The COVID-19 pandemic dramatically reshaped the healthcare landscape, leaving lasting impacts on both the delivery and consumption of care across various sectors. As the country moves further away from the peak of the pandemic, one trend that stands out is the marked increase in the utilization of behavioral health services. According to a recent report by Trilliant Health, behavioral health utilization in the U.S. surged by 40% in 2023 compared to pre-pandemic levels in 2019, and this rise is showing no signs of slowing down.
At the same time, other areas of healthcare are facing a decline in utilization, with primary care visits down 12% in 2023 compared to the pre-pandemic era. These striking disparities between the increasing demand for behavioral health services and the decrease in other forms of care shed light on shifting dynamics in the U.S. healthcare system. In this post, we will dive deeper into the findings of the Trilliant Health report and explore the factors behind this growing behavioral health utilization, its broader implications, and what it means for the future of healthcare.
The Growth of Behavioral Health Utilization
The data from Trilliant Health reveals a stark and accelerating trend: behavioral health services are in greater demand than ever. The 40% increase in behavioral health utilization from 2019 to 2023 is a significant indicator of the rising prevalence of mental health concerns in the U.S. This surge is not just a one-time spike; utilization increased by 13% in 2023 alone, compared to just 5% in 2022. The implications of these statistics are profound, as they underscore the escalating need for accessible, effective mental health services.
Several factors contribute to this surge in demand:
- Pandemic-related Mental Health Struggles: The COVID-19 pandemic had an undeniable impact on mental health. Increased isolation, financial insecurity, health anxieties, and general uncertainty contributed to a rise in conditions such as anxiety, depression, and substance use disorders. Even as the immediate public health crisis subsided, the psychological toll of the pandemic continued to reverberate across the population.
- Increased Awareness and Stigma Reduction: Over the past few years, there has been a concerted effort to reduce the stigma surrounding mental health issues, making people more willing to seek help. High-profile public figures, growing advocacy for mental health awareness, and changes in cultural attitudes have collectively made it more acceptable for people to seek behavioral health support.
- Telehealth Expansion: The rapid expansion of telehealth during the pandemic played a pivotal role in making mental health care more accessible, especially for those who might have faced barriers to in-person visits. As the telehealth infrastructure continues to evolve, it has enabled behavioral health professionals to provide care to patients who may have otherwise struggled to access traditional services.
The Decline of Primary Care Utilization
While behavioral health care utilization is on the rise, the opposite is true for primary care. According to Trilliant Health, primary care utilization dropped by 12% in 2023 compared to pre-pandemic levels. Furthermore, year-over-year utilization dropped by 4% in 2023. This decrease in primary care visits is concerning, as primary care is traditionally seen as a cornerstone of preventative health and early intervention.
Several factors may be contributing to this decline:
- Shift to Telehealth for Behavioral Health: As mentioned earlier, telehealth has been widely adopted for behavioral health care, and many patients prefer the convenience of virtual visits for these services. However, patients may not view telehealth as an adequate substitute for in-person visits for more traditional medical concerns. This preference shift may explain some of the decline in primary care utilization.
- Pandemic-driven Avoidance: During the height of the pandemic, many individuals delayed or avoided seeking in-person medical care out of fear of contracting the virus. While some of these hesitations have been alleviated, the impact on primary care utilization persists, with patients continuing to forgo visits for routine checkups or minor health concerns.
- Rising Healthcare Costs and Accessibility Issues: In a system where rising healthcare costs and insurance barriers are a consistent concern, many patients may be opting to delay primary care visits, especially if they perceive the costs as too high or if they have difficulty navigating insurance networks.
Behavioral Health and Telehealth: A Match Made in Virtual Heaven
A particularly striking finding from the Trilliant Health report is the role of telehealth in delivering behavioral health services. As healthcare shifts more toward virtual care options, behavioral health stands out as the primary domain where telehealth utilization is not just an alternative but often the preferred method of care.
In the fourth quarter of 2023, behavioral health accounted for 72% of all telehealth visits. This figure is a testament to the growing demand for flexible, accessible, and convenient mental health care. Telehealth has made it easier for patients to connect with providers, especially for those in rural or underserved areas, and the anonymity it provides can be a comfort to many seeking treatment for mental health issues.
Importantly, the continued high utilization of telehealth for behavioral health services calls into question the widely held assumption that patients overwhelmingly prefer in-person care. While there are certainly patients who value in-person interactions for certain types of care, the data suggests that, at least in the case of behavioral health, telehealth has become a highly effective and preferred method of care delivery.
The Rising Strain on Healthcare Providers and Hospitals
The increased utilization of behavioral health services has not come without its challenges, particularly for hospitals and emergency rooms. The report points out that through the Emergency Medical Treatment and Labor Act (EMTALA), hospitals have been effectively tasked with handling many of the country’s behavioral health crises. Emergency departments (EDs) are increasingly serving as a front-line response to the nation’s growing behavioral health needs.
This rising burden on hospitals has led to longer wait times, overcrowding, and higher stress levels among healthcare providers. Hospitals are being forced to allocate resources to behavioral health patients, further straining an already overwhelmed system. For patients, this means not only longer wait times but also a lack of continuity of care, which can negatively affect outcomes.
Addressing the Barriers to Behavioral Health Care
While the demand for behavioral health services is clearly rising, access to care remains a challenge. Trilliant Health’s report highlights that 14% of patients received out-of-network care for behavioral health services, compared to just 2% for physical health services. Additionally, 37% of patients said they stopped going to therapy because their health plan stopped covering it, making financial barriers one of the primary reasons people forgo care. The cost of care is a significant issue, with 22% of patients reporting that it was “too expensive” to continue therapy.
These statistics underscore the need for improved policies that increase coverage for behavioral health and make services more affordable for patients. Health insurers and policymakers must work together to create solutions that reduce out-of-pocket costs and improve coverage for behavioral health services, ensuring that patients are not left behind due to financial constraints.
Looking Ahead: Behavioral Health’s Role in the Evolving Healthcare Landscape
As we look toward the future, it’s clear that behavioral health will continue to play a central role in the U.S. healthcare system. With utilization steadily increasing, the demand for accessible and effective mental health services is only expected to grow. Healthcare providers, insurers, and policymakers must prioritize investment in behavioral health services, focusing on expanding access, reducing barriers to care, and integrating behavioral health more seamlessly into the broader healthcare system.
The pandemic’s legacy has been a mixed one, with both challenges and opportunities. As healthcare systems continue to evolve, the integration of behavioral health services, particularly through innovative solutions like telehealth, will be essential in addressing the mental health crisis and improving overall health outcomes for millions of Americans. The rise in behavioral health utilization is not just a trend—it is a wake-up call for a system that must adapt to the growing needs of the population and ensure that no one falls through the cracks.
