The $300 Video Call: How Telehealth Became a Goldmine for ADHD Prescriptions
The $300 Video Call: How Telehealth Became a Goldmine for ADHD Prescriptions
Imagine youve been struggling to focus for years. Youve read the threads, taken the online quizzes, and youre almost certain you have ADHD. You find a psychiatrist who offers video consultations. Within a week, youre on a 30-minute call. By the end of it, you have a script for stimulants. It feels like a breakthrough.
Now imagine the same scenario, but you live in a regional town with no local psychiatrist. The waitlist for a face-to-face appointment is eight months long. The nearest specialist is a four-hour drive away. When you finally get a telehealth appointment, the out-of-pocket cost is higher than what your city cousin paid. And the psychiatrist on the screen is based in one of the wealthiest postcodes in the country.
Thats the double-edged reality of telepsychiatry in Australia, according to a new analysis of nearly four million Medicare records. The study, published in Psychiatry Research, reveals that since Medicare-reimbursed telepsychiatry became permanent in January 2022, the service has been dominated by ADHD consultations. And the business model behind it, the researchers argue, benefits the rich while potentially crowding out care for everyone else.
A threefold jump in scripts
The numbers are striking. Before COVID, fewer than one in 20 psychiatry consultations were linked to an ADHD prescription. Fewer than one in 50 were conducted by video. By 2022, the share of ADHD-associated prescriptions had jumped almost threefold, from 4.3% to 11.8%. About one in four video psychiatry consultations now ends with a stimulant prescription.
Meanwhile, prescriptions for other psychiatric conditions linked to video consultations barely shifted. In some cases, they fell.
This isnt just about more people being diagnosed with ADHD, although thats happening too. Australian Institute of Health and Welfare figures show ADHD medication dispensing rose roughly elevenfold between 2004–05 and 2023–24. The new analysis shows that the growth in psychiatric appointments created by telehealth was largely taken up with ADHD assessments—specifically, the kind that end with a new prescription rather than ongoing follow-up care.
The wealthy postcode problem
Heres where the story gets uncomfortable. One of the researchers earlier papers showed that telepsychiatry helps alleviate psychiatrist shortages in rural areas. So they expected ADHD prescribing via telehealth to be concentrated among psychiatrists working in underserved regional and remote areas—the patients telehealth was explicitly designed to reach.
Thats not what happened.
The steepest rise in ADHD prescribing occurred among psychiatrists practicing in Australias most socioeconomically advantaged postal codes. Almost half of all psychiatrists in the dataset were based in the wealthiest areas. This group accounted for the bulk of the increase in video ADHD prescriptions.
And those video consultations cost patients more out-of-pocket than an equivalent face-to-face appointment. So the picture is less about telepsychiatry improving access and removing the cost barrier to care. Its more about creating well-paid spe cialist services for people who can already afford them.
Why ADHD, specifically?
Interest in ADHD has exploded for a number of reasons. Social media has allowed more people to recognize their symptoms, particularly adults who were never assessed as children. Search terms like “ADHD treatment” and “ADHD medication” climbed steadily across the study period. The researchers found this online interest tracked closely with the rise in video prescribing of stimulants.
Others point to the attention economy—social media platforms, digital notifications, emails, and algorithmic content taxing the brain, making it harder to focus for long periods. That, they argue, may also contribute to people thinking they have ADHD and seeking a diagnosis.
None of this means the demand isnt real or the diagnoses are wrong. Drug treatment for ADHD has a strong evidence base and can be life-changing. The shift was strongly associated with a higher proportion of female patients, whose ADHD has been historically under-recognized. Thats a genuine positive.
The business model hiding in plain sight
But these video ADHD consultations can be lucrative. They offer a way for psychiatrists to see more patients, faster. A single “one-off” assessment of 30 minutes or longer that results in a script—the type the researchers identified—is an attractive business model. You dont need to follow up. You dont need to manage complex, ongoing care. You assess, prescribe, and move on.
When ADHD comes to dominate Medicare funding for telehealth that was originally designed to broaden access to all psychiatric care, access to care for people with other mental illnesses may be crowded out. Thats the real risk. Someone with treatment-resistant depression or complex PTSD might find it even harder to get a video appointment because the market has shifted toward the fast, profitable ADHD assessment.
So yes, telepsychiatry is expanding access. But the study shows its model is focused on a single, lucrative, fast-growing diagnosis and prescription business.
What happens when GPs step in?
Until recently, only psychiatrists could diagnose ADHD and start medication for adults in most of Australia. But in response to the difficulty accessing psychiatric consultations, state governments are moving to let GPs diagnose and prescribe for ADHD. While this sounds sensible, the researchers are concerned that similar issues could emerge in general practice—an increase in the commoditization of ADHD care.
The lesson here isnt that telehealth is bad or that ADHD treatment is overprescribed. Its that the incentives matter. When a system pays for quick assessments and prescriptions rather than ongoing, holistic care, thats what it will get. And when the psychiatrists providing those assessments are concentrated in wealthy areas, the people who need help most may still be left waiting.
What would a better model look like? Perhaps one that rewards follow-up care, not just prescriptions. One that ensures rural and remote patients arent paying more for video calls than city patients pay for in-person visits. One that doesnt treat mental health as a transaction.
The next time you see a telehealth ad promising a quick ADHD diagnosis, ask yourself: who is this really designed to serve?
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Mike Brown
Mike Brown – One of those authors who helps readers not get lost in today's news flow. He dives into political affairs as well as world events, social trends, and everyday stories that matter to everyone. The main focus of his work is fact-checking, clear language, and the ability to lay out the key points so that the reader gets a comprehensive and reliable picture of the topic in just a few minutes.
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