Mental health expert discusses whether telehealth is appropriate for severe disorders

August 14, 2026 - 17:01

As virtual therapy becomes a permanent fixture in American healthcare, one New York psychotherapist is raising a critical question: when is a screen simply not enough? Jonathan Alpert, who has spent years treating patients in Manhattan, says that while telehealth has proven effective for many, it falls short for those grappling with the most severe psychiatric conditions.

Alpert acknowledges that virtual sessions have expanded access to care, especially for people in rural areas or those with mobility issues. For mild to moderate anxiety, depression, or adjustment disorders, video calls can work just as well as in-person meetings. Patients often feel more at ease in their own homes, and the convenience cuts down on missed appointments.

But the picture changes when someone is in acute crisis. Alpert points to patients experiencing active psychosis, severe suicidal ideation, or dangerous manic episodes. In those moments, a therapist needs to read body language fully, notice subtle changes in hygiene or motor activity, and sometimes intervene physically. A camera cannot capture the full scope of a person's state, and a patient can easily hide symptoms or disconnect mid-session.

"There comes a point where a screen may not be enough," Alpert said. He stressed that clinicians must be honest about these boundaries rather than pushing telehealth for every case. The key, he argues, is a hybrid model: use virtual care for ongoing support and check-ins, but require in-person visits for initial assessments, crisis situations, and treatment planning for serious disorders.

As more insurance companies and clinics push digital-first approaches, Alpert's warning serves as a reminder that technology has limits. The goal is not to abandon telehealth, but to know when it is a tool and when it becomes a barrier to real healing. For the most vulnerable patients, the human presence in the room still matters.