by Heather Butler and Aakanksha Deoli

The advent of the COVID-19 pandemic engendered a precarious environment that significantly exacerbated existing mental health disorders and triggered new ones. According to Mental Health America, roughly one in five American adults suffered from a mental health condition in 2019. In the same year, the American Academy of Family Physicians reported that one in six children had a mental health disorder. One year later, the Centers for Disease and Control and Prevention found that the pandemic placed a significant burden on the country: reports of mental health illness and substance abuse among U.S. adults rose to 40 percent in June of 2020. This “second pandemic” of mental health crises especially impacted essential workers, unpaid caregivers for adults, youth (ages 18-24 and 25 to 44), people of color, less educated populations, and other marginalized communities.

In treating mental health conditions during the pandemic, one avenue of care is telehealth, which offers a remote option for patients and providers. In recent months, mental health has been one of the most common telehealth services by health insurance claims. In April 2022, 70.8 percent of commercial and Medicare telehealth claim lines were mental health diagnoses. Compared to other specialties, many mental health clinicians report telehealth as efficient and of high quality. In a study published in 2022 in the Journal of the American Medical Association, researchers found that 41.7 percent of mental health providers in the sample claimed that video call visits with established patients were higher in quality than in-person visits with masks, and 49.7 percent said they found the two modes to be equivalent in quality.

Policymakers further looked toward increasing the accessibility of tele-mental health and incentivizing its use in the pandemic era. For example, the Senate Finance Committee introduced a bill that expands tele-mental health resources post-public health emergency. In the bill, it would remove Medicare’s requirements for in-person visits in order to qualify for telehealth reimbursement and, most notably, create a “Bill of Rights” for telehealth mental health care that ensures that information on telehealth services is clearly conveyed to patients. As people with low health literacy have difficulty navigating healthcare information, such measures are crucial in improving the country’s trust in reliable health resources.

One of telehealth’s greatest strengths in delivering mental health services is its convenience for both the provider and patient. For example, LGBTQ+ adults often experience challenges in finding local therapists that they can trust due to their stigmatized identities; however, telehealth has enabled LGBTQ+ persons access to therapists across the country with whom they feel comfortable connecting. In addition, due to remote care, LGBTQ+ people are able to receive gender-affirming care, such as hormones, without traveling long distances. With LGBTQ+ adults facing mental health challenges at twice the rate as their cisgender and heterosexual counterparts, access to mental health during the pandemic and beyond is imperative for their well-being.

Some studies even suggest that investing in mental health services improves the emotional well-being of students and prevents mass shootings. In response to the recent tragedy in Uvalde, Texas, President Biden signed the Bipartisan Safer Communities Act, which directs federal funding toward telehealth services, especially mental health care in schools and community centers. In effect, such services will focus on treating existing mental health conditions as well as mitigating the risk of new ones.

Nonetheless, telehealth has its limitations. In some circumstances, mental health services are most effective when provided in person due to a perceived lack of connection between the patient and provider. According to one study in the Psychiatric Quarterly, 10.5 percent of surveyed mental health providers still preferred traditional face-to-face visits during the pandemic as they are less “dehumanizing and depersonalizing” than remote visits.

Moreover, low socioeconomic status (SES) communities tend to experience barriers to care when seeking tele-mental health services. Throughout the COVID-19 pandemic, lower SES communities were more likely to visit the emergency department for mental health than higher SES communities, which may suggest that they have reduced access to tele-mental health due to poor health coverage and/or low digital literacy. Thus, in addition to any mental health conditions, low SES families face further stress when pursuing mental health services, especially during the pandemic.

Despite the push towards reopening health facilities and utilizing in-person visits, the use of telehealth is slowly increasing; between March and April of 2022, national usage has grown by nearly 7 percent. Furthermore, mental health conditions compose over 65 percent of the diagnoses administered through telehealth. In response to the persistence of COVID-19, on July 15, 2022, the Department for Health and Human Services (HHS) extended the public health emergency (PHE) until mid-October. The PHE preserves temporary telehealth policies that Medicare and Medicaid users benefit from, which includes mental health care. Thus, unless HHS decides to renew the PHE or implement permanent changes to telehealth coverage, the option of covered tele-mental health care may be eliminated from many beneficiaries.

Fortunately, the Centers for Medicare and Medicaid Services (CMS) has started to solidify pandemic-era regulations, stating that it would cover certain telehealth behavioral care services—such as group psychotherapy—beyond the PHE. Unlike federal policies, state telehealth politics tend to be more contingent on the prevalence of COVID-19. For example, in December of 2021, Governor Murphy signed a bill that establishes payment parity for telehealth visits. The coverage is set to expire at the end of 2023, which may make it more difficult for users of telehealth to cover health care costs.

The United States consistently ranks below other developed nations in mental health outcomes despite being one of the highest spenders of mental health services in the world. While lawmakers have made efforts to encourage the use of telehealth for treating mental health conditions, it is imperative that policymakers continue to expand access to tele-mental health services and provide diverse options for patients and providers due to unique needs and preferences.

Heather Butler is an undergraduate student at the School of Environmental & Biological Sciences at Rutgers, The State University of New Jersey.
Aakanksha Deoli, MHA is an Instructor of Teaching and UG Internship Coordinator at Edward J. Bloustein School at Rutgers, The State University of New Jersey.