When Should You Send a Psychiatry eConsult? Practical Guidance from Dr. Jadah Johnson

Psychiatric presentations in primary care are rarely straightforward. A patient may need help with medication management, diagnostic clarification, risk assessment, or referral—but psychiatric symptoms can also overlap with sleep disorders, medical conditions, hormonal changes, substance use, and other factors.

In our first Alethea podcast-style interview, we sat down with Dr. Jadah Johnson, Psychiatrist and Alethea consultant, to discuss where psychiatry eConsults can add the most value and how Primary Care Providers can use them to support patient care.

Dr. Johnson brings experience across inpatient, emergency, consultation-liaison, addiction, outpatient, and child and adolescent psychiatry. She also has a particular interest in the intersection between internal medicine and psychiatry.

When Should You Send a Psychiatry eConsult?

Dr. Johnson’s advice is refreshingly simple: if you’re wondering whether psychiatric input would be helpful, consider sending the eConsult.

Not every question needs to be highly complex. Sometimes a second set of eyes can help confirm a treatment approach, clarify a diagnosis, or identify something that deserves further investigation.

There are certain life stages where Dr. Johnson finds psychiatric eConsults particularly valuable, including adolescence, pregnancy and postpartum, and older adulthood. These periods often bring together psychiatric symptoms with developmental, medical, hormonal, medication, and neurocognitive considerations.

The postpartum period is one area where early input can be especially important. Dr. Johnson noted that postpartum depression and psychosis may not always resemble more typical depressive or psychotic presentations. When something seems unusual, she would rather providers reach out early than wait until significant safety concerns emerge.

eConsult or In-Person Referral? Sometimes It's Both.

One of the most useful takeaways from the conversation was that providers don’t necessarily need to choose between an eConsult and an in-person psychiatry referral.

Dr. Johnson sees the two as part of a continuum of care.

An eConsult can help determine what workup to complete, what treatment can begin in primary care, what red flags to monitor for, and whether an in-person referral should be prioritized. When a referral is necessary, it can also provide guidance on how to support the patient while they wait.

Concerns such as suicidality or risk of harm to the patient or others require appropriate urgent assessment. However, psychiatric eConsult advice may still complement that pathway by helping with questions around risk analysis and safety planning.

Is It Psychiatric—or Could Something Medical Be Contributing?

Another major theme of the interview was the importance of looking beyond the psychiatric diagnosis itself.

Dr. Johnson has a particular interest in the intersection of psychiatry and medicine, including psychiatric manifestations of autoimmune illness. But in everyday outpatient practice, some contributors can be much more common.

For adolescents, that might mean looking carefully at sleep, screen time, gaming, caffeine, and substance use. For women, the onset of symptoms around postpartum or menopausal transitions may provide important context. In adults, Dr. Johnson highlighted considerations such as obstructive sleep apnea, low iron, and low B12. And when an older adult develops new-onset psychosis or depression, providers should consider whether a neurocognitive disorder could be contributing.

The broader lesson is simple: before assuming a new presentation is purely psychiatric, consider what else may be happening medically.

Your Clinical Impression Matters

When submitting an eConsult, laboratory results and medication histories are useful—but so is something much less quantifiable: your clinical impression of the patient.

Dr. Johnson emphasized that the consulting psychiatrist isn’t in the room and doesn't have access to the subtle observations a PCP develops from speaking with and knowing their patient.

If you have a feeling that cognition, personality, stress, or another factor may be influencing the presentation, include it. Even if you aren't certain, that context can help the consultant better understand the case and tailor their response.

Extending Psychiatric Expertise Into Primary Care

Ultimately, Dr. Johnson sees eConsults as a way to extend specialist expertise beyond the patients she can see face-to-face.

With in-person psychiatric waits sometimes stretching for months, timely specialist guidance can help a PCP begin treatment, refine a management plan, or determine that an in-person referral may not be necessary.

We've seen that impact reflected directly in feedback from Alethea users. One physician who regularly sends eConsults to Dr. Johnson shared:

“I have been able to help so many patients with her guidance, and I genuinely would not have had the same confidence to manage some of these cases without the support provided through Alethea. It has been very rewarding to see how well these patients are doing.”

For Dr. Johnson, that ability to indirectly impact a much broader group of patients is one of the most meaningful parts of providing eConsults.

Want to Learn More?

This article highlights just a few of the topics discussed with Dr. Johnson, including diagnostic clarification, medication management, medical contributors to psychiatric presentations, risk assessment, lifestyle factors, and referral guidance.

Click here to read the full learning notes.

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