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. 2023 Dec;100(6):1149-1158.
doi: 10.1007/s11524-023-00795-y. Epub 2023 Nov 27.

Temporal Trends in Telehealth Availability in Mental Health Treatment Settings: Differences in Growth by State Rurality, 2015-2020

George Pro  1   2 , Brian Fairman  3 , Jure Baloh  4 , Don Willis  5 , Broome E E Montgomery  6   7
Affiliations

Temporal Trends in Telehealth Availability in Mental Health Treatment Settings: Differences in Growth by State Rurality, 2015-2020

George Pro et al. J Urban Health. 2023 Dec.

Abstract

We sought to investigate temporal trends in telehealth availability among outpatient mental health treatment facilities and differences in the pace of telehealth growth by state urbanicity and rurality. We used the National Mental Health Services Survey (2015-2020) to identify outpatient mental health treatment facilities in the US (N = 28,989 facilities; 2015 n = 5,018; 2020 n = 4,889). We used logistic regression to model telehealth, predicted by time, state rurality (1 to 10% rural, 10 to < 20%, 20 to < 30%, or [Formula: see text] 30%), and their interaction, and adjusted for relevant covariates. We estimated the predicted probability of telehealth based on our model. We estimated effects with and without data from 2020 to assess whether the rapid and widespread adoption of telehealth during the COVID-19 pandemic changed the rural/urban trajectories of telehealth availability. We found that telehealth grew fastest in more urban states (year*rurality interaction p < 0.0001). Between 2015 and 2020, the predicted probability of telehealth in more urban states increased by 51 percentage points (from 9 to 61%), whereas telehealth in more rural states increased by 38 percentage points (from 23 to 61%). Predicted telehealth also varied widely by state, ranging from more than 75% of facilities (RI, OR) to below 20% (VT, KY). Health systems and new technological innovations must consider the unique challenges faced by urban populations and how best practices may be adapted to meet the growing urban demand. We framed our findings around the need for policies that minimize barriers to telehealth.

Keywords: Behavioral health services; Epidemiology; Telehealth.

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Figures

Fig. 1
Fig. 1
Telehealth availability among specialty mental health outpatient treatment facilities by state, rurality, and over time
Fig. 2
Fig. 2
Predicted probability of offering telehealth, year*rurality interaction. Notes: Models adjusted for facility owner type, health department licensure, CARF accreditation, and integrated primary care; year*rurality interaction difference in slopes p < 0.0001 for both models
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