Is Online Psychiatry Right for You?

The first step in figuring out whether online psychiatry is right for you is to determine whether a psychiatrist or a psychologist would be a better fit for your mental health needs.

Just as psychiatry and psychotherapy offer different services in person, they also differ in what they can provide online.

A psychologist, therapist, or counselor, on the other hand, is a state-licensed mental health professional. Psychologists can diagnose mental health conditions and create treatment plans.

In most states, psychologists cannot prescribe medications. However, a few states allow psychologists with extra credentials to prescribe medications under the supervision of a primary care provider. These states include:

• Illinois
• Louisiana
• New Mexico
• Iowa
• Idaho

For most people, the first appointment with any new healthcare professional takes some time. During your first online appointment, your psychiatrist may:

• need to verify your identity
• ask you questions about your medical and mental health history
• request copies of your medical records
• talk about any lab tests or physical exams you might need
• explain how sessions work
• make sure you understand how to reach out in case of an emergency
• listen to your expectations, concerns, and goals
• recommend therapy or other treatment options

Later sessions will probably be shorter — possibly just 15 minutes to talk about how your treatment plan is affecting your symptoms or to discuss the side effects of any medications you’re taking.

Generally speaking, studies that have been conducted so far show that online psychiatry produces similar results to in-person appointments.

Research shows that psychiatric evaluations and assessments conducted using videoconferencing are as accurate and reliable as in-person assessments.

Although more long-term research needs to be done, there’s solid evidence that online psychiatry is as effective at creating good clinical outcomes as face-to-face psychiatry.

Yes, many medications that are used to treat mental health conditions can be prescribed by a psychiatrist during an online appointment.

Under normal circumstances, a psychiatrist needs to conduct an in-person exam or assessment before prescribing medications classified as controlled substances.

Some medications that are commonly prescribed for mental health conditions fall into this category. They include:

• stimulants such as Adderall and methylphenidate (Ritalin or Concerta), which are used to treat ADHD, depression, and other conditions
• benzodiazepines such as Xanax, Ativan, Klonopin, and Valium, which are prescribed for anxiety and panic disorders
• hypnotics such as Ambien, Lunesta, and Sonata, which can help with insomnia

As a response to the COVID-19 public health emergency, the Drug Enforcement Agency (DEA) temporarily changed these regulations. Psychiatrists are now allowed to prescribe controlled substance medications to online patients, but only in emergency situations.

The DEA is regularly reevaluating this regulation and will return to previous rules when the emergency declaration is lifted.

The number of telehealth providers is growing quickly. Here’s a glimpse of several popular online psychiatry providers.

LiveHealth Online

Visits cost $59 or less, depending on your plan.

All LiveHealth Online psychiatrists are board certified, and you can choose your own psychiatrist after reviewing their profiles.

Amwell

Initial evaluations run $269, and 15-minute follow-up sessions are $99.

Amwell psychiatrists are available across the nation. According to the website, you’ll probably have an appointment scheduled around 2 weeks after signing up.

Talkspace Psychiatry

The online therapy giant Talkspace has expanded its offerings to include psychiatric evaluation and treatment.

Initial evaluations are $199 and follow-up visits are $125.

One note: Talkspace describes its providers as “licensed psychiatric prescribers” not “psychiatrists.”

Online psychiatry appeals to some people and not to others. Here are a few questions to keep in mind as you think about your options and whether this is the right fit for you.

Is online psychiatry more convenient for you?

Online psychiatry and online therapy can expand options for people who live in places where there aren’t very many psychiatric practitioners.

If you live in a small community or rural area, the closest psychiatrist could be many miles away. Travel time, transportation costs, and the need to take time off from work could make in-person visits a hardship.

Online psychiatry may make it more convenient to get the care you need.

Does anxiety keep you from finding in-person mental healthcare?

For some people, the thought of leaving home, traveling to an appointment, and interacting face-to-face with a healthcare professional is enough to provoke anxiety or panic.

Online interactions may feel easier or less intimidating.

Are you unable to leave your home right now?

Does your health make it difficult for you to travel to an appointment? Are you a caregiver who can’t leave someone in need at home?

In these situations, online psychiatry can make it possible to get necessary services without venturing out.

Do you want to work with a psychiatrist with a particular specialty?

Research shows that large urban areas generally offer a greater variety of medical and mental health specialty services.

If you want to work with a psychiatrist who specializes in treating your condition, online psychiatry may make it possible for you to get that specialized care no matter where you live or work.

Do you want a psychiatrist who shares an aspect of your identity?

Finding a psychiatrist who feels like a good match is really important.

Online psychiatry could increase your access to healthcare professionals who are skilled at creating safe, accepting treatment spaces. This may be especially important if your health has been affected by discrimination or marginalization in the past.

Studies have shown that having a culturally responsive therapist can mean a more satisfying treatment experience.

How comfortable are you with technology?

For some people, dealing with apps, laptops, and video conferencing technologies can be stressful. The anxiety caused by learning the technology might not feel “worth it.”

Ask yourself if you feel confident in using technology for an online appointment. Or, do you have someone you can rely on to help you get it set up and working properly?

Another important point to keep in mind is whether you have a reliable internet connection. If you don’t have a strong, reliable internet connection, online psychiatry might not work well for you.

Do you have vision, hearing, or a disability that would make online sessions impractical?

For some people, accessing psychiatric services is complicated by a disability. Although assistive devices do exist, not everyone has them or feels comfortable using them.

Researchers have noted that some peoples’ hearing and eyesight made it necessary to have in-person visits.

Do you need a more affordable option?

Cost is a deciding factor for many people when it comes to choosing between healthcare professionals.

If you have health insurance, you will need to confirm coverage of online psychiatry services. Depending on your plan, you might also need to find out if the psychiatrist you want to see is included in your insurer’s provider network.

If you’re covered under Medicaid, your online psychiatry evaluations, medication monitoring, and psychotherapy are probably covered.

For a detailed explanation of what services are covered, contact your state Medicaid office or check this guide prepared by the National Telehealth Policy Resource Center.

Medicare Part B covers medical services including telehealth evaluations and psychotherapy. During the COVID-19 crisis, Medicare lifted the requirement that you have to live in a rural zone to get telehealth services.

Starting in 2020, some Medicare Part C (Medicare Advantage) plans began offering more coverage of telehealth services. To find out if online psychiatry is covered by your Medicare plan, check with Medicare directly if you have original Medicare. You can check with your insurer if you have a Medicare Advantage plan.

If you’re concerned about affordability, you can look for an online psychiatrist who offers a sliding scale or income-based fee structure.

Do you have concerns about privacy?

State and federal governments have set standards for protecting your personal information during telepsychiatry sessions.

If you want to be sure your online psychiatrist is keeping your information secure, you can ask whether they follow the guidelines issued by the American Psychiatric Association to:

• use a videoconferencing platform that is secure
• encrypt video and audio signals, along with encrypting patient data
• protect their devices with passcodes and two-factor authentication
• comply with all other HIPAA and state security regulations

Do you prefer an in-person interaction?

Some people simply don’t like interacting with a health professional online. You may be one of many who prefer to talk to a mental health professional face-to-face.

If that’s the case, you’re certainly not alone. In a recent analysis of telepsychiatry in Australia during COVID-19, researchers found that after an initial spike in online psychiatry, many people returned to the in-person care model when COVID-19 case numbers dropped.

Are you having a mental health emergency or thinking about self-harm?

If you need immediate help, don’t wait for an online appointment that could be weeks away. You can talk to someone supportive at one of the following helplines.

If you need help now

• Call the National Suicide Prevention Helpline at 800-273-8255.
• Text TALK to 741-741 to text with a trained crisis counselor.
• Reach the Substance Abuse and Mental Health Services Administration (SAMSHA) Helpline at 800-662-4357.
• Contact The Trevor Project Lifeline at 866-488-7386 or text START to 678-678.

Online psychiatry is a convenient, effective way of getting mental health treatment. It has also opened up the possibility of treatment for people who might otherwise have fewer options.

An online psychiatrist can evaluate your symptoms and coordinate with a primary care physician. They can also prescribe medication and work with you to create a treatment plan.

Finding the right psychiatrist takes patience. Online psychiatry isn’t right for everyone, but it may make the process easier by expanding your access and options beyond your geographic limitations.