Telehealth for mental health: how online therapy and psychiatry work

What works well by video

Much of outpatient mental health care is conversation, which carries over to video well. Many practices offer therapy, medication management follow-ups and many initial evaluations by telehealth. For people with long drives, unpredictable schedules, limited transport or mobility problems, it can be the difference between getting care and not.

Some people simply prefer it. Others find it harder to open up through a screen. Both are fine, and you can usually switch between video and in-person visits if the practice offers both.

Telehealth can also make it easier to keep a steady schedule, which matters in mental health care. A lunch-break session from a parked car is often more realistic than an hour of driving each way, and regular visits tend to be more useful than occasional ones.

What may still need an in-person visit

Some things are hard to do by video, and a practice may ask you to come in at least occasionally.

• Physical checks such as blood pressure or weight, which some medications require.
• Lab work, which happens at a lab regardless of how your visit is held.
• Some controlled medications. Federal rules on prescribing them by telehealth have been changing, so ask the practice how they currently handle it.
• Situations where the clinician needs a fuller picture than a camera gives.

Why your location matters

Health professionals are licensed by states. HHS guidance on telehealth says a clinician generally needs to be licensed, or otherwise legally permitted to practice, in the state where the patient is located. For you, that means the state you are physically in during the visit, not where the practice is based or where you usually live.

In practice: a clinician licensed in Tennessee can generally see you by video while you are in Tennessee. If you will be travelling, at college in another state, or living near a state line, tell the practice. Some states allow short temporary practice for existing patients and some do not, so ask before you assume a visit from out of state is fine.

Expect to be asked where you are at the start of each visit. That is partly for licensing and partly so the clinician knows where to send help in an emergency. If you move to another state, tell the practice before your next visit rather than at it.

Keeping it private

Practices covered by federal health privacy law have to protect your information on video as they would in an office. Your part is the room you are in.

• Use a room with a door, or your car parked somewhere quiet.
• Wear headphones so others nearby cannot hear the clinician.
• Avoid shared or work computers where you can; use your own device.
• Use the link or app the practice gives you rather than a personal video account.
• If someone walks in, it is fine to pause. Agree a signal with your clinician in advance if that helps.
• If you cannot get privacy at home at all, tell the practice. A phone visit, a different time of day or an in-person visit may work better, and clinicians would much rather adjust than have you hold back.

Questions to ask the practice

Telehealth arrangements differ from one practice to the next. A few questions when you book prevent surprises later.

• "Can my first visit be by video, or does it need to be in person?"
• "Which app or link do you use, and do I need to download anything?"
• "What happens if the video connection fails partway through?"
• "Will I ever need to come in, for example for checks or certain medications?"
• "Do you bill my plan the same way for video visits as for office visits?"

Tech tips that save the session

Most lost minutes in telehealth are technical, and almost all of them are avoidable.

• Test the link, camera and microphone the day before, not five minutes before.
• Charge the device and plug it in if you can.
• Close other apps that use the camera or a lot of bandwidth.
• Sit facing a window or lamp so your face is visible.
• Save the practice's phone number so you can call if the video drops; many practices can finish by phone.
• If your home internet is unreliable, try your phone's data connection, or ask whether a phone visit is an acceptable backup.
• Join a few minutes early. Many platforms put you in a virtual waiting room until the clinician lets you in.

Coverage and emergencies

Many plans cover telehealth mental health visits, but not always in the same way as in-person visits. Ask your insurer whether video visits have the same copay, and ask the practice whether they bill your plan for telehealth.

Telehealth is not an emergency service. If you are in crisis, call or text 988 for the Suicide and Crisis Lifeline, or call 911 if you are in immediate danger.