ABSTRACT Telehealth is increasingly being adopted in mental health service delivery, particularly since the onset of COVID-19. However, the literature on the uses and applications of telehealth in mental health social work is still emerging, and a critical understanding of telehealth practice is vitally needed. This research explored how the use of telehealth impacts the practice of mental health social workers and what this means for service users. Ten semistructured interviews were undertaken with mental health social workers. It was found that although telehealth is becoming embedded into service delivery, there are implications for workload, training and support, and skills in reflexively adapting practice to ensure ethical practice when using telehealth technologies. Telehealth can align with the profession of social work if the practical benefits are clearly understood and the limitations of the approach are monitored and supported with adequate training and support. IMPLICATIONS Telehealth has many practical benefits for practice, but it presents a challenge for the relational skills social workers rely on for face-to-face practice. Social workers should be critically reflective on how telehealth can impact ethical practice. Training and support around the practical implications of telehealth for those implementing telehealth would be beneficial.