Mental health care use has increased significantly during the coronavirus pandemic, as teletherapy has lowered barriers to routine visits, according to a large study of insurance claims published Friday in JAMA Health Forum.
From March 2020 to August 2022, mental health visits increased by 39 percent, and spending increased by 54 percent, the study found. Its analysis of 1,554,895 claims for clinician visits also identified a tenfold increase in telehealth use.
The studying covers visits for the roughly seven million adults nationwide who receive health insurance through their employers, so it excludes many patients with severe mental illness, and it does not cover chronic or residential care.
The increases are likely to be sustained, even as insurers weigh the benefit of continuing to pay more, said Christopher M. Whaley, a health care economist at the RAND Corporation and an author of the study.
“It’s a huge cost, and we’re paying that cost through higher premiums and higher deductibles,” Mr. Whaley, an associate professor at Brown University.
On the other hand, he added, patients with unmet mental health needs are less likely to take their medications, and less likely to turn to emergency rooms in crisis, behaviors that are also changing. of large costs in insurance pools.
“The insurer’s challenge, and what we have to think about as a health care system, is what really costs more,” said Mr. Whaley.
Most mental health visits were for anxiety and depression, which accounted for 45 percent and 33 percent of total visits, respectively; Post-traumatic stress disorder visits comprised 10 percent; bipolar disorder, 9 percent; and schizophrenia, 2.6 percent.
Of the five diagnoses, anxiety disorders saw the steepest increase in visits during the pandemic, at 73.7 percent. PTSD visits increased by 37 percent; bipolar disorder visits by 32 percent; and depression visits by 31.9 percent. Schizophrenia visits did not change.
The researchers were surprised to discover that the use of telehealth for mental health did not wane at the end of the pandemic, as it did in other areas of medicine.
“This is one part of the health care system where patients and providers are in some sense voting with their feet.,” said Mr. Whaley. “It’s a change that seems likely to last beyond the pandemic.
The increase in use of mental health services reflects both shrinking stigma and decreasing practical barriers to mental health visits, said Dr. Robert L. Trestman, the chairman of psychiatry at Virginia Tech’s Carilion School of Medicine, oversees a psychiatric system in the west. Virginia.
In his own system, Dr. Trestman, the pandemic years have brought “incredible increases in billing” for patients with anxiety and depression. Historically, about half of all people with symptoms of these disorders did not receive mental health care, he said.
As more people seek care, the numbers are “really more consistent with the underlying epidemiology that we might expect,” he said.
“They are restricted by finding a clinician, to take time off work to see them,” said Dr. Trestman, who is also chairman of the American Psychiatric Association’s council on health care systems and financing. “With emergency public health and the expansion of telehealth, those limitations have really evaporated.”
He added that he expects the trend to continue, as Americans manage financial and housing insecurity and repay loans after the pandemic.
“I don’t see any evidence of any decline that we can see or foresee,” he said.
It is unclear whether insurers will try to curb higher levels of spending.
Patients have long complained about the difficulty of getting mental health visits covered, despite the passage of a federal law, the 2008 Mental Health Parity and Addiction Equity Act.
Insurers need to determine whether telehealth prevents patients from accessing more expensive forms of care, such as using emergency rooms for mental health crises, Dr. Jane M. Zhu, an associate professor of medicine at Oregon Health and Science University who studied the accessibility of mental health services.
“It’s going to trickle down at some point,” he said. “This means that overall spending will increase, if more people use telehealth, or insurers will look for ways to reduce their spending.”
Acceptance of telehealth varies among different populations, said Dr. Zhu. The studying published in Health Affairs in 2022 found that people with schizophrenia were slower to move away from treatment, whereas those with anxiety and fear-related disorders were faster.
A 2022 review by the federal Office of Health Policy found significantly lower use of telehealth among uninsured people and young adults. Video visits are highest among white and higher-income people, and lowest among people with less education; people over 65; and Latino, Asian and Black people.
said Dr. Zhu that the increase in the use of services is remarkable.
“I’ve never seen anything like that in the literature,” he said. “Obviously, this is a whole new era that we’re in.”
