A new RAND Corporation study shows that the availability of telemedicine for mental health care varies widely across states, from states like Mississippi and South Carolina where less than half of treatment facilities are reachable to states like Maine and Oregon The state can contact all treatment facilities.
Researchers found differences in services provided based on whether a mental health treatment facility is located in a rural or metropolitan area.
There was also considerable variation in the types of services provided by clinics and the types of telemedicine modalities available, with about a quarter of clinics not offering virtual medication management and about a third not offering virtual diagnostic services.
The results come from a “secret shopper” study in which researchers called nearly 2,000 clinics across the country, posing as patients of various races and ethnicities seeking telemedicine appointments for a variety of mental health issues.Research results published in journal JAMA Health Forum.
We found considerable variation in the types of telehealth services provided by mental health clinics across the United States. On the positive side, we found no significant differences in the availability of telehealth services based on callers’ stated mental health status or perceived race and ethnicity. “
Jonathan Cantor, the study’s lead author and a policy fellow at the RAND Corporation
The use of telemedicine has expanded significantly in the United States during the COVID-19 pandemic. While telemedicine use has returned to near pre-pandemic levels in most areas of medicine, in mental health care, telemedicine use remains well above pre-pandemic levels.
While studies have examined telehealth use throughout the pandemic, less is known about the availability and composition of mental health telehealth services. This includes the ease of making an appointment, the mental health conditions treated, the types of telehealth services provided, and the types of insurance accepted for payment.
“Understanding the availability of telemedicine is important for developing policies that maximize the potential benefits of telemedicine for mental health care,” Cantor said.
Using a standardized client script, RAND researchers conducted a telephone survey of a nationally representative 1,938 outpatient mental health treatment facilities treating adults between December 2022 and March 2023 to inquire about current facility availability of telehealth. . Despite repeated calls to some clinics, researchers were able to contact personnel at only 1,404 clinics.
“We tried to replicate the experience of a typical client seeking specialty care from a U.S. mental health treatment facility,” Cantor said. “The fact that we were unable to contact anyone at one in five facilities suggests that many people may have difficulty getting there. Clinic asks about mental health care.”
Of facilities successfully contacted, 87% are accepting new patients and 80% say they are currently offering telehealth services. The average wait time for a telemedicine appointment is just over two weeks, with wide geographic variation, from more than two months at a Maine mental health clinic to four days at a North Carolina clinic.
About half of telemedicine providers currently say telemedicine is available only via video appointments, 5% of respondents said they use audio only for appointments, and 47% use both video and phone appointments.
Among current telemedicine providers, 97% said they offer counseling services, 77% offer medication management, and 69% offer diagnostic services via telemedicine. There were no significant differences in responses based on the clinical status described by the caller.
Compared to public facilities, private facilities were nearly twice as likely to offer telehealth services. Additionally, private for-profit facilities were significantly less likely than public facilities to offer medication management via telemedicine 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.
The research was supported by the National Institute of Mental Health. Other authors of the study include Megan S. Schuler Samantha Matthews, Aaron Kofner, Joshua Breslau and Ryan K. McBain.
RAND Healthcare promotes a healthier society by improving the health care system in the United States and other countries.
Cantor, J., et al. (2024). Availability of psychological telehealth services in the United States. JAMA Health Forum. doi.org/10.1001/jamahealthforum.2023.5142.