Telehealth Availability at Mental Health Facilities Varies Across States

The availability of telemental healthcare services varies widely across states, with high telehealth availability in states like Maine and Oregon and low availability in states like Mississippi and South Carolina, according to new research.

The study by nonprofit research organization RAND Corp. assessed telehealth availability, wait times, and service features for various mental health conditions and facility-, client-, and county-level characteristics associated with telehealth availability.

Telehealth remains a popular mode of mental healthcare delivery. Even as overall telehealth usage dropped from pandemic highs, telemental healthcare use remained higher than average. Data from Epic Research shows that though telehealth comprised 31.2 percent of all visits in the second quarter (Q2) of 2020, it dropped to 5.8 percent in the third quarter (Q3) of 2023. In Q3 2023, 37 percent of mental health visits were still occurring virtually.

For the study, RAND researchers conducted a cross-sectional analysis of a secret shopper survey of mental health treatment facilities throughout the United States, except Hawaii. From December 2022 to March 2023, the research team contacted 1,938 facilities to inquire about telehealth availability. Of the facilities contacted, 1,404 responded.

Among the 1,221 facilities accepting new clients, 980 (80 percent) reported offering telehealth services, with 573 (47 percent) reporting their telehealth appointments were available via video and 49 (5 percent) reporting audio-only telehealth availability.

Researchers did not find evidence that telehealth availability among mental health treatment facilities differed significantly according to the clinical condition. The analysis showed that telehealth services were available at 79.6 percent of facilities for generalized anxiety disorder, 81.4 percent for major depressive disorder, and 83.1 percent for schizophrenia.

Further, a vast majority (96.9 percent) of facilities reported the availability of virtual counseling services, and most facilities offered virtual medication management (76.7 percent) and diagnostic services (68.7 percent).

However, telehealth availability varied widely at the state level. Less than half of mental health treatment facilities in Mississippi and South Carolina were offering telehealth services versus all mental health treatment facilities contacted in Delaware, Maine, New Mexico, and Oregon.

In addition, mental health treatment facilities that provided only outpatient services were more likely to offer telehealth compared to facilities also offering hospital inpatient or residential services. Private for-profit facilities were more likely to provide telehealth than their public counterparts.

Meanwhile, mental health treatment facilities located in metropolitan counties were more likely to offer medication management services but significantly less likely to offer diagnostic services via telehealth, the study showed.

Regarding wait times for initial telehealth appointments, researchers found that the median time was 14 days. Maine had the longest median wait time for a telehealth appointment (75 days), while North Carolina had the shortest (four days).

However, the study noted that the wait times did not differ according to clinical condition, caller, facility, or county characteristics.

Still, the differences found at the state-, county-, and facility-level indicate widespread disparities in access to telemental healthcare.

“Understanding the availability of telehealth is important for informing policies that maximize the potential benefits of telehealth for mental healthcare,” said study lead author Jonathan Cantor, a policy researcher at RAND, in an emailed press release.

The enduring popularity of virtual mental health services has led to more research on their use.

For instance, a study published in JAMA Health Forum last week investigated the number and characteristics of mental health specialists who shifted entirely to telehealth during the COVID-19 pandemic.  

The study used the OptumLabs Data Warehouse to identify claims for commercial insurance and Medicare Advantage enrollees from January 1 to December 31, 2019, and January 1 to December 31, 2022.

Of the 51,309 mental health specialists included in the study, 13 percent had shifted to a telehealth-only practice in 2022. Additionally, being female and working in counties in the top quartile of housing value and population was linked to higher odds of shifting to a telehealth-only practice.