During the pandemic, the number of Americans receiving psychotherapy has increased by 30 percent as in-person appointments have replaced virtual sessions. But new research dampens hopes that technology will make mental health care more accessible to those most in need.
In fact, researchers found that the shift to teletherapy exacerbated existing disparities.
The increase in psychotherapy is occurring among groups that already enjoy greater access: those with higher incomes, who live in cities, have stable employment and more education. Research has revealed this. The latest study was published on Wednesday. American Journal of Psychiatry.
The researchers found that among those not benefiting from the boom were children from low-income households, black children and adolescents, and adults with “severe psychological distress.”
“The entire system of care, and I think Internet delivery is part of it, seems to be moving away from the people who are most in need,” said Dr. Mark Olfson, a professor of psychiatry at Columbia University Irving Medical Center. spoke. Lead author of the study on access to care.
“We see that those in the greatest distress are at a disadvantage in terms of their chances of accessing treatment. This is a very important and disconcerting trend to me,” he added. .
It wasn't supposed to be like this. In the 1990s, teletherapy gained traction as a way to provide treatment to disadvantaged patients living in remote areas where there were few psychiatrists. Ten years later, it presented itself as a more accessible alternative to face-to-face sessions, fundamentally lowering barriers to care.
“Telemedicine has not lived up to the hype,” said C. Vail Wright, senior director of the American Psychological Association's Office of Healthcare Innovation. The reason is not surprising, she added. Because many Americans don't have access to reliable broadband and insurance companies don't adequately reimburse providers, insurers are choosing to treat customers who pay privately.
“If you can't afford the treatment, you can't afford it, regardless of the treatment,” Dr. Wright says. She added that weekly therapy sessions may simply not be scalable to a wide range of people, and the field needs to explore lighter-touch alternatives such as single-session interventions and digital treatments.
As telehealth platforms grow, they may be luring local clinicians with promises of flexible work hours and better conditions, says an Oregon Health & Science University School of Medicine researcher who studies the accessibility of mental health services. said Associate Professor Dr. Jane M. Zhu. .
Selecting from a large patient pool, you may choose to treat patients with milder symptoms and better ability to pay. “That's certainly something we should know,” says Dr. Zhu. “There has to be some light here. Who are these companies serving? And what does this mean for patients who need help the most?”
Dr. Olfson said the percentage of Americans receiving psychotherapy remained relatively stable at 3 to 4 percent for several decades, then began to gradually increase.
Two factors then contributed to the sharp increase: the pandemic and the proliferation of teletherapy, with the number of adults receiving psychotherapy increasing from 6.5 percent in 2018 to 8.5 percent in 2021. (By comparison, the annual percentage of adults taking psychotropic drugs remains unchanged), holding steady at about 17.5%. )
Dr. Olfson said he was surprised by the size of the increase. “We've never had anything like coronavirus before, and we've never had this technology before,” Dr. Olfson said. “There was a lot of social isolation and loneliness, and those are things that psychotherapy was designed to address in a way that medications cannot.”
The findings are based on the Health Expenditure Panel Survey, which is conducted by the federal government and measures how civilian Americans use and pay for health care. The study does not include people in the military, incarcerated, nursing homes, hospitals or homeless shelters.
Previous research based on insurance data shows that Americans' mental health spending increased by 54 percent from 2020 to 2022, while the use of teletherapy increased tenfold.
A new study sheds light on the kind of care Americans receive. An analysis of 89,619 adults published last month in JAMA Psychiatry found that the use of psychotherapy increased the most among the youngest respondents, the most highly educated, and those in the top two income brackets. It turned out that
An analysis of telehealth use by children and adolescents in 2,445 households reached similar conclusions. A study published today found that children from wealthier families with private insurance were much more likely to use teletherapy. Children in urban areas were almost three times more likely to take advantage of it than children in rural areas.
During the years of the pandemic, Black children and youth's use of mental health services declined, dropping from 9.2% in 2019 to 4% in 2021. During the same period, white children's use of mental health care increased to 18.4%. In another study, the researchers found an increase from 15.1 percent to %.
“What we're finding is that it appears to just be exacerbating existing disparities,” Dr. Olfson said. “I think there really needs to be an effort to address that.”
