Many patients lack choice of remote vs. in-person behavioral health care

The growing use of telehealth was expected to give patients the choice of receiving in-person or remote care. But a new study finds that telehealth is the only option for many patients seeking behavioral health services, even if they prefer in-person treatment.

In the study, a team from Rand Corporation and Harvard University surveyed and interviewed 571 adults who used behavioral health services during the prior year, including 26 who had been treated for bipolar disorder or depression. Patients were asked if they felt they had a choice of methods for conducting visits for medication and therapy services, and how the decision to use a particular method was made.

Their research showed that about a third of the patients receiving medication or therapy visits saw clinicians who did not offer both telehealth and in-person care. In addition, 32% said they didn’t typically receive care via their preferred method, and nearly half (45%) didn’t think their clinician considered their preferences when deciding on the visit type.

About 80% of study participants receiving individual behavioral therapy in the prior year had telehealth visits, the study found, compared to only 42% with in-person visits. Slightly more (58%) of those having medication visits received them in person compared to those who had them virtually (54%).

Many participants interviewed for the study said they preferred in-person therapy visits because it was more personal and enabled them to establish a better rapport with their clinician. Regardless of their preference, however, a majority said they wanted clinicians to offer both options.

“These findings suggest that patients’ modality preferences need to be a greater consideration in both clinical discussions and policy decisions,” Jessica Sousa, M.P.H., the study’s lead author and a RAND senior policy analyst said in an accompanying news release. “Expanding telehealth increases access to care, but telehealth alone might not be sufficient. Ideally, patients should have access to some amount of in-person care, given that many prefer it or may need it.”

At the start of the COVID-19 pandemic many payers began reimbursing for telehealth services so clinicians could continue providing care, leading some behavioral health providers to offer only telehealth visits because of its lifestyle and productivity advantages.

“Although generous payment policies may encourage clinicians to offer telehealth, they may also inadvertently lead to cannibalization of in-person care,” Sousa said. “For telehealth to achieve its potential to increase overall access to high-quality, patient-centered care, it is important to implement it in a manner that expands, rather than contracts, behavioral health access and options for patients.”

The study, “Choosing Or Losing In Behavioral Health: A Study Of Patients’ Experiences Selecting Telehealth Versus In-Person Care” appears in the September 2023 issue of Health Affairs.