More Evidence of Mental Health Services Shifting to Telehealth: Health Affairs Study

Findings published in the April issue of Health Affairs show a huge jump in telehealth visits, but the researchers also detected that a pattern that suggests that people with conditions such as schizophrenia did not make the switch to telehealth as readily as people with anxiety and some other disorders.

Mental health services migrated to telehealth in huge numbers during the first year of the COVID-19 pandemic but much more for some conditions than others, research findings reported in this month’s Health Affairs shows.

Using a data from a claims clearinghouse that included just over 100 million outpatient mental health encounters, a research team led by Jane Zhu, M.D., M.P.P., M.S.H.P., at Oregon Health & Science University found that telehealth accounted for less than 1% of the mental health encounters in the three years prior to the pandemic but shot up to 39.6% during March-December 2020.

Their findings fit with the general pattern for medical services during 2020 a steep drop-off in-person visits during the initial three months of the pandemic and then a rebound in June followed by a plateau. Meanwhile, telehealth visits skyrocketed in March and April and then started to gradually decline.

Here is the chart that shows the 2020 trends:

When Zhu and her colleagues compared claims for encounters during the three pre-pandemic years with claims for encounters during the initial pandemic year of 2020, they found evidence of usage of outpatient mental services varying with the mental health condition. For example the average number of monthly encounters, in-person and via telehealth, for bipolar disorders fell by 10.6% in 2020 compared to the pre-pandemic years of 2016,2017 and 2018. There was also a decline in encounters for depression (-8.2%) and schizophrenia and other psychotic disorders (-8.5%). But, not surprisingly, encounter for anxiety and fear-related disorders increased, by 12.1%

The shift to telehealth also varied among the mental health conditions. In 2020, 2.7% of the in-person visits were for schizophrenia and related disorders compared with 1.7% of the telehealth visits. Similarly, 9% of the in-person visits were for bipolar and other related mood disorders compared to 5.7% of the telehealth visit. By contrast, 25.5% of the in-person visits were for anxiety and related disordered compared to 27.5% of the telehealth visits.

“Our data suggest that although telehealth uptake helped bridge access during the pandemic, the volume of encounters dropped for certain conditions, such as a bipolar disorder and schizophrenia, in part because of relatively lower telehealth uptake among these groups,” Zhu and her colleagues wrote.

Telehealth may be “uniquely suited” to delivering mental health services, they note, in part because it doesn’t typically involve the need for physical exam or lab test.But they sound a note of caution about the need for strategies for meeting the needs of people with “more serious mental health comorbidities.”

The data that Zhu and her colleagues used came from the Office Ally claims clearinghouse. The claims data they analyzed came from all 50 states and Washington, D.C., but they noted that Office Ally is used primarily by smaller practices on the West Coast.