Telehealth Offset Declines in In-Person Mental Healthcare in 2020

A study published in JAMA Network Open found that during the COVID-19 pandemic, there was a significant increase in using telehealth to treat mental health conditions, alongside a decrease in in-person service use.

In the study, researchers from RAND Corp. and Castlight Health reviewed how US adults accessed mental health services during 2020. They conducted a cohort study using county-level service use data from a national US database of commercial medical claims. They gathered data on adults between Jan. 5 and Dec. 21, 2020. 

In total, researchers analyzed data on 5.1 million commercially insured adults. Researchers calculated the per-week use of mental health services per 10,000 beneficiaries across five psychiatric diagnostic categories: major depressive disorder (MDD), anxiety disorders, bipolar disorder, adjustment disorders, and posttraumatic stress disorder (PTSD).

Researchers found that the COVID-19 pandemic led to a sharp decrease in the use of in-person services for mental healthcare, with utilization rates dropping by 50 percent during the study period.

The average per-week mental health service usage rate across all five psychiatric diagnostic categories declined. The per-week utilization rates per 10,000 enrollees decreased by 57 percent for MDD, 55 percent for anxiety disorders, 52 percent for bipolar disorder, 55 percent for adjustment disorders, and 57 percent for PTSD.

The study shows that during the same period, there was a sharp increase in telehealth use for these conditions. Overall, telehealth use jumped 16 to 20-fold.

The per-week mental health service utilization rates per 10,000 enrolled increased by 1,725 percent for MDD, 1,495 percent for anxiety disorders, 1,925 percent for bipolar disorder, 1,832 percent for adjustment disorders, and 1,714 percent for PTSD.

On combining in-person and telehealth service utilization rates, researchers also noted an overall increase in care for MDD, anxiety, and adjustment disorders during the study period.

Based on these findings, researchers concluded that the COVID-19 pandemic led to the rapid uptake of telehealth for treating mental health conditions, offsetting the drop in in-person care.

"While preliminary studies documented a marked increase in scale-up of telehealth services, to our knowledge, this is the first study to show that the magnitude of this increase (roughly a 16- to 20-fold increase in utilization) fully compensated for the decline in in-person care," they wrote.

But the researchers noted several limitations to the study, including the use of data from a subset of patients with employer-based private insurance, the lack of knowledge regarding the duration of insurance coverage, and the fact that the study results are confined to 2020.

Overall, the findings align with prior research on telehealth use for mental healthcare.

Another study published in JAMA Network Open last November found that increased telehealth availability within federally qualified health centers (FQHCs) led to improved engagement in mental healthcare among Medicaid beneficiaries.

Researchers reached this conclusion following a cohort study of patients in Massachusetts who had at least one visit to an FQHC within 18 months before each month studied. They found that although overall visit rates within FQHCs decreased amid the pandemic, the increased availability of telehealth was linked to higher visit rates compared with lower telehealth availability.

Further, surveys show that telemental healthcare is popular among patients.

A survey of 1,004 US adults, conducted between July 5 and 8, 2022, showed that despite a general preference for in-person care, telehealth use remained high among young adults and patients in need of primary and mental healthcare.