Wide Disparity in Mental Telehealth Services Among States

TOPLINE:

Availability of telehealth services for mental healthcare varies widely from state to state, a new study shows. One fifth of all facilities contacted reported no mental telehealth options and wait times for those that did ranged from 4 days to > 2 months, depending on the state.

METHODOLOGY:

• Between December 2022 and March 2023, researchers contacted a nationally representative sample of 1938 adult outpatient mental health treatment facilities (MHTFs) posing as potential patients with major depressive disorder, generalized anxiety disorder, or schizophrenia to inquire about telehealth availability. Data did not include individual private practitioners.
• Callers used a standardized script (“secret shopper” model) and used historically female and male names and Black, White, or Hispanic names to ascertain the potential presence of a form of linguistic profiling over the telephone.
• Facility addresses were used to link county-level data within the Health Resources and Services Administration’s Area Health Resource Files.
• The primary outcome was current availability of telehealth services at each facility, with other measures of interest including telehealth offerings for specific conditions, types of services offered, and number of days until the next available appointment.

TAKEAWAY:

• 1221 clinics of the 1404 successfully contacted were accepting new patients and 80% of those offered telehealth services, with no difference in availability between the three clinical conditions or based on the perceived sex, race, or ethnicity of the caller.
• Among those offering telehealth services, 97% reported availability of counseling services, 77% medication management, and 69% diagnostic services.
• Facilities that offered mental telehealth services were more likely to be those that provided only outpatient vs inpatient services (adjusted odds ratio [aOR], 3.76); private for-profit and private non-profit vs public (aOR, 1.75 and 2.20, respectively); and those that accepted Medicaid (aOR, 4.27).
• There was wide state-level variation in availability and appointment wait time, with mental telehealth offered in less than half of MHTFs contacted in Mississippi and South Carolina but in all of those contacted in Delaware, Maine, New Mexico, and Oregon and wait times ranging from > 2 months in Maine to 4 days in North Carolina.

IN PRACTICE:

Approximately one fifth of facilities did not respond despite multiple attempts, suggesting that “many individuals seeking a specialty mental health service may encounter difficulty in inquiring about treatment services,” the authors wrote. One potential vehicle the authors recommended for improving telehealth wait times is to “broaden policies allowing facilities to offer telehealth across state lines.”

SOURCE:

Jonathan Cantor, PhD of the RAND Corporation, was the lead and corresponding author on the study. It was published online on February 2, 2024, in the JAMA Health Forum.

LIMITATIONS:

The secret shopper survey focused on MHTFs, but it’s possible that telehealth availability and services may differ at other types of facilities. Moreover, the researchers did not directly measure telehealth utilization or quality, only availability. Importantly, the study didn’t include measure of broadband coverage as a covariate.

DISCLOSURES:

The study was funded by the National Institute of Mental Health. The authors declared no relevant financial relationships.