Pediatric Telemental Health Use Swells to 2,300% of Pre-Pandemic Levels

Telehealth accounts for a significant share of mental health service utilization and spending among pediatric patients in the United States, with telemental health service utilization soaring 2,300 percent higher than pre-pandemic levels in August 2022, according to new research.

There is an ongoing mental health crisis among American youth. According to a 2022 Agency for Healthcare Research and Quality report, nearly 20 percent of children and adolescents aged 3 to 17 have a mental, emotional, developmental, or behavioral disorder. Another study published earlier this year in the Journal of the American Medical Association showed that the proportion of emergency department visits for pediatric mental health issues approximately doubled between 2011 and 2020, including a five-fold increase in the share of visits for suicide-related symptoms.

The new research letter published in JAMA Network Open aimed to assess how telehealth availability influenced pediatric mental health service utilization and spending before and during the pandemic. The researchers examined pediatric mental health service utilization and spending rates from January 2019 through August 2022, as well as the proportion of utilization and expenditure associated with telehealth and in-person mental healthcare.

The research team gathered monthly medical claims data from Castlight Health for 1.9 million children and young adults (younger than 19 years) receiving care for common pediatric mental health diagnoses, including anxiety disorders, adjustment disorder, attention-deficit/hyperactivity disorder (ADHD), and major depressive disorder.

They studied trends and changes in monthly utilization and spending rates across three phases: pre-pandemic (from January 1, 2019, to March 12, 2020), acute (March 13 to December 17, 2020), and post-acute (December 18, 2020, to August 31, 2022).

The study shows that overall mental health service utilization increased by 21.7 percent, and spending rates increased by 26.1 percent from January 2019 to August 2022.

During the acute phase of the pandemic, in-person pediatric mental health services declined by 42 percent compared with utilization in the pre-pandemic phase. However, telehealth services skyrocketed 3,027 percent, a 30-fold increase, versus pre-pandemic utilization.

By August 2022, in-person services had returned to 75 percent of pre-pandemic levels, but telehealth-based pediatric mental health utilization was 2,300 percent higher than pre-pandemic levels.

Researchers also observed a gradual increase in mental health spending rates for in-person, telehealth, and total visits in the post-acute period compared with the pre-pandemic phase. Further, in a diagnosis-specific analysis, researchers found that ADHD, anxiety disorders, and adjustment disorder accounted for the most utilization and spending in all phases.

“Our findings indicate that pediatric telehealth care for mental health needs filled a critical deficit in the immediate period following the emergence of COVID-19 and continues to account for a substantial proportion of pediatric mental health service utilization and spending,” the researchers concluded.

The study findings align with prior research on telemental health use among adults.

Data from market research firm Trilliant Health released in March revealed that telehealth-delivered behavioral health services spiked 45-fold following the onset of the COVID-19 pandemic.

Trilliant Health researchers examined data from various sources, including the company's proprietary all-payer claims database, individual health plan and company financial statements, and Health Resources & Services Administration Workforce Projections.

Before the pandemic, 1 percent of all behavioral health visits were performed via telehealth, but as of the second quarter (Q2) of 2022, 32.8 percent of all visits were conducted through telehealth.

In the same period, behavioral healthcare began to account for higher shares of telehealth use. In Q2 2019, 34.4 percent of telehealth visits were related to behavioral healthcare. By Q2 2022, that figure jumped to 63.8 percent, an increase of almost 30 percentage points.