Telehealth psychiatry in Australia: how it works and MBS context

Psychiatry was one of the earliest and strongest use cases for telehealth in Australia, and it remains one of the best. Much of the assessment is history and mental state examination, the evidence for video delivery is well established, and it dramatically improves access for people who can’t easily reach a psychiatrist in person. The RANZCP supports telehealth as an effective way to deliver psychiatric care, noting that studies show outcomes comparable to in-person consultations (RANZCP).

Here’s how telehealth psychiatry works, and what to keep in mind clinically and on billing.

How telehealth works in psychiatry

In practice, telehealth psychiatry is usually a scheduled video consultation: initial assessments, medication reviews, and ongoing management delivered by videoconference, sometimes with a GP, support worker or family member at the patient’s end. Telehealth became a permanent part of Medicare in 2022 and now sits alongside face-to-face care as a standard delivery option (Department of Health, Disability and Ageing).

The access benefit is real and specific to the specialty. Psychiatrist distribution across Australia is heavily weighted to metropolitan areas, so for rural and remote patients, video may be the difference between timely specialist input and a months-long wait or a long drive. The RANZCP highlights improved access for rural and remote populations as one of telehealth’s clearest advantages (RANZCP).

What the RANZCP expects

Telehealth doesn’t lower the bar. The RANZCP’s professional guidance frames video consultations as being held to the same clinical and ethical standards as in-person care, with attention to privacy, consent, technical quality and the suitability of each patient for remote assessment. The college publishes professional practice guidance, privacy checklists and technical specifications for psychiatrists setting up telehealth (RANZCP).

Telehealth in psychiatry works best as a considered clinical choice, not a default. The question for each patient is whether a video assessment can meet the same standard as seeing them in the room — and having a clear plan for the times it can’t.

The MBS picture for psychiatry telehealth

Psychiatrists have their own set of MBS telehealth items, generally paralleling the face-to-face specialist items and split by video and phone, and by whether the consultation is an initial or subsequent attendance (Services Australia). A few features are worth knowing:

• Video is the primary telehealth modality, with phone available in more limited circumstances.
• There are patient-end support items that another practitioner (often a GP) can claim for supporting the patient at their end during a specialist video consultation.
• Some telehealth arrangements carry loadings or specific items for patients in regional, rural and remote areas, reflecting the access rationale above.

Fees, item numbers and conditions change with each MBS update, so describe the arrangement to patients in general terms and check the current MBS for the exact item before you claim. For how the items are organised across provider types and modalities, see our overview of telehealth MBS item numbers.

Prescribing and shared care

Psychiatrists can prescribe by telehealth within the usual clinical and regulatory rules, and electronic prescriptions make that straightforward. The important exception is controlled drugs: Schedule 8 medicines are governed by state and territory legislation and real-time prescription monitoring, and telehealth doesn’t change those obligations — the same authorities and checks apply as they would in person (see Schedule 8 controlled drugs, telehealth and RTPM). This is particularly relevant in areas such as ADHD care, where stimulant prescribing rules vary by jurisdiction.

Telehealth also supports shared care well. Once treatment is established, coordinating reviews with the patient’s GP — sometimes with the GP or a support person joining at the patient’s end — keeps care connected without needing everyone in the same room.

Safety, suitability and the mental state exam

The core clinical skills translate to video, but a few things need deliberate attention:

• Confirm identity and location at the start of every consult, and keep a call-back number and the patient’s local emergency and crisis service details on hand. If a patient becomes acutely unwell or at risk during a session, you need to know where they physically are.
• Assess suitability honestly. Acute risk, significant cognitive impairment, or presentations where subtle physical or behavioural signs are central may be better served in person, or with a support person present.
• Adapt the mental state examination. You can observe appearance, speech, affect, and thought process well on video, but be alert to what the frame hides — psychomotor signs, the smell of alcohol, the full room. Narrate and ask more than you would in person.
• Get and document consent to the telehealth format, note who else was present, and record any limitations of the remote assessment.

Our general guide to running a great telehealth consultation covers webside manner, safety-netting and documentation in more detail, and much of it applies directly to psychiatry.

Platform and privacy

Psychiatric consultations are among the most sensitive in medicine, so the platform matters. You want reliable video, genuine privacy, and no recording by default. MedCall is made for Australian clinicians and lets the patient join a 1:1 video call by tapping a texted link — no app, no account, no download, which is a real advantage when a patient is anxious or unwell. Calls are Australian-hosted and never recorded, and 1:1 video is end-to-end encrypted. Your bookings, notes and billing stay in the software you already use.

Where a colleague such as a GP is supporting the patient at their end, the low-friction join is doubly useful — one texted link, and everyone is in.

The bottom line

Telehealth psychiatry is well evidenced, permanently funded, and one of the most effective ways to widen access to specialist mental health care in Australia. Hold it to the same standard as in-person care: assess suitability for each patient, adapt the mental state examination to the medium, plan for risk, and confirm the exact MBS item on the current schedule before claiming. For the college’s resources, see RANZCP telehealth in psychiatry; for the billing overview, see Services Australia. Whether you consult solo or coordinate shared care with a GP or psychologist, the same platform principles apply on both sides.