Increase in Mental Health Spending Seen During the Pandemic

As both a licensed clinical social worker and a client who has primarily utilized telehealth psychotherapy since Covid, I was not surprised to read the results of a large study of insurance claims recently published in JAMA Health Forum which stated “telehealth service utilization expanded rapidly at the COVID-19 pandemic outset, particularly for mental health conditions.”

Telehealth is more accessible and convenient for clients and removes many of the barriers to mental health care that may have been present prior to the pandemic, such as travelling to the therapist’s office and taking time off work or getting a babysitter. While it’s true that one still needs to have an uninterrupted hour set aside, it’s still much easier to do that than to take up to three hours, including travel time.

This study analyzed 1,554,895 mental health service claims, among which “in-person visits decreased by 39.5% and telehealth visits increased roughly 10-fold. Utilization and spending rates for mental health care services among commercially insured adults increased by 38.8% and 53.7%, respectively, between 2019 and 2022.”

In terms of the efficacy of in-person therapy vs. online therapy, CBT (cognitive behavioral therapy) is a common form of psychotherapy for depression. In one study, researchers identified 17 RCTs (randomized controlled trials) comparing eCBT (electronic cognitive behavioral therapy) with face-to-face CBT, measuring improvements in patients’ depressive symptoms. The results demonstrated a relatively large effect size, favoring the electronically-delivered modalities for depressive symptom severity with a GRADE rating of “moderate.” For quality of life and participants’ satisfaction, eCBT was found to be as effective as face-to-face CBT.

Reporting on the surge in telehealth visits, an article in the New York Times stated that “Most of the mental health visits were for anxiety and depression, which made up 45 percent and 33 percent of the total visits, respectively; post-traumatic stress disorder visits made up 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, of 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.”

Will insurers continue to pay for this surge in telehealth therapy? The increase in tele-health therapy has resulted in additional mental health visits being covered by insurance, a long-awaited desired outcome of the 2008 Mental Health Parity and Addiction Equity Act. We have been waiting for parity with physical health coverage for a long time.

The question remains: Did the increase in telehealth psychotherapy visits impact clients utilizing higher — or more expensive — levels of care? Are clients still visiting emergency departments or being admitted to inpatient psychiatric units at the same rate as before? What was the ripple effect on clients being prescribed psychotropic medication and insurers having to pay for antidepressants, mood stabilizers or anti-psychotics?

I can only hope that this access to mental health care continues.

Thanks for reading.

Andrea