We have developed an encrypted web-based e-mail application for the purpose of paediatric and adolescent telepsychiatric consultations. Open source libraries from OpenSSL were used for the development of our system. Our web-based architecture forced all communication between psychiatrist and patient to be encrypted using Secure Socket Layer or Transport Layer Security. The use of encrypted e-mail is an administrative recommendation of the Information Security Standard for the state health department. Our system was implemented for use by Child and Youth Mental Health Services in October 2005. During the first 13 months, between October 2005 and November 2006, 140 teleconsultations were performed via encrypted e-mail. Many of the patients lived in regional and remote areas of Queensland. We have found that e-mail teleconsultations are most useful as an adjunct to face-to-face consultations for these patients. We suspect from early experience that the email service has allowed more consistent therapeutic contact with patients, resulting in positive patient outcomes. This case report demonstrates that e-mail-based telepsychiatry has both a place in under-served regional communities and for patients undergoing therapy, regardless of their geographical location.