Vulnerable populations tap telemental healthcare, study shows

Telehealth remains a popular way to deliver mental healthcare, but who tends to use that option varies. Recent research reveals that even though rural Americans use telemental health services less than their urban counterparts, utilization is high in areas of social vulnerability.

Areas of social vulnerability include those with higher socioeconomic challenges, a greater proportion of racial minorities and heightened social determinants of health. Prior research shows telehealth uptake is lowest among disadvantaged populations, but a study published in Telemedicine and e-Health finds that people living in socially vulnerable areas are more likely to use telehealth. This is possibly due to transportation barriers, caregiving demands and multiple jobs, the study authors wrote.

The researchers analyzed 28 million outpatient mental health visits delivered to 1.8 million adults between January 2023 and December 2025. They found that 76.2% of visits were delivered virtually in 2025, a slight decrease from 79.7% in 2023. A majority of visits (87.1%) were with a psychotherapist, while 12.9% were with a psychiatric prescriber.

However, the research shows that use of telemental health services varies by numerous factors, including age, gender, diagnosis and location.

Young adults used telemental health services more than older adults, with utilization peaking among individuals in their late 20s and early 30s. Women also used telemental health services more than men, though utilization was highest among non-binary individuals.

Telemental healthcare volumes also differed by state, with utilization ranging from 54% in Kansas to over 88% in Massachusetts, New York and Hawaii. A majority of people using telehealth for mental healthcare lived in urban and metropolitan areas (93.8%) compared to 6.2% living in rural areas.

Still, 40% of patients using telemental health services lived in ZIP codes with high social vulnerability, whether in urban or rural areas. The share of patients using telehealth-based mental healthcare rose with increasing social vulnerability, the study found.

Diagnosis also matters, influencing telemental health utilization. Most patients sought virtual care for attention-deficit/hyperactivity disorder (79.6%), followed by anxiety disorders (76.0%) and depressive disorders (76.5%).

These disparities in utilization show that virtual mental healthcare should be provided in addition to -- not as a universal replacement for -- in-person care, the study authors concluded.

"Hybrid care models that allow patients and clinicians to flexibly choose visit modality based on clinical needs, patient preferences, and access constraints may help maximize the benefits of telehealth while minimizing inequities," they wrote.

The study findings can also help inform lawmakers as they decide the future of pandemic-era telehealth flexibilities. These flexibilities significantly expanded access to virtual care and have been lauded as providing a lifeline to underserved communities across the country. However, Congress has yet to make these calls permanent, despite calls from the industry to do so, citing concerns around cost.

The telehealth flexibilities, which nix the requirement for an in-person visit within six months of an initial Medicare telemental health service, will expire on Dec. 31, 2027.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers healthcare IT and innovation, including artificial intelligence, digital healthcare, EHRs and interoperability.