Expanding access to telehealth can bring mental health care to rural communities, provide cost savings, and make it more convenient to receive care if there is a provider shortage in an area. Though limited research has been conducted on how telemental health services impact disparities in access, research has shown telehealth to be safe, effective, and flexible. During the COVID-19 pandemic, emergency authorizations were widely granted to expand telehealth access, including for mental health care. However, a recent study found a decrease in recent availability of telemental health services due to policy barriers and a lack of targeted approaches to make telehealth more accessible for Medicaid covered populations. Providing broader access to telemental health services has been gaining ground as a national policy priority as some federal flexibilities are set to expire at the end of this year. Over the last year, Congress considered different ways to expand telehealth access for mental health care. Some examples of approaches included:
The Telemental Health Care Access Act of 2023 (H.R.3432/S.3651)
- Introduced separately in each chamber with strong bipartisan support, House Bill 3432/Senate Bill 3651 would extend Medicare coverage of telehealth and permanently remove the need to have prior in-person services.
- Eliminating an in-person requirement will create more equitable access to behavioral health services allowing individuals with disabilities and those living in rural areas to seek mental health care.
Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (S. 3430)
- Senate Bill 3430 designates the Department of Health and Human Services to create guidelines for non-English speakers and those who are visually and hearing impaired that need mental health services through telehealth.
- The bill unanimously passed in the Senate Finance Committee.
- Ensuring that services are accessible for these communities is essential to help address inequities in remote mental health care options.
Prioritizing Rural Hospitals Act (H.R.9093)
- House Bill 9093 is in the early legislative stages and allows grants and loans to be used on creating better telehealth infrastructure for behavioral health facilities in rural areas over the next six years.
- Rural communities could benefit by gaining access to reliable and efficient telemental health services.
There were many other legislative initiatives introduced or discussed to increase access for rural communities, patients with disabilities, and non-English speakers. However, access is just one aspect that needs to be considered when deploying telehealth across multiple behavioral health settings. Significant research gaps still exist on the effectiveness of telehealth when used with underserved communities. For example, one study showed disparities by race, age, and insurance in the number of missed telemental health appointments pointing to potential issues with accessibility of these services for underserved populations. However, funding for research that can further examine the effectiveness and delivery of telehealth is largely missing in recent legislation.
Even less research has also been conducted on behavioral health outcomes for individuals receiving telehealth who have multiple comorbidities, who are at risk of suicide/experiencing a mental health crisis, or are diagnosed with a substance use disorder. Individuals with complex mental health needs struggle with receiving reliable mental health care despite having a high need for these services. Tailoring telehealth services could make mental health care more accessible for these populations; however, research is mixed on the effectiveness of telehealth interventions for high-risk populations which requires further attention. Finally, questions remain about how prepared mental health workers are to administer therapy remotely and how evidence-based therapies translate to real world application outside of randomized controlled trials. Telehealth has not been fully adapted to the needs of certain populations (e.g., racial and ethnic minority groups) and with patients possessing specific mental health diagnoses (e.g., children with neuropsychiatric disorders).
Health service researchers and federal policymakers like the Agency for Healthcare Research and Quality should be at the forefront of ensuring that evidence generation and usage is prioritized ensuring that legislation, regulation, and clinical best practices are effective for patients. Creating more access to this tool can be beneficial if researchers can evaluate what works best for different populations. In addition to writing into laws and regulations this evidence generation process, it is critical that federal grantmaking agencies have the resources and directions to fund this process. The uncertainty in this funding stream due to Fiscal Responsibility Act of 2023 budget caps and proposals by the House Appropriations Committee to eliminate this research entirely is detrimental to research programs. We are at the cutting edge of new behavioral care tools, and as researchers we must be focused on providing insights and evidence to understand disparities in telehealth usage, behavioral health outcomes for populations outside of research settings, and best practices to maximize health outcomes for all patients.
Health services researchers have the tools to deliver better health care, the question is will Congress and federal regulators use them?