providers for medical professionals. Although these therapists are licensed and certified, most do not accept insurance and cannot prescribe medication like online psychiatrists. These services usually offer a monthly subscription package for treatment and may also provide financial aid. Of course, there are services and providers that accept insurance, offer therapy, and can prescribe medication, such as Talkspace, but be sure to read the fine text if you know you’ll need the full suite.

If you’re interested in an online service but don’t know where to start, check out our guide to online psychiatrists to learn more about the most popular providers and what they offer. Once you have an appointment scheduled with your chosen provider, you’ll need to prepare just as you would for an in-person session. Make sure you’re in a well-lit room that you feel is private and comfortable.14

Ensure you have the telepsychiatry or telemental health provider’s software (such as Zoom) downloaded on your smartphone, tablet, or laptop, and ensure the microphone and camera are in working order. Though it’s not technically necessary, having high-speed Internet with an ethernet cable offers more stability than a Wi-Fi connection. Use headphones to clearly understand your provider and reduce distractions.

When it’s time for your appointment, log on to your provider’s platform. You’ll likely join a virtual waiting room and will be prompted to enter a room when your provider is ready. Just like an in-person appointment, have your prescription medications and supplements on hand to show to your provider should they ask. Remember to write down any questions or concerns before the appointment to make the session run more smoothly. And don’t forget to breathe: they’re here to help.

Telepsychiatry is a great option for people experiencing a mental health condition who think they might need medication. Before signing up for any telemental health service, take your resources and limitations into account. If it fits your lifestyle safely and is cost-effective, telepsychiatry can be a great way to manage your mental health, time, and money. If you already have a psychiatrist or mental health provider, ask them if they provide remote sessions; many are willing to make the switch without any extra fees.