Use of Telehealth Services for Mental Health Dramatically Increased in 2020, Offsetting Rapid Decline of In-Person Care


Individuals in metropolitan counties used mental health services more than individuals in rural counties.

The COVID-19 pandemic changed the landscape of mental health care in the United States. While rates of in-person mental health services dropped by more than 50% in 2020, an influx of people sought telehealth services for mental health, according to a study published in JAMA Network Open. This slightly increased the amount of people who used mental health services during the first year of the pandemic.

“These estimates mask a remarkable transition in the US health system from in-person to virtual care,” the study authors wrote. “This is the first study to show that the magnitude of this increase (roughly a 16- to 20-fold increase in utilization) fully compensated for the decline in in-person care.”

There are 50 million people in the United States who are affected by a mental illness. And a significant number of people developed mental health disorders during the first year of the COVID-19 pandemic; however, only approximately 50% of patients accessed a mental health service.

Researchers decided to analyze the use of weekly mental health services among commercially insured adults from January 5, 2020, to December 21, 2020, to understand how mental health services were being used during the pandemic. The study authors examined mental health issues across 5 diagnostic categories—major depressive disorder, anxiety disorders, bipolar disorder, adjustment disorder, and posttraumatic stress disorder (PTSD).

Following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline, investigators assessed service utilization rates by studying the weekly medical claims of 5,142,577 commercially insured adults across all 50 states. They also calculated demographic differences according to patient age category, sex, and mode of service delivery, comparing telehealth or in-person.

Between March 14, 2020, and December 20, 2020, use of mental health services increased 8% across all 5 diagnostic categories. Anxiety disorders, major depressive disorder, and adjustment disorders ranked highest among treated conditions, which led to the overall increase in care for mental health disorders.

Pre-pandemic, females had an observably higher use of mental health services. In its first year, females still trumped males in use of these services for anxiety disorders. But there was a 20% jump in use of mental health services for anxiety disorders overall by the end of that same year. Individuals in rural communities and adults 46 years of age and older were among those less likely to use telehealth services.

The study had some limitations, the first of which being that it excludes publicly insured individuals. Second, there was no accounting for individuals who were continually insured throughout the study period, and they did not collect data of service utilization into 2021. Finally, researchers did not assess differences in quality of care between in-person and telehealth services.

“Service utilization for anxiety, depression, and adjustment disorders gradually increased throughout 2020, although it is likely that the treatment gap for care remained large. It will be important to observe whether and to what extent these trends continue to shift,” the study authors wrote.


McBain, Ryan, Cantor, Jonathan, Pera, Megan, et al. Mental Health Service Utilization Rates Among Commercially Insured Adults in the US During the First Year of the COVID-19 Pandemic. JAMA Health Forum. 2023;4(1):e224936. doi:10.1001/jamahealthforum.2022.4936.

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