The Lindsay Clancy murder trial has intensified questions about when virtual mental health care may no longer be sufficient for someone experiencing a severe psychiatric crisis. Jonathan Alpert, Ph.D., a New York psychotherapist, said telehealth can work very well, but that "there comes a point where a screen may not be enough."

Nearly half of American adults with serious mental illness receive some form of mental health treatment through telehealth. The Substance Abuse and Mental Health Services Administration places that share at 48.3%.

Clancy reportedly met virtually with her primary psychiatrist, Dr. Jennifer Tufts, 14 times during a five month period from September 2022 through Jan. 23, 2023, according to testimony reported by The Associated Press. Their final appointment occurred on Jan. 23, the day before the killings of Clancy's three children, and the two never met in person.

During cross examination, Clancy's defense attorney, Kevin Reddington, asked Tufts whether she had ever suggested that Clancy come to the office instead of meeting by computer. Tufts responded, "Talking to her over the video didn't seem like an issue," adding, "It didn't seem like there was something I was missing."

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Alpert was not involved in Clancy's care and spoke generally about telehealth rather than the details of her treatment. He said clinicians should reconsider exclusive reliance on virtual appointments when a patient becomes suicidal, psychotic, manic, unstable or unable to function.

"The priority has to be getting an accurate picture of what’s going on and keeping the patient safe," Alpert, author of "Therapy Nation: How America Got Hooked on Therapy and Why It's Left Us More Anxious and Divided," told Fox News Digital. He also emphasized that telehealth serves an important role in mental health care.

Virtual therapy allows Alpert to see more people in a day than he could through office treatment. Patients also avoid traveling to a therapist's office, which can improve access for people with busy schedules, although he said the format has limitations when someone has a severe psychiatric disorder.

A video appointment may not reveal every important detail about a patient's condition. Alpert said hygiene, movement, agitation, intoxication and general behavior can be less obvious on Zoom than they might be during an office visit.

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"Someone can pull themselves together for an appointment and look relatively fine for 30 minutes even though they're falling apart outside of it," he said. Therefore, continued deterioration despite frequent appointments should be treated as a significant warning sign.

"More appointments aren't necessarily more treatment," Alpert told Fox News Digital. He said another video call should not automatically be considered sufficient when someone is becoming more suicidal, paranoid, manic, disorganized, aggressive or unable to function.

"At some point, the treatment plan has to change, whether that means seeing the person in person, getting an emergency evaluation or moving them to a higher level of care." Alpert said therapists should be direct whenever there is concern about suicide or violence.

He identified questions clinicians should ask, including, "Are they having thoughts of hurting themselves or someone else?" They should also ask, "Do they have access to weapons or other lethal means?" and "Have they done anything recently that suggests the risk is escalating?"

Alpert said a statement about wanting to die is very concerning, while the existence of a plan involving a weapon or pills raises the situation to another level and would warrant intervention through police or emergency services. He also advised therapists to know a patient's location during each appointment so they can respond if an emergency develops.

Information from relatives or other people in a patient's life may sometimes be necessary because the patient might not provide the full picture, Alpert said. He also distinguished postpartum depression from postpartum psychosis, saying the latter may involve delusions, disorganized thinking or hallucinations and, when those symptoms are occurring, warrants inpatient treatment.

Overall, Alpert said telehealth itself is not the problem and has helped people obtain care they otherwise might not receive. The central questions are whether the clinician has completed a thorough assessment and whether the level of care continues to match the patient's condition.

A capable clinician can recognize serious risk during a video appointment, while serious danger can also be missed during an office visit, Alpert noted. Still, he added, "The sicker and more unstable someone becomes, the less comfortable I'd be relying exclusively on a screen."

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If you believe someone is in immediate danger, call emergency services right away. Even a small step, like reaching out to a trusted friend, family member, or professional, can help create a path forward.