The use of telehealth has dramatically reshaped healthcare delivery in recent years, with mental health services standing out as a particularly prominent and persistent area of virtual care. A newly released study by the RAND Corporation offers a comprehensive look into the current state of virtual mental health access in the United States. This research provides valuable insights into how telehealth is functioning across different regions, patient demographics, and types of providers — while highlighting ongoing challenges and important policy considerations.
Telehealth and Mental Health: An Unprecedented Expansion
Virtual mental health care’s rise has been one of the most notable trends in healthcare since the COVID-19 pandemic. Unlike many other specialties that saw telehealth use drop back after the initial surge, mental health services have sustained high levels of virtual utilization. In fact, data from FAIR Health shows that as recently as November 2023, mental health-related conditions accounted for more than two-thirds (66.4%) of all telehealth insurance claims nationwide. This means millions of Americans continue to rely on remote mental health care, underscoring telehealth as an essential lifeline for many.
However, despite this growth, there has been limited granular understanding of exactly what virtual mental health services are available, how they differ regionally, and whether telehealth is equitably accessible. RAND’s latest study helps fill this knowledge gap by surveying nearly 2,000 outpatient mental health treatment facilities across the country using a “secret shopper” methodology to evaluate virtual mental health access.
Key Findings From the RAND Study
Accessibility Barriers: The “Ghost Network” Phenomenon
One of the most troubling discoveries is that about 21% of facilities contacted could not be reached by phone at all. This “ghost network” issue suggests many patients may struggle to even make initial contact with mental health providers — a critical first step to accessing care. As study lead author Jonathan Cantor explains, this barrier could significantly hinder those seeking help, especially during times of urgent need, further complicating efforts to improve virtual mental health access nationwide.
Telehealth Adoption Rates Are High, But Not Universal
The study found that 80% of contacted facilities offered telehealth services, and 87% were currently accepting new patients. This high uptake demonstrates that telehealth has become firmly embedded in outpatient mental health care. Yet, that still leaves a meaningful minority of clinics without virtual offerings — a gap that must be addressed to expand virtual mental health access equitably.
Regional Variations Shape the Telehealth Landscape
Location matters. Facilities in metropolitan areas were more likely to offer virtual medication management but significantly less likely to provide diagnostic services remotely. Overall, roughly one in four clinics did not offer virtual medication management, and one in three did not provide virtual diagnostic services.
Wait times for a first appointment also showed wide geographic disparities. The median wait was 14 days, but this ranged from as little as 4 days in North Carolina to a staggering 75 days in Maine. These differences highlight uneven virtual mental health access and capacity across states, which may compound existing rural-urban disparities in mental health care.
Ownership Status Influences Service Availability
The study observed that privately owned outpatient mental health clinics were twice as likely to offer telehealth as public facilities, which lagged behind. Among private providers, those operating for-profit were least likely to offer medication management virtually but most likely to provide diagnostic services remotely.
These findings suggest that business models and ownership structures influence the scope of telehealth services offered, which could affect patient options depending on where and how they seek care — an important consideration in efforts to improve virtual mental health access.
No Evidence of Disparities Based on Race, Ethnicity, or Clinical Condition
A particularly encouraging aspect of the study is that the researchers did not find systematic biases based on the perceived race or ethnicity of the caller, the client’s stated clinical condition, or county-level sociodemographic factors. This indicates that telehealth has not exacerbated disparities in access for vulnerable groups, at least at the point of initial contact and service availability, supporting equitable virtual mental health access for diverse populations.
Medicaid Acceptance Correlates With More Telehealth Counseling
Facilities that accept Medicaid were significantly more likely to offer telehealth counseling than those that do not accept Medicaid. This finding underscores Medicaid’s critical role in expanding virtual mental health access to low-income and underserved populations, supporting ongoing efforts to use public insurance programs as a vehicle for improving mental health care equity.
Modalities and Services Offered Through Virtual Mental Health Care
When looking at how telehealth is delivered, the study found:
- 47% of clinics provided services only via video calls
- Another 47% offered services via both video and phone calls
- 5% relied solely on phone calls
- About 1% were uncertain of their telehealth modalities
In terms of specific services offered virtually:
- 97% of facilities offered counseling services
- 77% offered medication management
- 69% provided diagnostic services
This breakdown reveals counseling remains the core virtual mental health service, with medication management and diagnostics also widely available, though less universally so.
The Policy and Regulatory Environment: What’s Next for Telehealth?
Telehealth continues to be a dynamic and evolving area within healthcare policy. Several recent and ongoing legislative efforts illustrate the high priority federal lawmakers place on expanding virtual mental health access:
- In 2025, bills have been proposed aiming to remove the in-person examination requirement for virtual mental health services under Medicare. Because Medicare often sets standards that ripple across other insurers, this change could greatly enhance telehealth availability for older adults and people with disabilities, particularly in rural areas.
- Other legislation focuses on reducing barriers for rural populations needing mental health care, a critical issue given workforce shortages and travel challenges.
- A major outstanding question concerns federal regulation of prescribing controlled substances via telehealth. During the pandemic, temporary flexibilities were introduced allowing providers to prescribe controlled substances without an in-person visit. Whether these rules will become permanent under the Biden administration remains uncertain but will have profound implications for treating conditions such as ADHD and opioid use disorder remotely.
Why This Matters: Telehealth’s Role in Closing Mental Health Care Gaps
Access to mental health services has long been a challenge in the U.S., with significant barriers including stigma, provider shortages, geographic distance, and cost. Telehealth emerged as a powerful tool to mitigate many of these barriers by bringing care directly into patients’ homes, increasing convenience, and expanding provider reach.
The RAND study underscores telehealth’s potential while also revealing important gaps and regional disparities that must be addressed to fully realize its promise. Ensuring that telehealth services are broadly available, equitable, and integrated with other forms of care will be essential to meeting the growing demand for mental health treatment across America.
Final Thoughts
As telehealth continues to evolve, research like the RAND Corporation’s study is invaluable for guiding policy decisions and healthcare strategies. It highlights the progress made while identifying critical areas for improvement—especially in increasing facility responsiveness, expanding virtual medication management and diagnostics, and reducing wait times in underserved regions.
For patients, providers, and policymakers alike, understanding these nuances is key to shaping a mental health care system that is accessible, fair, and effective for all Americans, maximizing virtual mental health access for everyone who needs it.
