COVID-19 pandemic shows telehealth’s potential for providing mental health services

Decrease in in-person visits during pandemic offset by jump in telehealth use, study finds

Among its other effects, the COVID-19 pandemic may have shown that telehealth is a viable method for providing mental health counseling.

That is one of the conclusions to emerge from a newly published study comparing use of mental health services before and during the early months of the pandemic. But while telehealth could increase the use of mental health services, it also has the potential to worsen existing disparities in access to these services.

The study’s authors used claims data to analyze and compare use of outpatient mental health services from March through December in 2016, 2017 and 2018 with the same months in 2020. They found that in-person visits dropped sharply early in the pandemic, falling by 50% and 56%, respectively in April and May 2020 compared to the same months in earlier years. Telehealth visits jumped from averaging a few thousand per month to comprising 48% of all outpatient mental health encounters by December 2020.

The authors also found significant variations in pre- and post-pandemic use of mental health services by age, condition, and likelihood of telehealth use. The number of post-pandemic encounters fell among those age 12-17, 45-54 and 55-64, but increased for other age groups. The percentage of visits that were telehealth ranged from 23.6% among those age 35-44 to 6.2% for those 65 and older.

Similarly, the average number of monthly visits fell among patients with bipolar disorders, schizophrenia, psychotic disorders and depressive disorders, but rose among those diagnosed with anxiety and with fear-related disorders. The largest percentage of telehealth visits—32%--were for trauma and stress-related disorders, while only 1.7% were for schizophrenia and other psychotic disorders.

“Our study suggests that telehealth services for mental health counseling expanded significantly and is likely to stay,” Janet Zhu, M.D., its lead author and assistant professor of medicine at Oregon Health & Science University said in an accompanying news release.

The authors note that their findings are consistent with others showing increased use of telehealth for mental health services and cite several reasons why telehealth may be uniquely suited to that purpose. Among these are that therapy and counseling for mental health conditions usually don’t require detailed physical exams or lab tests, and the generally high acceptance of and satisfaction with telehealth for outcomes such as remote patient medication and symptom telemonitoring.

They caution, however, that they don’t know if their findings are limited to people already connected to mental health care, noting concerns that “telehealth is more likely to supplement and complement in-person care among those who already receive mental health services” than to increase access for people otherwise unable to obtain in-person care.

“Increased reliance on telehealth could exacerbate existing health care disparities or worsen care outcomes for other populations, particularly if access to broadband internet is limited in some regions or unavailable to lower-income or clinically vulnerable populations,” they warn.

The study, “Trends In Outpatient Mental Health Services Use Before And During The COVID-19 Pandemic” appears in the April 2022 issue of Health Affairs.