The number of Americans seeking psychotherapy increased by 30 percent during the pandemic, as virtual sessions replaced in-person appointments — but new research has dampened hopes that technology can improve mental health for needy populations. Will make care more available.
In fact, the researchers found, the shift to teletherapy has exacerbated existing disparities.
Psychotherapy increased among groups that previously had greater access: those living in higher income brackets, those living in cities, those with steady employment and more education, researchers found in a series of studies. , the most recent of which was, Published on Wednesday. In American Journal of Psychiatry.
Among those who did not benefit from the boom, the team found, were children from low-income families, black children and adolescents, and adults with “severe psychological distress.”
“I think the entire system of care — and maybe Internet delivery is a piece of that — is moving away from the people who need it most,” said Dr. Mark Olfsen, MD, professor of psychiatry and at Columbia University Irving Medical Center. Dr. Mark Olfsen said. Main author of study On access to care.
“We’re seeing people who are suffering the most, losing ground in terms of their treatment options, and that’s a very important and troubling trend to me,” he added. added.
It wasn’t supposed to be this way. In the 1990s, teletherapy was championed as a way to reach disadvantaged patients living in remote locations where there were few psychiatrists. A decade later, it was presented as a more accessible alternative to face-to-face sessions, which could drastically reduce barriers to care.
“Telehealth has not lived up to the hype,” said C. Wyllwright, senior director of the Office of Healthcare Innovation at the American Psychological Association. The reasons, he added, aren’t surprising: Many Americans don’t have access to reliable broadband, and insurers don’t adequately reimburse providers who, in turn, privately Paying clients choose treatment.
“If you can’t afford it, no matter the procedure, you can’t afford it,” Dr. Wright said. He added that weekly therapy sessions may not be scalable to a wider population, and the field should explore light-touch alternatives, such as single-session interventions and digital therapies.
As telehealth platforms grow, they are attracting clinicians from community settings with the promise of flexible hours and better conditions, said Dr. Jane M. Zhu, an associate professor of medicine at Oregon Health & Science University. who study access to mental health services. .
By choosing from a larger patient pool, they can choose to treat patients with milder conditions and a higher ability to pay. “It’s definitely something we should be aware of,” Dr. Zhou said. “There should be light around this. Who are these companies serving? And what does that mean for the patients who need it the most?
Percentage of Americans receiving psychotherapy remained relatively stable3 to 4 percent, for several decades before starting to gradually increase, Dr. Olfsen said.
Then two factors — the pandemic and the explosion of teletherapy — led to a sharp increase, with the number of adults receiving psychotherapy rising from 6.5 percent in 2018 to 8.5 percent in 2021. Steady, on About 17.5 percent.)
Dr Olfsen said he was surprised by the magnitude of the increase. “We haven’t had anything like Covid before, and we haven’t had this technology before,” Dr. Olfsen said. “There was a lot of social isolation, a lot of loneliness. And those are the things that psychotherapy is designed to address, in a way that medication can’t.
The findings are based on the Medical Expenditure Panel Survey, which is conducted by the federal government and measures how Americans use and pay for health care. The survey does not include people who are in the military, incarcerated or in nursing homes, hospitals or homeless shelters.
Previous studies, Based on insurance data, it appears that Americans’ mental health spending will increase 54 percent from 2020 to 2022, amid a tenfold increase in teletherapy use.
New study reveals which Americans are caring. Analysis of 89,619 adults Published last month in JAMA Psychiatry. Psychotherapy use increased among the youngest respondents among the most educated and among the highest income groups.
one An Analysis of Telehealth Utilization Similar conclusions were reached by children and adolescents in 2,445 households. The study, published today, found that children from wealthier households using private insurance were more likely to use teletherapy. Children in urban areas were almost three times more likely to use it than their rural counterparts.
During the years of the epidemic, use of mental health services by black children and adolescents declined, falling from 9.2 percent in 2019 to 4 percent in 2021. In the same period, mental health care utilization among white children increased to 18.4. 15.1 percent to percent, The team found In another study.
“What we found is that it’s only exacerbating existing disparities,” Dr. Olfsen said. “I think there’s a real need to try to address this.”