The study highlights the transition in the US mental health system from in-person to virtual care
Telehealth services for common mental health issues increased 16- to 20-fold during the first year of the COVID-19 pandemic, more than offsetting a decline in in-person care that occurred during the period for a number of conditions , according to a new study from the RAND Corporation.
Examining the experiences of more than 5 million adults with private health insurance, the researchers found that in-person services for depressive disorders, anxiety disorders, bipolar disorder, adjustment disorders and PTSD have decreased by more than 50% after the public health emergency was declared in 2020.
While in-person mental health care use declined sharply, telehealth services grew steadily during the first year of the pandemic. In December 2020, mental health services treatment for some of the disorders was 10% to 20% higher than in January 2020. The study is published in JAMA Health Forum.
Our findings highlight a remarkable transition in the US mental health system from in-person to virtual care."
Christopher M. Whaley, senior author of the study and an economist at RAND
While the increase in the use of telehealth mental health services during the pandemic is well known, the study is the first to show that the magnitude of the increase in telehealth use more than offset the decline in in-person treatment .
Many previous studies have documented an elevated level of psychological distress and mental health disorders such as anxiety and depression during the COVID19 pandemic.
Meanwhile, concerns about the spread of the coronavirus have led many mental health providers to phase out or reduce in-person services.
In response, many providers have switched to providing telehealth mental health services, and public and private insurers have expanded coverage for telehealth services.
To examine trends in mental health services since the start of the pandemic, the researchers looked at claims from commercially insured adults from January to December 2020. Information about the claims came from Castlight Health, a health benefits manager for mental health plans. Employer-sponsored health insurance for approximately 200 employers in all 50 states.
The study found that the increase in telehealth use was lowest for bipolar disorder and highest for anxiety disorders.
When in-person and telehealth service rates are combined, there was an overall increase in care for major depressive disorders, anxiety disorders, and adjustment disorders. The increase in the use of mental health services for anxiety disorders during the pandemic has been higher for women than for men.
Among the group studied, people in rural areas were least likely to use telehealth services. Additionally, people older than 46 had lower service rates than younger adults.
"Although this may be partly due to a lower prevalence of certain conditions among older Americans, the consistency of this trend across different diagnosis categories suggests that factors such as lower digital literacy and less comfort using telehealth may also play a role," said Ryan K. McBain, lead author of the study and a policy researcher at RAND.
Support for the study was provided by the National Institutes on Aging and the Robert Wood Johnson Foundation. Other authors of the study are Jonathan Cantor and Joshua Breslau, both of RAND; and Megan F. Pera and Dena M. Bravata, both of Castlight Health.
RAND Health Care promotes healthier societies by improving health care systems in the United States and beyond.
Magazine reference:
McBain, R.K. et al. (2023) Mental health utilization rates among commercially insured adults in the United States during the first year of the COVID-19 pandemic. JAMA Health Forum. doi.org/10.1001/jamahealthforum.2022.4936.
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