Telepsychiatry

Domain IX · Biomedical, neuro & digital

What it is

Telepsychiatry (and its wider family, telemental health, telepsychology and online therapy) is not a therapy or school; it is a mode of delivering assessment, psychotherapy and psychiatric care at a distance, mainly by live video, also by telephone, and in hybrid combinations with in-person care.…

Format

• Telemental health has no fixed session count; it runs for the length of whatever therapy you deliver. The guidelines imply a sequence of set-up and per-session tasks, arranged here as six stages.
• Stage B. Intake, suitability and consent (first contacts). Goals: decide whether remote care is safe and suitable for this client, and obtain informed consent. Tasks: suitability and risk screening (4.3); a non-clinical technology test or "pre-session" (4.4); telehealth consent and contract (4.5);…

Who practises it, and how they are trained or regulated

• Stage A. Practice set-up (before any client). Goals: lawful, insured and secure practice. Tasks: confirm licensure for every jurisdiction where clients will be physically located (4.1); choose a secure platform and sign any required agreements (4.2); write policies for emergencies, disruptions, recording, communication and records (4.7, 4.10, 4.15, 4.21); confirm indemnity insurance covers online work in all…
• Version followed: APA/ATA Best Practices in Synchronous Videoconferencing-Based Telemental Health (American Psychiatric Association and American Telemedicine Association, March 2022) as the core procedure; the American Psychological Association's Guidelines for the Practice of Telepsychology (eleven guidelines, approved by the APA Council of Representatives in August 2024) for psychologists; UKCP Guidelines for…
• Who does what: psychotherapists, psychologists and counsellors deliver psychotherapy by video within their own licence and scope. Psychiatrists and other prescribers additionally prescribe by telemedicine under separate drug-control rules (US: the Ryan Haight Act and DEA telemedicine flexibilities; see 4.25). This guide is written for the psychotherapist; prescribing material is descriptive and for collaboration…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• AI note-takers enabled by default, clients relying on chatbots in crisis. Working: no undisclosed processing of session content.
• fragmented care across platforms, each clinician assuming the other holds the safety plan. Working: one shared, current emergency plan.
• recordings used in disputes or shared online; clients recording to replay you compulsively. Working: no recordings exist that nobody agreed to.
• gaps in supply, clients obtaining medicines from unregulated online sources. Working: the client has a plan with the prescriber for continuity.
• clinical content creeping into reminders, crisis disclosures by text out of hours. Working: written channels stay administrative unless deliberately agreed otherwise.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.