Image description: A blue and purple graphic shows an image of Dr. Churi and the text "Hear from a Psychiatrist: What's Online Psychiatry Like?"
If you've never had an online psychiatry visit before, you might have some questions about how the process works. Dr. Churi, Amwell’s staff psychiatrist, shares answers and helpful information about telepsychiatry.
What is your role in providing care?
Psychiatrists with Amwell primarily provide medication management. Many patients who see a psychiatrist talk with a therapist as well. Therapists are trained in talk therapy (using approaches like Cognitive Behavioral Therapy to build coping skills) and are available to meet for longer periods of time to talk, listen, and provide support.
What types of conditions can a psychiatrist treat online?
There is no condition or diagnosis that we cannot treat with telemedicine. We can help with just about any diagnosis in the DSM-V.
Now, there is always a caveat to that, as certain diagnoses may require a lot more wraparound care. For example, I might recommend in-person care for eating disorders, dementia, or if someone needs some assistance with finances or housing. During those situations, it's typically better to have care managed in a community mental health center.
Some of the most common conditions we treat in collaboration with primary care and a therapist are anxiety, PTSD, OCD, bipolar, and depression.
When is medication appropriate?
There are a few factors to consider here. There is an objective piece where I will say as a physician, "You are appropriate for starting medications and will benefit in these ways."
There is also a subjective piece where I consider your preference towards medication. I can provide the options, risks, benefits, and how we would proceed if you went this route.
Having said that, there are certain diagnoses, such as bipolar and psychosis, that do require medications for a patient to feel stable and able to function at their best.
When it comes to common conditions like anxiety and depression, some questions I ask are:
- How are your symptoms impacting your life? Are they impacting your relationships, your job, or the time that you spend with your children or pets?
- Are your symptoms lasting a couple of weeks and you find yourself bouncing back? Or, has this been going on for over 12 weeks, or even six months?
If your symptoms are ongoing and pervasive, we probably do want to address them with medication. I also focus on the distress the patient experiences. One person might be able to cope and figure out some strategies to deal with two weeks of anxiety, while another person might find it so distressing that it impacts their functioning. We’re all different! It’s important to get the care you need.
When is it a good idea to see a psychiatrist? Do I need to see a primary care provider (PCP) first?
If you're not feeling well and think you need to see a psychiatrist, don't stop yourself. Go ahead with that!
There are different avenues by which you could see a psychiatrist. There's no right or wrong answer. You can self-schedule an appointment with Amwell. You could also start by contacting your PCP (or your therapist) and get a sense of "Hey, can I get the treatment rolling?" That can help prevent any delays and lead to collaborative care.
How does collaborative care work?
With collaborative care, you (the patient) are in the center and there's a team rooting for you. The team might include a psychiatrist, PCP, and a therapist. The PCP is usually the primary prescriber and the psychiatrist has a consultative role for medication management, tracking symptoms, providing psychoeducation, and recommending community resources.
Often, there is also a care manager who helps track the patient's response. Technology can replace that role because you can always send secure messages to check in.
One great benefit of Amwell is that you have full visibility into the documentation and the evaluation we do. That's a great resource to be able to take it to your primary care office. Often, I will also check in with the PCP or other provider and give my contact information. We function together as a team for the patient.
Can you prescribe controlled substances?
Currently, we do not prescribe controlled medications via telehealth. If a controlled medication is indicated after thorough evaluation, I can collaborate with the PCP and recommend the medication, dosage, alternative options, and monitoring recommendations. The medication is then prescribed by PCP, while I play a role of consultant.
Do you need a diagnosis to see a psychiatrist?
There’s no need to have a diagnosis before seeing a psychiatrist. I often do new evaluations for a nuanced set of symptoms.
At the same time, if you do have a diagnosis, it's always helpful to have that past history and we typically go over that in your intake appointment.
How does telehealth help make psychiatry more accessible?
The most meaningful part of the work I do is hearing from patients about how telehealth has helped them access care.
It could be transportation or that there's no psychiatric care close by. It could be stigma or fear and having a visit from home is more comfortable, especially if someone is experiencing severe anxiety. Being able to have a visit from home offers a safe space.
Other times, telehealth is so helpful simply for its flexibility. You don’t have to drive or sit in a waiting room. It’s convenient for many patients, especially for older adults or parents with young kids.
How often should I see a psychiatrist?
There is no standardized treatment plan across all patients. Your psychiatrist will work with you to find the right treatment plan and appointment schedule — whether it’s an initial evaluation and a few follow-up appointments during the year or more regular check-ins.
What’s an initial intake appointment like?
The initial appointment is usually one hour. During the first visit, I get to know you and I also ask about a few topics, including:
- What led you to schedule a visit?
- What is your history (medical history, psychosocial history, substance use)?
- What are your current symptoms?
I also ask about any other medical conditions because those can impact your mood and functioning. Then, I determine a treatment plan and share any medication options.
I like to make a shared decision with the patient. I might say, “These are our options. This is what I ideally would recommend. What are your thoughts and questions?”
Then, if any labs are needed, we get started on that.
How do follow-up appointments with Amwell work?
These are shorter check-in visits for medication — usually about 15 minutes. Some patients might need closer follow-ups and other times we can stretch out the visits.
Having that secure messaging system with Amwell is great. The patient can reach out to me whenever they need to and say they would like to see me if they aren’t feeling well.
It's a helpful way of communicating and I encourage patients to use the messaging feature.
How has COVID-19 impacted what you’re seeing with patients?
There are a lot of new diagnoses. The statistics are showing nearly double the rates of depression and anxiety compared to before the pandemic. People will say, "You know what? I've never struggled with this sort of feeling before and the isolation is really catching up on me." Additionally, people who were stable for several years have found themselves relapsing.
Having said that, one positive thing I am seeing is that there are people reaching out for help today who did not feel comfortable reaching out several years ago. The pandemic has opened a platform to be able to talk about mental health. People are more okay saying, "I'm not feeling okay today. I probably need to talk to a psychiatrist or a therapist."
There are higher rates of diagnoses but there are also more people who feel more comfortable saying “I'm not feeling well.”
Do you have any final tips for patients having a psychiatry visit with Amwell?
Yes! Here is some information to keep in mind:
- At this time, you must be 18 years or older to have a psychiatry visit with Amwell.
- Your location matters. Make sure you’re starting your visit from the same location you booked your appointment. If you move or are traveling, be sure to update the state you’re in so you can see a psychiatrist who is licensed in your area.
- Before your visit, check your technology and internet connection to be sure it is working so we can communicate well.
I look forward to meeting you!