Explainers Harm Reduction

Expanding Access to Mental Health Care Through Telehealth

Chelsea Boyd
Resident Research Fellow, Harm Reduction
Pritika C. Kumar
Former Resident Senior Fellow

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Why is access to mental health care important?

The United States is in the midst of a mental health crisis. In 2019, suicide was the tenth most common cause of death for all ages and the second most common cause of death for people under 35. COVID-19 has further exacerbated the mental health crisis due to increased fear, stress and social isolation. Substance use disorders are another facet of mental health, and in 2020, drug overdose deaths reached a new high.

What is telehealth?

Telehealth or telemedicine allows people to access health care without an in-person office visit. Telehealth appointments can consist of audio-only appointments, which can take place over the phone without the need for an internet connection, or video appointments, which require an internet connection or smartphone. Telehealth services can be delivered synchronously or asynchronously. Synchronous telehealth services are real-time audio or video visits between a patient and provider. Asynchronous telehealth services include text message services, remote patient monitoring (RPM) or “store and forward” services where patients upload information such as medical history, images and reports to a platform and then a practitioner forms a treatment plan.

How can telehealth services be used for mental health care?

When telehealth is used to provide mental health care, it is known as telemental or telebehavioral health. Telebehavioral health connects trained and licensed behavioral health professionals, such as psychiatrists, psychologists and social workers, with clients in remote locations. People experiencing serious mental illness (SMI), substance use disorders (SUD) and/or other behavioral health conditions can benefit from telebehavioral health services.

Across the continuum of care, telebehavioral health can be used to screen for and diagnose conditions through online scales, assessments and questionnaires; provide care through individual and group teletherapy, medication management, case management, crisis services, recovery support or monitoring through text message reminders; and educate patients and providers through online webinars.

Is telehealth effective for behavioral health conditions?

Studies show that telehealth is an equally or more effective method of delivering care for mental health conditions, including anxiety, depression, substance use disorders and post-traumatic stress disorder (PTSD). Telehealth can also improve symptoms related to attention deficit hyperactivity disorder (ADHD) in children, while significantly reducing distress to caregivers. Telebehavioral health produces improvements in symptoms, quality of life, medication adherence, treatment adherence and patient satisfaction.

Are people willing to engage with telehealth services for mental health conditions?

Even though we have witnessed a surge in telehealth use during the current pandemic, studies prior to COVID-19 show patient acceptance of telehealth as a care modality. The COVID-19 lockdowns showed a dramatic increase in public willingness to engage with mental health practitioners through telehealth services. Telehealth visits for mental health increased by 556 percent between March 11 and April 22, 2020. Furthermore, a Cigna 2020 analysis showed that practitioners conducted nearly two-thirds of mental healthcare appointments virtually, and the demand for virtual mental health care remained strong through the end of the year, even while demand for telehealth services in other medical specialties decreased. Data from McKinsey & Company similarly show that in February 2021, 50 percent of psychiatry appointments took place virtually—the highest of any specialty. For SUD treatment, services offered through telehealth increased from 13.5 percent in 2016  to 17.4 percent in 2019.

How does telehealth expand access?

Telehealth is a promising approach for improving access to mental healthcare. Despite high demand for mental health practitioners, many people struggle to access these services. Telebehavioral health care increases access, safety, privacy and convenience to patients by decreasing challenges that delay care. Health care delivery also improves with the use of telebehavioral health because it eliminates or reduces barriers such as traveling long distances for services, lack of anonymity, long wait times, fear of stigma, the need for time off work and child care services.

Telehealth is an effective mode of service delivery in rural and underserved areas, and recent evidence shows its utility in urban centers alike. Further decreasing barriers to care, audio-only services allow people who do not have the necessary internet access to participate in telehealth services.

Is telebehavioral health care cost-effective?

Telehealth is not only a valuable tool for improving mental health outcomes; it also improves the timeliness of care and produces cost-savings. Studies done in veteran and civilian populations demonstrate that telehealth offers significantly lower costs compared to traditional in-person care—without sacrificing the quality of care.

What are some limitations of telebehavioral health services?

Limitations of telebehavioral health services may include a lack of access without broadband internet connections; a lack of consistent reimbursement by insurance providers; lack of coverage by employer insurance plans; a shortage of mental health care providers in the United States; a lack of incentives for providers and consumers to adopt telehealth; and the fact that telebehavioral health services might not be appropriate for all patients under all circumstances. Licensing restrictions that prevent providers from practicing across state lines also limit access. Additionally, despite the recent increase in telehealth use, underserved populations, including elderly, Medicaid, low income and rural populations, engage with telehealth services at far lower rates.

What policies can be implemented to improve telebehavioral health access?

• Consider permanent extensions of COVID-19 telebehavioral health allowances and cross-state licensing reform to promote innovation and competition in mental health care delivery.

• Promote competition among mental health care providers through reimbursement parity between telehealth and in-person visits.

• Consider permanently expanding the availability of telebehavioral health services that do not require broadband access, such as audio-only visits, RPM and store and forward, to promote equitable access for vulnerable and rural populations.

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