45% of Patients Say Therapists Didn’t Consider Their Telehealth or In-Person Preference

Nearly half of all individuals in outpatient mental health care said they do not get care in their preferred setting, according to new survey data.

The survey report highlights the various trade-offs and downsides of the rise of telehealth in outpatient mental health. About 45% of respondents said their mental health clinician did not consider their preference to meet in person or via telehealth. The report also posits that telehealth-in-person payment equity may threaten the availability of in-person therapy at the expense of patient preferences.

The coronavirus pandemic kicked off a huge and durable increase in telehealth utilization in behavioral health. The number of mental health telehealth visits grew by 84 times in 2022 compared to 2019, according to other research.


“Although generous payment policies may encourage clinicians to offer telehealth, they may also inadvertently lead to cannibalization of in-person care,” the report states. “If behavioral health clinicians are reimbursed the same for in-person and telehealth visits and prefer the convenience of telehealth, they may offer few in-person appointments.

“As a consequence, patients who prefer in-person care might not have the option, especially considering shortages of behavioral health clinicians in many communities.”

The result may be substandard care.


The survey included a representative sample of 2,071 adults and “semistructured” interviews, of whom 571 were behavioral health service recipients. The interviews revealed that participants felt less impactful relationships with providers, which hurt patient satisfaction.

About 32% of respondents said they did not typically receive care in their preferred setting and 31% said their clinician only offered one mode of care. If a clinician only offered one modality of care, it was most often telehealth (22%), compared to in-person (9%).

The survey examined individual therapy and medication visits. About 80% of individual therapy recipients received telehealth; about 54% of medication visits were done via telehealth.

About 24% of the time, the therapist decided on the visit modality. About 35% did so for medication visits.

The lack of meeting patient’s preferences may lead to clinicians losing patients.

“Multiple participants switched providers because their provider did not offer the modality they preferred,” the report states. “Others thought about switching or attempted to do so but found it too difficult.”

Released Monday, the survey was produced by the RAND Corp., the Department of Veterans Affairs, McLean Hospital, Harvard University and the Depression and Bipolar Support Alliance.

The rise of telehealth in the outpatient mental health space has also led to another issue: elevated spending. Previously released RAND Corp. research shows that spending on mental health overall has increased, driven by huge increases in the telehealth space. That research posited that insurance companies may push back against the new norm of telehealth use of such services.

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