Telehealth experienced a rapid surge during the COVID-19 pandemic, reshaping the delivery of many health services. However, a detailed report from Trilliant Health, a Brentwood, Tennessee-based predictive analytics company specializing in health care, highlights behavioral health telehealth trends that stand out. The findings reveal a striking truth: behavioral health is the only sector where telehealth truly acts as a substitute for in-person care, with virtual visits proving to be largely equivalent to face-to-face appointments in effectiveness, occasion, and patient preference.
Understanding Telehealth as a Substitute Good
In economic terms, a substitute good is a product or service that can replace another, fulfilling the same need and function in essentially the same way. Applying this concept to health care, Trilliant Health’s report concludes that telehealth services in behavioral health satisfy the same patient needs and outcomes as in-person therapy or psychiatric care. This is unique in the health care landscape, where telehealth more often supplements or complements traditional care but does not replace it.
For most other medical specialties, telehealth has been more of an add-on, enhancing access or convenience but not serving as a full alternative to in-person visits. Behavioral health, however, stands apart — virtual care visits in this space often provide the same value and patient experience as seeing a provider in person.
Telehealth Usage: Limited but Concentrated
Despite the rapid rise in telehealth during the pandemic, the Trilliant Health report highlights a surprising limitation: only about 25.6% of Americans used telehealth services during the two years since COVID-19 emerged. This is a much smaller proportion than many had anticipated, particularly given the massive investments and technology rollout aimed at expanding telehealth.
Sanjula Jain, Senior Vice President of Market Strategy and Chief Research Officer at Trilliant Health, explains that while the telehealth market has been built on the premise that virtual care would be widely preferred, the reality is that the demand is concentrated in a smaller subset of the U.S. population. This nuance is crucial for health care organizations and policymakers planning future investments and infrastructure.
Behavioral Health’s Dominance in Telehealth Visits
One of the clearest takeaways from the report is the outsized role behavioral health plays in telehealth utilization. Before the pandemic, the overwhelming majority of patients — about 98% — received care exclusively in-person. By 2020, in-person-only care dropped to about 71% as telehealth exploded in response to lockdowns and safety concerns. However, by 2021, in-person visits bounced back to roughly 80%, indicating that many patients returned to traditional care settings once restrictions eased.
Yet, within the telehealth visits that continued, behavioral health held a commanding share. Between April 2019 and November 2021, behavioral health visits made up 47.5% of all telehealth visits, the largest single category among all health care services delivered virtually.
Following the onset of the pandemic, behavioral health telehealth visits surged dramatically — increasing by 55% from March 2020 to November 2021. This rise is notable given the overall decline in telehealth utilization for other services during the same period. By November 2021, monthly telehealth visits had decreased to about 6.9 million from the pandemic peak of 16.9 million visits in April 2020, a 59% drop. Despite this, behavioral health visits consistently accounted for the majority of telehealth usage, averaging 57.9% of telehealth visits throughout 2021.
These statistics are core to understanding behavioral health telehealth trends, which clearly demonstrate that telehealth in this space is not a niche service but a dominant mode of care delivery.
Why Behavioral Health Leads Telehealth Utilization
Several factors contribute to behavioral health’s leading role in telehealth adoption and substitution:
- Nature of the care: Behavioral health treatments — including therapy, counseling, and psychiatric consultations — often require conversation and interaction rather than physical exams or procedures. This makes them more adaptable to virtual platforms.
- Patient comfort and convenience: Many patients find telehealth reduces stigma and logistical barriers, such as travel time and scheduling challenges, especially for ongoing mental health support.
- Continuity of care: Telehealth provides an effective way to maintain treatment during disruptions like the pandemic, which is critical for managing mental health conditions that require regular follow-up.
- Provider readiness: Behavioral health providers were relatively quick to adopt telehealth technologies, partly due to regulatory flexibility and reimbursement adjustments during the pandemic.
All of these factors are critical elements behind the latest behavioral health telehealth trends, which indicate sustained telehealth use in mental health care even as overall telehealth visits decline.
The Broader Telehealth Reality: Preference for In-Person Care Persists
Despite behavioral health’s success with telehealth, the report emphasizes that most Americans still prefer in-person care overall. This is evidenced by the rebound in in-person visits after the initial pandemic surge and the fact that only a quarter of the population engaged with telehealth at all.
The data suggest that while telehealth fills an essential role, especially in behavioral health, its broader use in the health care system is constrained by patient preference, clinical requirements, and other factors.
What the Future Holds for Telehealth in Behavioral Health and Beyond
Trilliant Health’s findings offer a reality check against overly optimistic assumptions that telehealth will fully replace in-person health care across the board. Instead, telehealth’s lasting and most transformative impact appears to be in behavioral health, where it functions as a direct substitute for traditional care.
For health care leaders, investors, and policymakers, this insight highlights the importance of targeted telehealth strategies that recognize behavioral health as a core driver of virtual care demand. Investments should prioritize expanding telehealth infrastructure and services where telehealth meets patient needs equivalently or better than in-person options, particularly in mental health care.
At the same time, understanding the limits of telehealth’s appeal in other clinical areas will help avoid misallocated resources and better tailor hybrid care models that combine the best of virtual and in-person services.
In summary, behavioral health telehealth trends clearly show that virtual care is here to stay as a substitute for in-person behavioral health services — shaping the future of access and treatment models for mental health care.
