The COVID-19 pandemic brought about a seismic shift in the delivery of mental health care, with telehealth emerging as a lifeline for millions. Almost overnight, virtual therapy sessions and remote consultations became the norm, offering unprecedented access to care for individuals who might otherwise have gone without. However, as the dust settles and telehealth becomes a permanent fixture in the mental health landscape, a new set of challenges has emerged. A recent survey reveals that nearly half of individuals in outpatient mental health care are not receiving care in their preferred setting, raising important questions about the trade-offs of telehealth’s rapid rise and its impact on patient satisfaction, therapeutic relationships, and the future of in-person care.
The Telehealth Revolution: A Double-Edged Sword
The pandemic accelerated the adoption of telehealth in mental health care at an astonishing pace. By 2022, the number of mental health telehealth visits had surged to 84 times the pre-pandemic levels of 2019. For many, this shift was a welcome change. Telehealth eliminated barriers such as transportation, childcare, and time constraints, making it easier for individuals to access care. It also allowed clinicians to reach patients in remote or underserved areas, expanding the reach of mental health services.
However, the rapid transition to telehealth has not been without its downsides. A new survey conducted by the RAND Corporation, the Department of Veterans Affairs, McLean Hospital, Harvard University, and the Depression and Bipolar Support Alliance highlights the unintended consequences of this shift. The survey, which included a representative sample of 2,071 adults and in-depth interviews with 571 behavioral health service recipients, found that 45% of respondents felt their mental health clinician did not consider their preference for in-person or telehealth visits. This disconnect between patient preferences and clinical offerings has significant implications for the quality of care and patient outcomes.
The Erosion of In-Person Care Options
One of the most concerning findings of the survey is the potential decline of in-person care options. The report suggests that payment equity between telehealth and in-person visits—while well-intentioned—may inadvertently threaten the availability of face-to-face therapy. If clinicians are reimbursed equally for both modalities but prefer the convenience and flexibility of telehealth, they may offer fewer in-person appointments. This could leave patients who prefer or require in-person care with limited options, particularly in communities already grappling with shortages of behavioral health clinicians.
The survey revealed that 32% of respondents did not typically receive care in their preferred setting, and 31% reported that their clinician only offered one mode of care. When clinicians limited their offerings to a single modality, it was far more likely to be telehealth (22%) than in-person care (9%). This trend is troubling, as it suggests that the convenience of telehealth for providers may come at the expense of patient choice and satisfaction.
The Impact on Therapeutic Relationships
The therapeutic relationship between a patient and their clinician is a cornerstone of effective mental health care. However, the shift to telehealth has altered the dynamics of this relationship, often for the worse. Many participants in the survey reported feeling less connected to their providers in a virtual setting, which negatively impacted their satisfaction with care.
“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.”
This dissatisfaction underscores the importance of aligning care delivery with patient preferences. For some individuals, the intimacy and immediacy of in-person interactions are essential for building trust and fostering meaningful progress in therapy. When these preferences are ignored, patients may disengage from treatment or seek alternative providers, further fragmenting their care.
The Financial Implications of Telehealth
The rise of telehealth has also had significant financial implications for the mental health care system. While telehealth has improved access for many, it has also driven up overall spending on mental health services. Previous research from the RAND Corporation shows that spending on mental health has increased substantially, driven largely by the expansion of telehealth.
This surge in spending has raised concerns among insurers, who may push back against the widespread use of telehealth services. If insurers begin to impose stricter limits on telehealth coverage or reduce reimbursement rates, it could create additional barriers to access for patients who rely on virtual care. At the same time, the financial incentives for clinicians to offer telehealth may further erode the availability of in-person care, creating a vicious cycle that leaves patients with fewer options.
The Broader Implications for Mental Health Care
The survey’s findings highlight a broader tension in the mental health care system: the need to balance efficiency and accessibility with patient-centered care. While telehealth offers undeniable benefits, it is not a one-size-fits-all solution. For some individuals, telehealth is a convenient and effective way to access care. For others, it is a poor substitute for the depth and connection of in-person therapy.
The challenge for clinicians and policymakers is to create a system that accommodates both modalities without sacrificing quality or patient choice. This will require a nuanced approach that takes into account the diverse needs and preferences of patients, as well as the realities of clinician practice patterns and financial incentives.
Recommendations for a Balanced Approach
To address these challenges, the mental health care system must prioritize flexibility and patient-centered care. Here are some key recommendations based on the survey’s findings:
- Prioritize Patient Preferences: Clinicians should actively seek input from patients about their preferred mode of care and strive to accommodate these preferences whenever possible. This could involve offering a hybrid model that combines in-person and telehealth options, allowing patients to choose the format that works best for them.
- Preserve In-Person Care Options: Policymakers and payers should consider incentives to ensure that in-person care remains available for patients who prefer or require it. This could include higher reimbursement rates for in-person visits or grants to support clinicians who offer both modalities.
- Invest in Training and Technology: To improve the quality of telehealth services, clinicians should receive training on how to build rapport and maintain therapeutic relationships in a virtual setting. Additionally, investments in technology can help bridge the gap between in-person and virtual care, such as platforms that facilitate more interactive and engaging sessions.
- Monitor Spending and Access: Payers and policymakers should closely monitor spending trends and access to care to ensure that the rise of telehealth does not come at the expense of in-person options or lead to unsustainable cost increases.
- Conduct Further Research: More research is needed to understand the long-term impact of telehealth on mental health outcomes, patient satisfaction, and the therapeutic relationship. This will help inform best practices and ensure that the mental health care system evolves in a way that meets the needs of all patients.
Conclusion: A Call for Flexibility and Patient-Centered Care
The rise of telehealth has transformed mental health care, offering new opportunities for access and convenience. However, this transformation has also introduced challenges that must be addressed to ensure that care remains effective, equitable, and patient-centered. The survey’s findings serve as a timely reminder that while telehealth is a powerful tool, it is not a panacea.
To truly meet the needs of patients, the mental health care system must embrace flexibility and prioritize the human element of care. This means listening to patients, preserving in-person options, and finding ways to balance the benefits of telehealth with the irreplaceable value of face-to-face interactions. By doing so, we can build a mental health care system that is not only accessible and efficient but also deeply attuned to the needs and preferences of those it serves.
The pandemic has shown us what is possible when we innovate and adapt. Now, it is up to us to ensure that these innovations serve the best interests of patients, clinicians, and the broader mental health community. The future of mental health care depends on it.
