Patients With ‘Serious Psychological Distress’ Are Getting Less Outpatient Mental Health

During the coronavirus pandemic, the rate of those with “serious psychological distress” received outpatient mental health at a diminished rate.

Further complicating the picture, the overall rate of American adults identified as experiencing serious psychological distress increased to 4.2% in 2021, compared to 3.5% in 2018, and gains in access to care were not seen equitably across various demographic groups, according to a new study.

“Several groups also had difficulty accessing telemental health care including, older individuals and those with lower incomes and less education,” Dr. Mark Olfson, the lead study author, said in a news release. “These patterns underscore critical challenges to extend the reach and access of telemental health services via easy-to-use and affordable service options.”

Other recent research also highlights unequal access to outpatient mental health via telehealth.

 Columbia University Mailman School of Public Health and Vagelos College of Physicians and Surgeons conducted the new research. The data for the study came from the 2018–21 Medical Expenditure Panel Surveys (MEPS), which is overseen by the Agency for Healthcare Research and Quality (AHRQ). 

The research ties the changes in rates of psychological distress, outpatient mental health use and telehealth use to the coronavirus pandemic.

“The trends and patterns we observed in the United States align with reports globally concluding that several mental health problems, including depression, and generalized anxiety disorder, have become more prevalent during than before the pandemic,” Olfson said in the release.

The study assessed two other levels of distress. The rate of patients with”less serious psychological distress” was up to 58.6% compared to 56.1%, while the rate of those with “no psychological distress” decreased from 40.4% to 37.2% in the same period.

At the same time, the overall utilization of mental health increased from 11.2% to 12.4%. But the rate of use decreased by about 6 percentage points — from 46.4% to 40.4% — for those with serious psychological distress. The rate of adults with less serious distress who received outpatient mental health increased to 16.4% in 2021. That rate was 14.8% in 2018.

Who received outpatient mental health? 

Young adults aged 18 to 44 received notably more mental health care than the other age groups. This age cohort saw utilization increase to 15.2% in 2021, compared to 12.4% in 2018. This increase in treatment rate was not seen among the middle-aged (45- to 64-year-olds) or among seniors (65 years and older). Similarly, employed folks saw increased utilization, while those unemployed did not.

The overall utilization rate jumped up by three percentage points — to about 15% — among college graduates and those not married. No major increases were seen among other education or marital status cohorts.

Who gets telehealth? 

Overall, 33% of those who received outpatient mental health in 2021 received at least one video visit.

However, video telehealth visits were higher for younger adults than for middle-aged or seniors. Younger adults use video visits at twice the rate of middle-aged adults and about six times that of seniors.

Similarly, video rates were higher among women compared with men, college graduates compared with adults with less education, those with higher income compared to those with less, those who are employed and unemployed.

Those with serious psychological distress were much more likely than others to use telephone mental health care. There was not a significant difference among distress groups in the use of any video or in-person mental health care.

“The national profile of adults who receive outpatient mental health care via telemental health – the younger adult, the employed, higher-income, and privately insured adults, raises concerns about disparities in access to virtual mental health care,” Olfson said. “Unless progress is made in reducing these barriers, primary care clinicians will continue to encounter challenges in connecting their older, unemployed, and lower-income patients to video-delivered outpatient mental health care.”