Expanded access to telemedicine visits helped to meet the surging need for mental health care during the coronavirus pandemic, a study of more than 100 million outpatient visits in the United States suggests.
For the study, researchers compared trends in outpatient mental health care before the pandemic — from 2016 to 2018 — to what happened in 2020 when stay-at-home orders limited access to care. The number of in-person visits declined 22 percent in March 2020 compared with the same period in pre-pandemic years, followed by plunges of 50 percent in April and 56 percent in May.
But starting in April 2020, the total volume of mental health care visits exceeded pre-pandemic levels, driven by gains in telemedicine appointments that more than made up for the loss of in-person encounters, researchers reported in Health Affairs. The combined number of in-person and virtual visits was 10 percent higher in April 2020 than in the same month during the pre-pandemic years studied.
By the end of 2020, almost half of all mental health visits were happening virtually, the study found.
“Our study suggests that telehealth services for mental health counseling expanded significantly and is likely to stay,” said the study’s lead author, Jane Zhu, MD, an assistant professor of general internal medicine and geriatrics at the Oregon Health and Science University School of Medicine in Portland, in a statement.
4 in 10 Suffered Anxiety and Depression During the Pandemic
The pandemic simultaneously restricted access to in-person care and increased the need for mental health services. During the pandemic, 4 in 10 adults suffered from anxiety and depression, up from 1 in 10 people before, a previous study found.
Based on the average monthly numbers of total patient encounters — including both in-person and virtual visits — the new study suggests that the potential for telemedicine to meet rising demand for treatment may vary by patients’ diagnosis.
For example, average monthly total encounters for anxiety and fear-related disorders climbed by 12 percent during the pandemic. But average monthly total encounters declined by 8.2 percent for depression, by 8.5 percent for schizophrenia and psychotic disorders, and by 10.6 percent for bipolar disorders.
The differences might be explained by how much virtual visits helped make up for lost access to in-person care. For schizophrenia, the proportion of visits done via telehealth rose to 2.7 percent during the pandemic from 1.7 percent before. For anxiety, the proportion of visits done virtually climbed to 27.5 percent during the pandemic from 25.5 percent before.
Discrepancies in Access to Virtual Mental Health Services
Certain vulnerable populations also appeared less apt to access mental health services virtually, the study also found. Older adults, Black and Hispanic patients, individuals living alone, and low-income people were all less likely to access mental health treatment online.
One limitation of the study is that it focused disproportionately on what happened in California, Oregon, and Washington. It’s possible that these results might not be the same in other U.S. states, the study team notes.
Researchers also lacked data on individual patients to determine whether people had preexisting mental health conditions or developed psychological issues for the first time during the pandemic.
Telemedicine Likely to Remain Popular Post-Pandemic
Mental health care was the number one reason for telemedicine visits before the pandemic, and the study results suggest that virtual visits will remain popular even now that in-person care is more widely available again, says Michael Barnett, MD, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health in Boston.
“There are many pros for telemedicine for mental health — less travel, a potentially broader set of providers to see, and in some ways more privacy for patients,” says Dr. Barnett, who wasn’t involved in the new study. The downside may be that patients miss out on the therapeutic value of being face-to-face with somebody, or that patients aren’t able to get privacy in their homes to access online care, he adds.
It’s not clear from the study whether telemedicine can ultimately make mental health services accessible to more people who might otherwise go without care, Barnett says.
“There’s little doubt that some people wouldn’t access care unless they had telemedicine, but the question is whether just as many or more get locked out of care because they can’t or won’t do telemedicine,” Barnett says.
