13 Common Questions about Online Psychiatry for Children and Adults
When considering mental health solutions for you and your family, it’s important to make sure you understand your options. Telemental health care, when delivered by experienced and well-trained mental health providers, is equivalent to in-person care for the majority of mental health challenges.
While online psychiatry is well-established, and has a documented history of success, it’s natural to still have questions.
You’ll learn the answers to 13 questions about online psychiatry specifically, and digital mental health care more broadly.
Let’s start with the difference between online psychiatry and other types of mental health care. Then, we’ll explore benefits, risks, and more.
1. What’s the difference between online psychiatry and online mental health care?
Psychiatry refers to a specific medical discipline; online psychiatry is simply psychiatry, delivered online.
Psychiatrists are medical doctors who complete 4 years of medical school and then 4 years of adult psychiatry residency. Child psychiatrists complete another 2 years of child psychiatry fellowship.
Many digital mental health platforms, sometimes referred to as online mental health care, provide comprehensive mental health care which includes evaluation, therapy, and medication (if indicated). Most, if not all, online mental health platforms, are staffed by a range of mental health experts, not only by psychiatrists. So, when you access mental health care digitally, you might be experiencing online psychiatry, online therapy, online coaching, or the like.
2 What are some benefits of online psychiatry or mental health care?
There are a wide range of benefits to online psychiatry and mental health care:
Access: Adults and children in the US face a mental health crisis. Getting access to mental health care can be extremely challenging, particularly people who live outside major metropolitan areas or in rural areas. In addition, the average waitlist can be weeks or months long. Telemental health care vastly increases access to care, and is critical to solving the adult and mental health crisis.
Convenience. You do not have to take the afternoon off of work to travel to appointments, or pull children out of school to make it to your appointments. Digital mental health care allows you to connect with mental health experts when and where it’s convenient for you.
Comfort: With online mental health care, providers are meeting with families in their homes and thus learn a lot more about the natural family dynamics and context. Often children feel more comfortable talking with a psychiatrist or therapist from their home, rather than in an office.
Connection: With online mental health care, patients can also access asynchronous messaging and other digital resources that are not available in office settings. There’s also data showing reduced cancellations and no-show appointments with telehealth.
Access to Specialty Care: Online mental health care can allow you to more easily connect with specialists who may not otherwise be available in your area. At Little Otter we provide specialized, evidence-based care for a range of children’s mental health disorders and for special groups of children including infants and toddlers and preschoolers, medically ill children etc. You would not find the breadth of expertise at Little Otter in most clinics, except maybe in academic medical center clinics.
Involve the Whole Family: Telemental health care for kids increases participation by multiple caregivers. In one study, dads participated in 95% of digital sessions compared to 5% of in-person sessions.
Quality Control: Online mental health care sessions are often recorded for quality control. At Little Otter we record all of our video sessions for the purpose of supervision and quality control. The care is better, because we actually know what is happening in the sessions.
Access is one of the most important benefits that online mental health care can offer.
Adults and children in the US face a mental health crisis. Getting access to mental health care can be extremely challenging, particularly people who live outside major metropolitan areas or in rural areas. Telemental health care vastly increases access to care, and is critical to solving the adult and mental health crisis.
This unmet need for mental health care for children and their families is why my daughter and I founded Little Otter, a digital child and family mental health platform.
Even before the pandemic, we were in a child mental health crisis with 1 in 5 U.S children having an impairing emotional, behavioral, or developmental disorders. Approximately 80% of these children receive no mental health care.
The pandemic and increasing rates of child mental health challenges has made the situation worse; in fact, the US Surgeon General, the American Academy of Child and Adolescent Psychiatry, and the National Children’s Hospital Association declaring a public health emergency in child mental health.
It’s clear that we’ll never solve the child mental health crisis by training more providers. Nearly three quarters of the counties in the U.S do not have even a single child psychiatrist.
Little Otter is a fully digital mental health platform for kids and families because the evidence shows that telehealth works and is the only way to improve both access to care and access to specialized care for children and families. At Little Otter, we believe that we have to leverage technology, data science, and telemedicine to find solutions to the child mental health crisis.
3. Do psychiatrists require a special designation to treat children and adolescents?
As noted above, child and adolescent psychiatrists (CAPs) undergo an additional two years of training to become a child and adolescent psychiatrist. There are also separate board certifications for child and adolescent psychiatry.
A child and adolescent psychiatrist is trained to optimize the emotional, cognitive, social, and physiological development of all children and adolescents. This developmental perspective is absolutely critical.
That’s why it’s vital for children and adolescents to receive mental health care from pediatric trained mental health professionals, including child and adolescent psychiatrists. In addition, CAPs are trained to work with parents, schools, and caregivers, too.
While adult psychiatrists aren’t prohibited from treating children and adolescents, it’s important to keep in mind that children and adolescents aren’t mini-adults. Developmentally appropriate care is essential for children and adolescents, and CAPs are trained to provide just that.
4. What ages do child psychiatrists treat?
Child and adolescent psychiatrists (sometimes referred to as CAPs) are trained to treat children from infancy through age 18. However, as we touched on earlier, all CAPs are fully trained adult psychiatrists, who complete an additional two years to specialize in child and adolescent psychiatry. Thus, child and adolescent psychiatrists are fully trained to care for people from birth through late life.
Some child and adolescent psychiatrists get additional training to treat specialized populations. These may include infant, toddlers, and preschoolers (early childhood mental health); forensics (child mental health related to the legal system, which can include juvenile justice, child custody, abuse against children etc); and substance abuse, to name a few.
5. Does psychiatry for children differ from that of adults? If so, how?
The short answer is that yes, mental health care for children is different from mental health care for adults, whether virtual or not.
As we’ll discuss in more detail, children aren’t mini-adults, so mental health care should be tailored to their unique developmental stage.
In addition, parents and/or caregivers are usually involved in care for children. CAPs work with parents as well as children. Usually, parents/guardians seek mental health care for children/adolescents, so the CAP has obligations to both the individual patient and the young person’s guardians.
In many cases, the patients of CAPs are legally considered minors. Thus, consent for treatment of the minor belongs to the child or adolescent’s legal guardian(s). Some jurisdictions might require consent by adolescents of a specified age. However, the child and adolescent psychiatrist, whenever reasonably possible, obtains the assent of the minor and the consent of the legal guardian prior to starting care.
Just like any kind of mental health care (and medical care), respect for the patient’s privacy is critical.
Thus, the child or adolescent has the right to privacy and confidentiality so they can safely reveal their feelings and thoughts. However, when the safety or welfare of a child, adolescent, or others is in jeopardy, the child and adolescent psychiatrist may have the ethical responsibility to divulge information to parents or caregivers, in spite of the patient’s confidentiality rights.
When circumstances permit, the child and adolescent psychiatrist should make a reasonable effort to inform the child or adolescent and other interested parties in advance of such disclosures.
6. How does virtual psychiatric care for children and adolescents differ? What are some considerations?
Virtual mental health care must include engagement with both the child or adolescent, and their parent/guardian. It’s important for the CAP to ensure that the virtual set-up enables be privacy for the child/adolescent during sessions.
Since children and adolescents are not mini-adults, CAPs and other pediatric mental health providers must provide developmentally-appropriate care that takes into account the child’s preferences and capacities.
At Little Otter, we specialize in providing virtual care to children from early childhood through age 14. We use toys, puppets, and use the whiteboard features of Zoom to engage with children. Children can access the Zoom on devices like iPads or phones, and show the provider their room or special places in the home. The device can be set up so the child can sit on the floor and not have to sit to look at the screen.
In general, children are very adept at managing screens and engaging in virtual therapy.
There are some types of assessment and care that are difficult to deliver virtually. At this time, it is not possible to conduct a gold-standard assessment for autism spectrum disorder virtually. This is why we do not provide diagnostic assessment of autism spectrum disorder at Little Otter, although we do provide outstanding care for co-occurring mental health disorders like anxiety and ADHD that many children with ASD experience. Another example would be initial diagnostic assessment for a child with psychosis, since this assessment should include neurological work-up, etc.
Other considerations are the severity of the child’s challenges. Children who need intensive inpatient or outpatient care will not be best served by virtual care.
Lastly, CAPs providing virtual care can work with the child’s pediatrician to provide initial physical exams such as height, weight, blood pressure, although parents can also collect this information using tools at their home.
7. How does online psychiatry relate to medication and/or therapy?
It’s important that children and their families have access to comprehensive psychiatric assessments, evidence-based therapy, and, when indicated, medication management. Since many psychiatrists provide therapy along with medications, it’s important to understand what type of care is needed.
For most conditions, children shouldn’t be receiving only medication for mental health challenges. Medication should be combined with evidence-based psychotherapy and psychosocial interventions.
For children, there are rarely situations where children should receive medication without them or parents being in concurrent psychotherapy. The only exceptions would be children who have completed a course of therapy and are stable on a psychotropic medication, and need medication check ups.
Whether an adult needs medication and/or therapy really depends on the diagnosis and the individual needs of the patient.
8. What are some challenges with online psychiatry?
The challenges with online psychiatry are similar to those with in-person psychiatry.
Just like in-person mental health care, telehealth care has to be high quality. In addition, it must address potential technological challenges, including weak internet connection or lack of familiarity with video calling.
Also like an in-person clinic, telehealth companies must also establish very clear protocols for responding to psychiatric crises and to after-hours emergencies.
It’s also critical that any telehealth company clearly define what conditions are - and are not - appropriate for fully digital care. Some serious mental health disorders, including psychotic disorders and bipolar disorder, may not be appropriate for online treatment. In addition, children with more severe illness may require more intensive care, such as an intensive outpatient program.
Moreover, some people will prefer in person care and that is totally fine!
9. Do you need a referral from a primary care doctor to start psychiatry?
People can seek care from a psychiatrist or mental health care provider themselves. The issue of needing a referral is specific to the rules of your insurance, and reflects whether your care will be covered by your insurance. The need for referrals isn’t a medical question, but rather a reimbursement question.
10. How does online psychiatry differ from in-person visits?
Telemental health care, when delivered by experienced and well-trained mental health providers, is equivalent to in-person care for the majority of mental health challenges. The differences are primarily experiential.
The key aspects of quality care are the same for in-person and telemental health care:
Highly trained, experienced, and competent providers.
Comprehensive psychiatric evaluations that identify the challenges, diagnoses, and needs of the patient.
Delivery of evidence-based care that’s tailored to the problem the patient is experiencing.
Availability for asking questions between sessions.
Clear plans and protocols for emergencies.
11. What kind of therapy do psychiatrists provide that therapists cannot?
The key difference is that psychiatrists are medical doctors who receive at least 8 years of training. Psychiatry is a branch of medicine focusing on diagnosing and treating mental health disorders. As such, psychiatrists are medical doctors who can prescribe medications, conduct full medical and psychiatric evaluations, and treat the full range of mental health disorders.
Many psychiatrists also provide psychotherapy. However, it is most common that patients do therapy with a psychologist or master’s level therapist, and that the psychiatrist provides psychiatric evaluation and medication management.
“Mental health therapist” is a non-specific term referring to professionals who are trained to provide mental health treatment. Other terms used are psychotherapist or counselor.
Psychologists are PhDs who have a master’s degree and doctoral degree in psychology. They also complete postdoctoral training. Psychologists, like psychiatrists, are trained to diagnose mental health issues and disorders and then provide psychotherapy. However, they cannot diagnose medication.
There are also Master’s-level therapists, such as Licensed Clinical Social Workers (LCSW), Licensed Marriage and Family Therapists (LMFT), and licensed counselors who hold a master’s degree and have completed supervised internship training.
12. What should someone consider when looking for a psychiatrist online?
If you’re specifically seeking a psychiatrist who delivers care online, whether via an online platform or a teletherapy practice, you’ll want to look for the same things you look for if it is in-person care:
What is the doctor’s training? Where did they train and what areas do they specialize in?
Are they a licensed professional?
How many years of experience do they have?
Do you know any people who have seen this provider?
Have you asked your primary care provider for referrals?
Reading reviews can provide some insights, but are not often accurate. However, you can learn a lot from the first session.
13. What can someone do if their medication runs out and they need a prescription that day?
This is up to your specific provider. Ask about this at your first session!
Little Otter provides online mental health care for children and their families.
We know that when one member of your family is struggling, it impacts everyone. That’s why we offer whole-family mental health care that meets your family where you are.
Learn more and join today.
