By: James Varrell, M.D.

Originally published on Arizona Telemedicine Program

As a child and adolescent psychiatrist practicing in person for a number of years, and eventually making the shift to telepsychiatry, I have observed the subtle differences and nuances between the two mediums of care.

In my experience, telepsychiatry can be particularly powerful when working with children and teens. I had one experience with a 15-year-old adolescent who was admitted to the hospital for the fourth time with continued severe abdominal pain that could not be attributed to a medical cause. The hospital staff was puzzled, as the diagnostic tests did not show any signs of ailments and there were no physical afflictions present in the child. Interestingly enough, the teen had already been evaluated by another psychiatrist at the hospital, who was unable to get the teen to “open up.”

However, a caring on-site staff member had noted the teen admired technology. She recommended that the telemedicine cart that was normally used in the ED be brought up to the teen’s room to connect him to a telepsychiatrist who specializes in child and adolescent psychiatry. It was clear he felt much more at ease talking with me on a screen than he had been talking with his in-person providers. During our session, I was able to leverage his interest in technology, as well as my child and adolescent psychiatry experience, in order to ease his reservations about sharing his story.  I found that in the past the teen had seen his brother shot in the stomach, causing psychological trauma that resulted in his abdominal pain.

Just as my experiences have shown, the effect of technology on children in a clinical setting has been researched and shown to have positive impacts in a number of ways.  In one study, adolescents reported that telemedicine promoted a transfer of power and control by allowing them to feel more comfortable with terminating a consultation or walking out of it, that the process is more structured, and that the adolescents feel better informed when speaking with a telepsychiatry provider, which can result in a better understanding, sense of shared responsibility and better decision making.

Although telepsychiatry is almost identical to in-person psychiatry, there are small adaptations providers can make to facilitate responses, especially in the case of special populations, including children and adolescents. Provider flexibility is often the key to success. Slowing down your speech, communicating with gestures and remembering to not infantilize your speech when evaluating children can all contribute to establishing a more effective patient-provider relationship. I educate other telepsychiatrists about games they can play and questions they can ask to encourage children to interact with them more freely. It can also sometimes be beneficial to involve a child’s parents or an on-site facilitator in the session to observe interactions. These tactics have helped me gain trust and encourage meaningful responses from children I have treated through telepsychiatry.

In the case of the boy with stomach pain, instead of providing continued costly and time-consuming medical intervention, we were able to get him the appropriate psychiatric treatment after our conversation.

The best care, especially for children, adapts to the preferences and needs of each individual. Telemedicine is a fantastic tool for increasing specialty care options and making sure that every person can access the right provider and the right type of care for them.


By James Varrell, M.D. | Jul. 07, 2017 – Original article on

Anna struggled to leave her home because of her severe anxiety and depression. Because her psychiatrist’s office was more than an hour away, the stress of commuting often made Anna’s symptoms worse. Anna needed a more practical treatment option and believed there had to be one out there. In her search, she discovered telepsychiatry.

Telepsychiatry is a growing and clinically effective way to provide mental health care via online video calls. One of telepsychiatry’s newest applications called direct-to-consumer (D2C) telepsychiatry is quickly becoming a popular solution for many struggling to find convenient and effective care. D2C telepsychiatry allows providers to deliver mental health care to individuals in their homes (or any other private space) using computers, tablets or phones.

For Anna, and the millions of people living with mental health conditions, this innovative option takes away the stress of commuting to and from an in-person office setting. Telepsychiatry sessions are also far easier to fit into busy schedules. With telepsychiatry, Anna could have her sessions at home after her children had gone to bed. Most importantly, Anna could now receive consistent treatment, empowering her to better cope with her conditions.

The Benefits of Telepsychiatry

Unfortunately, Anna is not alone. More than 55 percent of U.S. counties are currently without any psychiatrists at all. Even in areas that do have mental health professionals, there are simply not enough providers to go around. And because most psychiatrists are concentrated in cities, many people outside these areas, like Anna, endure long commutes to reach the nearest psychiatrist with available appointment times.

For those who share Anna’s experience, D2C telepsychiatry offers an alternative. Here are some of the many ways a person can benefit from telepsychiatry:

  • Convenience. Anyone can schedule appointments—even outside of traditional workweek hours—and can easily attend sessions using any computer, tablet or smartphone with a webcam in any private space with a reliable internet connection.
  • Increased access to care. Telepsychiatry expands choices for providers beyond those who are within driving distance. Any licensed provider in the individual’s state can offer services to them, allowing individuals to connect with the provider most appropriate for him/her.
  • High-quality care. With more providers to pick from, a person can choose someone who best fits their personality, needs and schedule. Reputable D2C telepsychiatry programs train their licensed providers in best practices of delivering care appropriately and effectively through telehealth. Technical support is also available for pre-session test calls.
  • Privacy. Telepsychiatry removes the fear of running into someone you know in the waiting room, while also protecting your information and following state and federal regulations. Many D2C telepsychiatry providers have annual audits to ensure their encryption systems meet HIPPA standards—this is how telepsychiatry providers differ from Skype or FaceTime.

Telepsychiatry makes it possible for people like Anna to receive care in a comfortable, familiar environment. This new form of treatment has the capacity to improve the lives of millions by increasing access to mental health care across the country.


James R. Varrell, M.D. is a child and adolescent psychiatrist who has been practicing telepsychiatry for 18 years and is the Medical Director of InSight Telepsychiatry. InSight’s direct-to-consumer division that accepts patient referrals for psychiatry and therapy is called Inpathy.