Telehealth Availability for Mental Health Has Declined After COVID-19

The percentage of mental health treatment facilities (MHTFs) offering telehealth services declined after the end of the COVID-19 public health emergency (PHE), according to study findings published in JAMA Network Open.

Telehealth availability for mental health services increased substantially during the COVID-19 pandemic, facilitated, in part, by changes to Medicare and Medicaid policies that enabled reimbursement for these services. As the PHE ended in May of 2023, so did many of these policies and regulations. The current study sought to determine if telehealth availability at MHTFs was affected by these policy changes.

Investigators conducted a national secret shopper analysis to evaluate changes in telehealth availability at outpatient MHTFs across the United States before vs after the COVID-19 PHE. The investigators used the Substance and Mental Health Services Administration’s (SAMHSA) Behavioral Health Treatment Service Locator to identify 9568 outpatient MHTFs and 1938 (25%) were randomly selected for contact in wave 1, which occurred between December 2022 and March 2023. The facilities that were successfully contacted in wave 1 were recontacted between September and November 2023 in wave 2. The primary measure of interest was whether or not the MHTF currently offered telehealth services.

The investigators successfully contacted 1404 MHTFs in wave 1 of the study and 1001 in wave 2. Most facilities (71.2%) were located in metropolitan counties and 63.7% were private not-for-profit. Nearly all facilities (93.4%) accepted Medicaid.

At wave 1, 799 facilities (81.6%) offered telehealth services. At wave 2, telehealth availability decreased to 79.0% (n=765), resulting in significantly lower odds of telehealth availability after the COVID-19 PHE (odds ratio [OR], 0.84; 95% CI, 0.72-1.00; P =.046).

When stratified by type of telehealth services, the investigators found the percentage of MHTFs that offered audio-only telehealth services significantly decreased from 49.3% in wave 1 to 34.1% in wave 2 (OR, 0.53; 95% CI, 0.44-0.64; P <.001). Telehealth for comorbid alcohol use disorder also significantly decreased after the COVID-19 PHE (76.3% vs 66.5%; OR, 0.62; 95% CI, 0.50-0.76; P <.001).

At wave 2, the investigators found that facilities were more likely to report that telehealth availability was restricted to only certain conditions for therapy (OR, 2.62; 95% CI, 1.10-3.26; P <.001) and/or medication management (OR, 1.81; 95% CI, 1.48-2.21; P <.001). Additionally, lower adoption and higher discontinuation of telehealth services were more frequently noted among public MHTFs vs private MHTFs.

These results indicate that telehealth availability for mental health has declined since the end of the PHE. The investigators concluded, “Our results emphasize the importance of monitoring access to mental health care in a post-pandemic era, especially against the backdrop of the federal and state policy landscape.”

Study limitations include the potential for nonresponse bias and that the investigators did not account for possible changes to telehealth policies outside of the PHE.

This article originally appeared on Psychiatry Advisor