Telehealth psychiatry: when it works, when it does not

Telehealth psychiatry has become a normal part of Australian mental health care. For some people it has been transformative, particularly for those outside the inner suburbs of a capital city. For others it has obvious limits. This piece walks through where it works well, where it does not, and what to expect if you are thinking about it.

What telehealth psychiatry actually is

Telehealth means a video consultation, not a phone call (although Medicare does still cover some phone consults in particular circumstances). You are at home or at work or somewhere private. Your psychiatrist is in their consulting room. You see and hear each other through a secure video link. Other than the screen, it runs like any other psychiatry appointment.

Medicare covers telehealth psychiatry consultations with a valid GP or Nurse Practitioner referral, with the same item numbers and similar rebate structure as in-person consultations. There are some specific rules about who is eligible for telehealth rebates; your psychiatrist or their practice will check this before you book.

Where telehealth works well

Review appointments, once your psychiatrist knows you. Most ongoing psychiatric care is conversation, and that translates to video without much loss.
Medication titration check-ins, where the question is "how is the dose going, any side effects, any concerns".
Regional and rural patients who would otherwise have a four-hour round trip to see a specialist. Telehealth makes ongoing care viable that simply was not before.
People with mobility issues, chronic illness, or carer responsibilities that make leaving the house difficult.
Working adults who would otherwise need to take a half-day off to attend a 50-minute appointment.
Stable patients on long-term treatment who need an annual review for shared-care continuity.

Where telehealth has limits

First assessments. We prefer to do these in person. A first appointment involves picking up on a lot of subtle information: body language, how you are physically presenting, the room you walk into the consultation feeling like. That is much harder to read by video, and the assessment is the foundation of everything that follows.
Acute or crisis situations. Telehealth is not the right setting for someone in immediate distress; there is too much that cannot be done from a screen.
Complex new presentations where your psychiatrist needs to take a thorough physical-health history and may want to examine you.
Situations where you do not have a private, quiet space at the time of the appointment. A psychiatry consultation that someone else can overhear is not workable.
If the technology keeps cutting out. Most of the time it is fine, but if your internet is unreliable a phone call is sometimes a better fallback.

What to expect on the day

A few practical things help telehealth go well:

A private, quiet room. A bedroom, a closed office, even your parked car if it has to be. The key is that you are alone and cannot be overheard.
A laptop or tablet rather than a phone, if you can. The bigger screen makes it feel less rushed.
Headphones. Both for privacy and because the audio quality is meaningfully better.
Good lighting. A lamp or window in front of you, so your face is lit rather than backlit.
Your medications nearby, in case the clinician wants to check something on a label.
A glass of water. The appointment runs the same length as in person, usually 30 to 50 minutes for a review.

Our approach

We do your first appointment preferably in person at our Melbourne clinic. After that, review consultations can be delivered by telehealth across Victoria. For most patients this means in-person assessment, in-person follow-up shortly after to confirm everything is on track, and then video reviews from there on.

For regional patients particularly, this rhythm makes ongoing specialist care viable in a way that monthly trips to Melbourne are not. For Melbourne patients, it usually means an extra hour or two back in your day per review.

Next step

For more on how our ongoing psychiatric care works and where telehealth fits, see our Psychiatry Care page . To start an enquiry, send a short message . We will call you back within one working day.