Study: Telehealth did not boost mental health access in rural areas

Despite popular belief, telehealth adoption did not result in significant increases in mental health treatment among patients in rural and vulnerable communities, new research revealed.  

Published in JAMA Network Open, the study assessed whether telehealth could close mental health access gaps in rural areas and communities with low access to care. While health systems have increasingly turned to telehealth to expand access to mental healthcare, including for pediatric patients, the new study shows that greater telehealth uptake was associated with only small increases in mental health visits among rural and remote communities.  

Researchers from Harvard Medical School and the Brown School of Public Health used Medicare fee-for-service program data from January 1, 2018, to December 31, 2023, to identify mental health specialists. They divided the specialists into four categories based on the percentage of outpatient mental health visits delivered via telehealth in 2021: lowest quartile (less than 40%), low-middle quartile (41%-79%), middle-high quartile (80%-98%) and highest quartile (99%-100%). 

The study sample included 17,742 mental health specialists, of whom 25% used telehealth and were divided into the four categories described above.  

The researchers found that mental health specialists in the highest quartile were more likely to be based in urban areas and to treat fewer patients with low incomes than their counterparts in the lowest quartile. 

They also examined four measures of geographic reach and found that greater telehealth adoption was associated with small differences in mental health visits. For instance, visits with patients living 20 miles or more away increased 5.1 percentage points from December 2018 to December 2023 in the highest quartile group, while they increased 1.3 percentage points in the lowest quartile group. 

Further, specialists in the highest quartile group showed a 0.12 percentage-point increase in visits with patients living in mental health specialist shortage areas, compared with those in the lowest quartile group, between 2018 and 2023.  

Compared with specialists in the lowest quartile group in 2023, those in the highest quartile group had increases of 0.88 percentage points in visits with rural patients, 0.95 percentage points in visits with patients in another state and 2.62 percentage points in visits with patients 20 or more miles away.  

"This cohort study found little evidence that greater telemedicine uptake among mental health specialists improved access to care for patients in rural communities or communities with specialist shortages," the researchers concluded.  

"Tailored policy interventions may be needed for telemedicine to reach its potential of improving mental health care of individuals with the greatest difficulty accessing it in their local community." 

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.