Can forensic psychiatry really be done remotely?

In recent years, courts and clinicians have had to grapple with that question as more psychiatric evaluations, depositions, and expert testimony moves online.

In this episode of The Telepsychiatry Advantage, Dr. Edward Kaftarian draws on his own experience as a forensic psychiatrist and expert witness to explain what actually changes when the work happens remotely — and what absolutely cannot. From malingering and competency evaluations to courtroom testimony and technical failures, he breaks down where video works, where it creates new risks, and when showing up in person still matters.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.

Telepsychiatry did NOT start during the pandemic. Heck, it didn’t even start with the internet.

Actually, remote medicine is more than a hundred years old, and modern telepsychiatry dates back to the 1960s.

The reason people have kept pushing telemedicine forward is the same reason it still matters today: geography can stand between a patient and the care they need. Someone in a rural community may live hours from the right specialist. A hospital may need expertise that simply is not available nearby. Remote care became a way to close that distance instead of asking patients to go without.

In this episode of The Telepsychiatry Advantage, Dr. Edward Kaftarian traces back the history of telemedicine: doctors using telegraphs and telephones to reach patients from a distance, the first psychiatric video programs in Nebraska, early hospital experiments, and the decades of technological breakthroughs that eventually made virtual care mainstream.

Dr. Kaftarian walks through how we got here, why telepsychiatry took so long to catch on, and why the original promise of remote care still matters today.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.

Treating substance use disorders through telepsychiatry is not just a matter of moving the same office visit onto a screen.

These patients may be dealing with cravings, withdrawal, relapse, shame, unstable housing, limited transportation, or a recovery environment that makes treatment harder to sustain. So the question is not just what medication or therapy might help. It is how clinicians can keep patients engaged long enough for treatment to work.

In this episode of The Telepsychiatry Advantage, Dr. Edward Kaftarian breaks down how clinicians can treat substance use disorders through telepsychiatry. Opioid use disorder, alcohol, nicotine, stimulants, cannabis, benzodiazepines — he covers it all in this episode.

This is Part 2 of the substance use disorder series. Part 1 focused on assessment. This episode focuses on treatment — what to do next, how to keep patients connected, and even when telepsychiatry needs support from in-person resources.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.

Drug overdoses have killed more Americans than every major U.S. war combined That is the scale of the substance use crisis in this country. 

And for many of the patients most affected — people in rural areas, people with unstable housing, people without reliable transportation, and people who already struggle to access care — telepsychiatry may be one of the most important ways to help them.

But assessing substance use disorders through a screen comes with challenges. A patient may appear stable on video while hiding intoxication, withdrawal, overdose risk, suicidality, or an unsafe environment lingers just outside the frame.

In this episode of The Telepsychiatry Advantage, Dr. Edward Kaftarian explains how clinicians should assess substance use risk in a telepsychiatry visit: what to ask first, what warning signs to look for, why patient location matters, how the home environment can reveal risk, and when telehealth needs support from in-person resources.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.

Some patient encounters stay with you forever.

A patient gets angry. The conversation stops in its tracks. Logic does not work anymore. The tone changes. Suddenly, the appointment is escalating before the clinician can get it back under control.

In telepsychiatry, that moment can feel even more overwhelming because the clinician is not physically in the room. The only tools available may be your words, your voice, your face, your pacing, and your ability to recognize what is happening before the visit spirals.

In this episode of The Telepsychiatry Advantage, Dr. Edward Kaftarian breaks down how clinicians can de-escalate angry patients in a virtual setting. He goes skill-by-skill through what the best psychiatrists do to lower the temperature, preserve safety, and keep the appointment moving forward.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.

A common objection to telepsychiatry is that it simply doesn’t work for patients with psychosis. The concern was that patients might feel paranoid on camera, refuse to engage, or become more symptomatic because the visit was happening through a screen. 

But is that actually what the evidence shows? Not even close. 

In this episode of The Telepsychiatry Advantage, Dr. Edward Kaftarian looks at the research behind telepsychiatry for patients with psychosis and schizophrenia, and explains why clinicians should be careful not to rule out virtual care based on flat-out wrong assumptions.

The episode also gets into the practical side of treating psychotic patients through telepsychiatry: how to respond when a patient is uncomfortable, why access sometimes matters more than a perfect setup, and why the doctor-patient relationship still matters more than the camera.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.

Research articles referenced in the video:

https://pmc.ncbi.nlm.nih.gov/articles/PMC4132656/

https://pubmed.ncbi.nlm.nih.gov/23428781/

https://pmc.ncbi.nlm.nih.gov/articles/PMC3101132/

https://link.springer.com/article/10.1186/1744-859X-10-14

https://formative.jmir.org/2025/1/e59540/authors

https://pubmed.ncbi.nlm.nih.gov/28550756/

https://psychiatryonline.org/doi/10.1176/appi.ajp.2020.177901

The elderly population in America has nearly doubled since 1960, and by 2030, about 1 in 5 Americans will be 65 or older.

That means more elderly patients are going to need mental health care. But the number of geriatric psychiatrists is not growing fast enough to meet that demand. So whether a clinician specializes in geriatrics or not, they are going to see more elderly patients — in assisted living, nursing facilities, emergency departments, and at home.

In this episode of The Telepsychiatry Advantage, Dr. Edward Kaftarian explains why telepsychiatry can help close that gap BUT only if clinicians understand how to make it work for older adults.

Elderly patients may not be digital natives. They may get frustrated with technology faster. They may need simpler questions, a slower pace, more pauses, clearer routines, and a visit that feels easy to follow from the start.

That is the essence of this episode: how clinicians can remove the barriers that make virtual care harder for elderly patients and create a telepsychiatry visit that feels clear, calm, and accessible.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.

Choosing a telepsychiatry company to join is a major decision. Pick something that's not a good fit, and now you have some real problems. 

The issue is, it's often hard to know. The company might look good on paper, but once you are inside, the red flags can start showing up fast: poor support, bad partners, rigid schedules, unfair contracts, high turnover, or a company that treats clinicians like a commodity instead of part of a team.

In this episode of The Telepsychiatry Advantage, Dr. Edward Kaftarian breaks down what psychiatrists and mental health clinicians should look for before joining a telepsychiatry company — and what warning signs should make them ask more questions before signing on.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.

What separates a good telepsychiatrist from a best-in-class one?

It is not just credentials, experience, or being comfortable on video. The best clinicians know how to make patients feel heard through a screen, how to stay steady when the appointment gets complicated, and how to bring the same professionalism to virtual care that they would bring to any clinical setting.

In this episode of The Telepsychiatry Advantage, Dr. Edward Kaftarian explains about what “best-in-class” really means in telepsychiatry—and why the strongest clinicians are not just technically skilled, but thoughtful, prepared, and easy to trust.

Because great telepsychiatry is not just about showing up online, it's also about raising the standard of care once you are there.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.

Want to make sure a patient never wants to book a telepsychiatry appointment with you again?

Then this episode of The Telepsychiatry Advantage is for you. Dr. Edward Kaftarian walks through what the worst version of a virtual psychiatry visit looks like — the kind that makes patients feel ignored, uncomfortable, distracted, or unsure if the clinician is even present with them.

It’s a fun look at how telepsychiatry can go wrong, but the point underneath is serious. The virtual environment is your clinic, and the way a clinician shows up on camera can either support the therapeutic alliance or ruin it before the real clinical work even begins.

For more information about Orbit Health, visit us at:
https://www.orbithealth.com/

DISCLAIMER: The opinions expressed in the podcast are  Dr. Kaftarian's personal opinions regarding best practices and are not intended to establish or represent the standard of care. It remains the responsibility of each listener to ensure compliance with all applicable standards of care, laws, regulations, and professional requirements.