The availability of telehealth for mental health care varies greatly by state, from less than half of the facilities contacted in states such as Mississippi and South Carolina to every facility contacted in states such as Maine and Oregon. according to a new RAND study.
The researchers found that there were differences in services offered depending on whether the mental health facility was located in a rural or urban area.
The types of services offered—and the types of telehealth modalities available—also vary widely among clinics, with approximately one in four clinics not offering virtual medication management and about one in three not offering virtual diagnostic services.
The results are from a “mystery shopper” study in which researchers telephoned nearly 2,000 clinics across the country and attempted to make telehealth appointments for various mental illnesses, posing as patients of different races and ethnicities. The findings are published in the journal JAMA Health Forum.
We found considerable variation in the types of telehealth services offered by US mental health clinics. On the positive side, we did not observe significant differences in the availability of telehealth services based on the caller’s reported mental health status or perceived race and ethnicity.”
Jonathan Cantor, lead author of the study and policy researcher at RAND
The use of telehealth in the United States has expanded significantly during the COVID-19 pandemic. Although the use of telehealth has almost returned to pre-pandemic levels in most areas of medicine, it remains much higher than pre-pandemic levels in mental health care.
Although studies have examined the use of telehealth during the pandemic, little is known about the availability and composition of mental health telehealth services. This includes easy access to appointments, mental illnesses treated, types of telehealth services offered, and types of insurance accepted for payment.
“Understanding the availability of telehealth is important to inform policies that maximize the potential benefits of telehealth for mental health care,” Cantor said.
RAND researchers telephoned a nationally representative sample of 1,938 outpatient mental health facilities that treat adults between December 2022 and March 2023 using a standardized client script to inquire about current telehealth facility availability. Despite repeated calls to some clinics, the researchers were only able to reach someone at 1,404 clinics.
“We tried to replicate the experience of a typical client seeking specialized help from a mental health facility in the US,” Kantor said. “The fact that we were unable to contact anyone in one in five treatment facilities suggests that many people may have trouble getting to a clinic to inquire about mental health care.”
Of the medical facilities successfully contacted, 87% are accepting new patients and 80% report that they currently offer telehealth services. The average wait time for a telehealth appointment was just over two weeks, with significant geographic variation, ranging from more than two months at mental health clinics in Maine to four days at clinics in North Carolina.
About half of current telehealth providers report that telehealth is only available via video conferencing, 5% report using only audio conferencing, and 47% use both video and telephone conferencing.
Among current telehealth providers, 97% say they offer counseling services, 77% offer medication management, and 69% offer diagnostic services via telehealth. Responses did not differ significantly by the caller’s stated clinical condition.
Private facilities are nearly twice as likely to offer telehealth services as public facilities. In addition, private for-profit facilities were much less likely to offer medication management via telehealth than public facilities, but were more than twice as likely to offer diagnostic services.
“This may be because public and private facilities tend to serve different populations,” Cantor said.
Research support was provided by the National Institute of Mental Health. Other study authors include Megan S. Shuler, Samantha Matthews, Aaron Koffner, Joshua Breslau, and Ryan K. McBain.
RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.
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Journal reference:
Cantor, J., and others. (2024). Availability of mental health telehealth services in the US. JAMA Health Forum. doi.org/10.1001/jamahealthforum.2023.5142.
