Pandemic drives use of telehealth for mental illness

The COVID-19 pandemic has likely permanently increased the provision of mental health counseling via telehealth, according to new research from Oregon Health & Science University.

The retrospective analysis was published today in the April issue of the journal Health Affairs.

“Our study suggests that telehealth services for mental health counseling have grown significantly and are likely to remain,” the lead author said. Jane Zhu, MD, assistant professor of medicine (general internal medicine and geriatrics) at the OHSU School of Medicine. “Future applications of tele-mental health really should be focused on understanding the population, context, and disease conditions most conducive to this method.”

Zhu and his co-authors used a non-governmental complaints clearinghouse to analyze data from 2016 to 2018 and compare it with the period of the start of the pandemic, from March to December 2020, combing through a total 101.7 million outpatient mental health visits.

They found that at the start of the pandemic, in-person mental health visits initially dropped by 21.9%, despite the onset of a stressful pandemic. However, mental health visits rebounded quickly, with almost half – 47.9% – switching to telehealth by the end of the study period in December 2020.

The researchers detected differences in the use of telehealth between clinical conditions. For example, people seen for schizophrenia were less likely to use in-person visits, while those with anxiety and fear-related disorders used telehealth more.

The authors also cited additional research finding that older adults, black and Hispanic people, people living alone, and low-income people appear less likely to access mental health counseling online.

“Telemedicine is often seen as the next frontier in healthcare delivery,” Zhu said. “Yet the evidence in our paper suggests a lack of adoption among some groups who experience barriers to telehealth.”

Patients will continue to make extensive use of telehealth for years to come, the researchers expect.

Telehealth is particularly suited to mental health services, they write. Even before the pandemic, previous studies raised the potential for improving access to care for the 119 million Americans who live in areas defined as lacking healthcare professionals. Additionally, studies have shown high satisfaction in patients who do not necessarily need the detailed in-person physical exam or lab tests often required for medical or surgical care.

The authors conclude with a caveat:

“While reducing regulatory and payment barriers can improve access to care, increased use of telehealth could exacerbate existing health care disparities or worsen care outcomes for other populations, particularly if high-speed Internet access is limited in some areas or unavailable to low-income or clinically. vulnerable populations,” they write. “Future research is needed to understand how telehealth modalities can best improve equitable access to mental health care in the face of increased overall demand.”

In addition to Zhu, co-authors included Renae Myers, MPH, John McConnell, Ph.D.and Ximena Levander, MD, OHSU; and Sunny C. Lin, from Washington University in St. Louis.

The research was supported by the National Institute of Mental Health of the National Institutes of Health, grant numbers 1K08MH123624, R01MH122199 and R01MH123416. The content is the sole responsibility of the authors and does not necessarily represent the official views of the NIH.

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