The Pulse

A report on virtual consultations for mental health in the US

Mental health issues are one of the leading causes of disability in the U.S. While millions of people suffer from some type of mental illness of varying severity, not all of them have access to specialized mental health care. Telemedicine has emerged as an effective way of addressing these access barriers.

Telemedicine is projected to grow to $64.1 billion by 2025 in the U.S. while globally, the market is expected to cross $130.5 billion. The ongoing pandemic has served to speed up adoption of virtual mental health consultations. This report takes a deep dive into virtual mental health consultations in the U.S before and during the pandemic era.

Mental health statistics in the U.S.

Mental health issues are seen in one out of five adults in the U.S. that translated to 51.5 million people in 2019. The term ‘mental health’ is a collective term for many related conditions that vary in severity and nature. The NIMH(National Institutes of Mental Health ) categorizes mental health into AMI – Any Mental Illness and SMI – Serious Mental Illness.

AMI refers to emotional, behavioral or mental disorder that may cause mild to moderate impairment. SMI severely impacts normal functions and substantially interferes with major life activities. As per NIMH,

  • In 2019, 20.6 percent of U.S. adults had some form of mental health disorder.
  • Females had a higher rate of AMIs than males.
  • AMI was more prevalent in young adults between the age group of 18 to 25 as compared to older adults.
  • Before the pandemic, 13.1 million adults had SMI accounting for 5.2 percent of the U.S. adult population.

While anxiety and depression are highly prevalent, traditionally, patients have visited primary care for treatment. Although GPs (general practitioners ) provide comprehensive care typically to most patients, many patients with mental health conditions and somatic comorbidities often do not get proper treatment. In 2019, only 43.8 percent of adults with a mental health condition received treatment. On an average, the gap between onset of symptoms of mental illness and treatment is eleven years.

Some contributory factors include

  • lack of access to mental healthcare
  • long waiting times
  • immobility of older patients

An Accenturestudy shows that the challenges of access to and delivery of mental and behavioral health services are faced by all healthcare stakeholders. While social stigma, out-of-pocket costs and limited access impacts consumers, providers deal with poor reimbursement rates, rising costs of readmission and workforce shortages. Employers bear the burden of loss of productivity and coverage costs. A feasibility trial on virtual mental health consultations found that in the U.S., telehealth services overcome temporal and geographical barriers related to access to specialized mental healthcare.

The state of adoption of telehealth services before the pandemic

A studythat evaluated telehealth visits between 2005 and 2017 reported that most virtual healthcare visits related to mental health. The researchers found that the CAGR (Compounded annual growth rate) for virtual mental health consultations was 50 percent in these 12 years. However, only two visits were recorded per thousand enrollments in a year. Telemedicine use was much higher among those with serious mental illnesses. Earlier studies dating back to 2014 have found that there were 12 telehealth visits for every hundred Medicare beneficiaries who had SMIs. In some states, there were 45 visits for a hundred beneficiaries.

A new analysis conducted by Spivak and colleagues (throws light on the statue of adoption of virtual consultation for behavioral health in the U.S. The researchers leveraged the SAMHSA (Substance Abuse and Mental Health Services Administration) national survey findings to evaluate the extent of adoption of telemedicine. They formulated a descriptive analysis of both the characteristics and prevalence of the facilities that offered telemedicine. Telemedicine was defined as “the ability of healthcare providers to communicate with patients, diagnose conditions and provide treatment, using telecommunication technology.”

The study found that the pace of adoption of telehealth services was rapid in mental health facilities. From 15 percent in 2010, the facilities that offered telemedicine increased to 29 percent in 2017. In the South and Midwest states, close to 50 percent of mental health facilities provided telemedicine services.

These telemedicine facilities had some characteristics that distinguished them from facilities that did not offer the services. Virtual telemedicine providers were more likely to be funded from government sources, were publicly owned and were present in heavily rural states and underserved counties.

Some factors that contributed to the growth of virtual mental health services consultation in this timeframe include:

  • Provider shortages in rural areas driving the demand for telemedicine given the large distances patients need to cover to access mental health facilities
  • Expanding broadband Internet access that had earlier been the major bottleneck for telemedicine services in rural areas
  • policy focus on expanding telemedicine at insurer, local, state and federal levels.

The federalgovernment brought in legislation to encourage telemedicine adoption while removing reimbursement and regulatory barriers. The SUPPORT Act of 2018 eased restrictions related to Medicare reimbursement for virtual healthcare services. States also followed with payment parity laws to promote telemedicine reimbursement. Private insurers and Medicaid programs also expanded telemedicine service coverage.

Accordingto a 2018 Deloitte survey, 25 percent of consumers had a telehealth visit in that year. Close to 76 percent of hospitals were using teleconsultation technology and videos in 2017 to connect with patients. Another survey also found that 96 percent of. large companies were willing to provide telehealth coverage to employees in states where it was allowed. However, virtual consultations for mental health issues that earlier accounted for most telehealth visits dropped to the fifth position in the list in 2017. Virtual mental health visits constituted a mere 7 percent of telemedicine claim distribution.

Despite these advancements, only 11 percent of consumers in the U.S. accessed telehealth services in 2019. However, the COVID-19 pandemic created a major disruption in the healthcare scene and accelerated adoption of virtual mental healthcare consultations.

The growing demand during the pandemic

The ongoing COVID-19 pandemic has accelerated the demand for online mental health consultation. The social crisis and the pandemic-related stress are the key factors that contributed to record intakes by teletherapy providers in 2020. A mental health coaching, psychiatry and teletherapy provider, Ginger, witnessed the highest utilization rates in September 2020. The use of mental health coaching went up by 159 percent while virtual psychiatry and teletherapy consultations increased by 302 percent as compared to pre-pandemic times. The provider’s psychiatrists wrote 163 percent more anti-depressant and antipsychotic drug prescriptions.

Doctor-on-Demand, another telehealth provider, also experienced a 50 percent rise in demand for virtual mental health consultations in 2020. Many individuals and groups that had not availed of virtual consultations in the past (Medicaid beneficiaries and senior adults) also opted for virtual mental health consultations during the pandemic.

In terms of genders, more men have been taking virtual mental health consultations than women. In terms of age groups, 14 percent of the mental health visits were from Generation Z while virtual consultations increased among all age groups. The most notable increase in virtual consultations were seen in patients above 65.

The rise in demand stepped up investment in virtual behavioral and mental health startups. These startups received a funding of $588 million in the first six months of 2020. The other notable trends related to virtual mental health consultations during the pandemic include:

  • Virtual psychiatry consultations went up to 96 percent in 2020 from 80 percent in pre-pandemic era. These patients stated they were willing to make virtual visits for mental health care post-COVID-19.
  • Most consumers prefer virtual visits even after it becomes safe to make in-person visits to the doctor.
  • Substance and alcohol abuse rates went up in women
  • Men sought mental health care consultations for relationship/family issues more than women,
  • The diagnosis of anxiety increased in Millennials and Generation Z

As per a new Accenturestudy, 81 percent of U.S. adults are willing to book a virtual mental health consultation to manage their mental and behavioral health condition. Virtual delivery of mental health care could help provide access to 53 million Americans who have behavioral health issues. Researchers of this study surveyed 3,400 people diagnosed with mental and behavioral health conditions including anxiety, depression, attention-deficit disorder, PTSD ( post-traumatic stress syndrome) and substance addiction. While 58 million people have mental health issues in the U.S., only 43 percent are being treated.

Among the respondents, 63 percent preferred to use webchat, 55 percent were willing to use videos while an equal number preferred individual therapy with voice, video or both.

Conclusion

Virtual mental health consultations are emerging as the cornerstone of healthcare delivery, particularly during the COVID-19 pandemic. With consumers, health insurers, employers and providers demanding more coordinated, convenient and connected healthcare, this trend is likely to continue in the post-COVID era. Apart from the benefits of improved access to specialized mental health care, telehealth services improve patient satisfaction, experience and connectivity between caregivers and patients.

While addressing technology and regulatory barriers, promotion of digitally-enabled mental health care adoption boosts the efficiency of mental health system while freeing up resources for people in need of intensive clinical care.

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