Before 2020, fewer than one in fifty psychiatric visits in the United States happened over video. By the middle of that year, more than half did. Five years on, telepsychiatry has not retreated to its pre-pandemic floor — it has settled into a permanent place in mental health care, and a growing share of people with schizophrenia now see at least some of their providers remotely.
The natural question, asked at the time and still asked now, is whether seeing a psychiatrist through a screen is as good as seeing one in person — particularly for a condition where assessment depends on subtle cues, where patients sometimes lack insight, and where physical exams (for things like extrapyramidal symptoms) have always been part of standard care.
For ongoing maintenance care of stable schizophrenia, telepsychiatry produces outcomes broadly comparable to in-person care — but it is not equally suitable for all patients or all visit types.
What the evidence now shows
The pre-pandemic literature on telepsychiatry in schizophrenia was already cautiously positive. A 2018 review in Telemedicine and e-Health by Sharp and colleagues found that videoconferenced psychiatric assessments produced ratings on standard symptom scales (PANSS, BPRS) that matched in-person ratings closely, and that medication management could be delivered remotely with comparable adherence and relapse rates.
The pandemic vastly expanded the dataset. A 2022 analysis of US Veterans Health Administration data (the VHA is the largest single provider of mental health care in the US) by Crowley and colleagues found that veterans with serious mental illness who shifted to telepsychiatry during 2020 had no increase in psychiatric hospitalisations or mortality compared to those who continued in-person care. Studies from the UK, Australia, and Canada have reached broadly similar conclusions.
This does not mean telepsychiatry is identical to in-person. It means that, for the average patient already engaged in care, the medium of the visit matters less than the relationship and the medication.
Where it works particularly well
Maintenance medication management
Routine 15-to-20-minute follow-up visits — refilling prescriptions, checking side effects, reviewing labs — translate cleanly to video. For patients on stable regimens of aripiprazole, risperidone, or other oral antipsychotics, the difference between video and in-office is mostly logistical.
Geographic access
For people in rural areas, places without a local psychiatrist, or those without reliable transport, telepsychiatry has been transformative. The simple fact that a visit can happen has shifted from a real barrier to none at all.
Continuity during transitions
Patients moving cities, leaving hospital, or going to college can often continue care with a familiar clinician temporarily, smoothing the kind of handoffs that have historically been a relapse risk.
Family-inclusive visits
It is dramatically easier to include a parent in another state, or a sibling who works during clinic hours, on a video visit than in person. For schizophrenia care, where family involvement matters, this is an underappreciated advantage.
Where it does not work as well
Initial assessments
A first psychiatric evaluation for suspected psychosis benefits from in-person observation. Subtle motor signs, the quality of eye contact, the texture of disorganisation — these are easier to read in a room. Many systems do an initial in-person evaluation and then move to video for follow-up; this seems reasonable.
Active psychosis or crisis
Acute psychotic episodes, severe agitation, and any situation involving imminent risk are not well-served by video. The clinician's options are sharply reduced, and the patient may not be able to engage in the visit format. See when to call 911 and crisis stabilization units.
Long-acting injectable visits
If you receive an LAI like Abilify Maintena, Invega Sustenna, or Perseris, the injection itself has to happen in a clinic. Some practices split the visit — a video check-in with the prescriber, a separate in-person trip for the shot.
Patients with low digital access or paranoia about technology
A patient who cannot reliably use a smartphone, or for whom a camera in the room becomes part of a delusion, is not a good fit for video-only care. Telepsychiatry should be offered, not imposed.
Practical things that affect quality
- Internet stability. Frequent freezes break the visit. A wired or strong-Wi-Fi setup matters more than people expect.
- Privacy at home. Patients in shared housing or family homes may have nowhere private to talk. Some clinics offer a private room with a tablet for telepsychiatry visits.
- Clinician-side setup. Eye level camera, good audio, professional background — small things that signal seriousness.
- Audio-only as fallback. A phone call still counts as telepsychiatry under most US insurers, and is often more accessible than video. Outcomes are slightly worse than video, but much better than no visit at all.
Insurance and regulation
The pandemic-era flexibilities in US Medicare and Medicaid have largely persisted, with continued telehealth coverage for mental health that is on par with in-person visits. Regulations around prescribing controlled substances over telehealth remain in flux, but most antipsychotics are not controlled and are unaffected. Internationally, coverage varies. SAMHSA and the American Psychiatric Association publish current guidance.
What to ask your provider
- How often will we meet in person versus by video?
- How do we handle a missed video visit — call, message, reschedule?
- If I'm in crisis, how do I reach you, and what's the backup?
- Do you offer audio-only visits if my video isn't working?
- Will labs and any required physical exams be coordinated locally?
The honest summary
Telepsychiatry is not a downgrade. It is also not a free lunch. For most stable patients with schizophrenia, used thoughtfully alongside occasional in-person visits, it expands access without sacrificing quality. The wrong question is "is video as good as in person?" The right question is "does this format support this patient and this visit?"
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.