Virtual Mental Health Services Access Depends on Where You Live

A new study of virtual mental health access adds details to the portrait of telehealth in the U.S.

The RAND Corp study reveals significant regional variation in access to particular features of virtual mental health services. However, the study did not find evidence that telehealth aggravated access issues, especially for vulnerable populations.

“The findings of this secret shopper survey are encouraging insofar as we did not observe a systematic bias in which available services differed based on perceived race and ethnicity of the client, stated clinical condition of the client, or county-level sociodemographic characteristics,” the study states.


The study revealed patients continued to face ghost network issues. About 21% of the nationally representative 1,938 outpatient mental health treatment facilities contacted by researchers could not be reached.

“The fact that we could not reach anyone at one in five facilities suggests that many people may have trouble reaching a clinic to inquire about mental health care,” Jonathan Cantor, the study’s lead author and RAND Corp. policy researcher said, in a news release.

Across facility types, 87% said they were accepting new patients and 80% said they offered telehealth services.


Virtual mental health is exceptional in the broader context of telehealth. It’s the only health care sector to maintain significantly elevated utilization rates after the acute phase of the coronavirus pandemic. Separate research shows that mental health-related diagnoses were behind 66.4% of all telehealth insurance claims in November 2023, according to FAIR Health.

Yet, the exact picture of virtual mental health as a whole is not completely known, the study states, further noting that little is “known about the availability and composition of mental health telehealth services.”

Regionality has a significant bearing on what services are likely to be available. Facilities in metropolitan areas are more likely to offer medication management but significantly less likely to offer diagnostics. In the aggregate, about 1 in 4 clinics did not offer virtual medication management, while about one in three did not provide virtual diagnostic services.

The regional picture also varies when it comes to first-appointment wait times. Across states, the median wait time was 14 days, with a range of 4 days (North Carolina) to 75 days (Maine).

Facility ownership status had some bearing on service availability. Privately owned facilities offering only outpatient mental health were the most likely to offer telehealth services at all, twice the rate of public facilities, which were the least likely. Private for-profit facilities were also the least likely to provide medication management but most likely to offer diagnostic services.

“No differences were found to be associated with the client-caller’s perceived race, ethnicity, sex, or presenting mental health condition,” the report states.

Payer source also appeared to impact the availability of virtual mental health services. Facilities reporting Medicaid as an acceptable form of payment were significantly more likely to offer counseling services via telehealth compared with facilities that did not accept Medicaid, the report states.

Here’s a breakdown of the virtual mental health modalities that facilities offered:

— 47%, via only video call

— 47%, via both video and phone call

— 5%, via only phone call

— 1%, didn’t know

Here’s a breakdown of services offered:

— 97%, counseling services

— 77% medication management

— 69% diagnostic services

Telehealth continues to be a hot topic at the height of the American regulatory apparatus. Last month, federal lawmakers proposed a bill that would eliminate the in-person exam for virtual mental health services for those on Medicare. Medicare is seen as a harbinger for the rest of the payer market. It also continues to be a go-to tool for Congress to reach people in rural communities needing mental health services. Another bill proposed in December calls for several reforms for that population.

One of the most pressing regulatory issues left over from 2023 includes the federal government’s regulation of prescribing controlled substances via telehealth. During the pandemic, the Trump administration instituted several flexibilities, some of which exemptions from these laws. Now, it’s a question as to whether or not they will be made permanent under the Bidend administration.

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