A Look at the Current State and Future of Tele-Behavioral Health

A long-standing priority of mental health advocates has been to ensure mental health and physical health care go hand-in-hand, including screening and treating mental health conditions in primary care—commonly called “integrated care.” Even with ample evidence behind this model, the adoption has been incremental and, in many cases, non-existent. However, an unintended consequence of the COVID-19 pandemic was the change in the conversation around tele-mental or tele-behavioral health.

What is tele-mental or Tele-behavioral Health?

“Telemental health uses telecommunications or videoconferencing technology to provide mental health services. It is sometimes referred to as telepsychiatry or telepsychology. Research suggests that telemental health services can be effective for many people, including, but not limited to those with attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), depression, and anxiety”[1].

COVID-19 Pandemic implications:

Psychological distress, anxiety, and depression—the secondary traumas of the pandemic—are affecting millions of Americans. 2020 was a year of challenges, marked by loss and the uncertainty of the COVID-19 pandemic; in only one year, 21% of Americans (one in five adults) reported having a mental health illness. Only 46.2% received treatment[2]. When the U.S. Centers for Disease Control and Prevention cautioned against seeking nonessential medical services, mental health care plummeted. In response, federal and state lawmakers temporarily bolstered telehealth, for example, using videoconferencing platforms like Zoom, issuing new reimbursement codes to cover payment for telehealth, and establishing mandates that private health insurers must pay for telehealth services.

As a result, the landscape of mental health services today looks remarkably different, with treatment by phone or video conference a staple feature.

Future of Tele-Behavioral Health:

With acceptance from both the providers and patients, there is no question telehealth is here to stay. The question is – at what level?

With the end of PHE in sight, many providers are looking toward cutting back on providing telehealth services. However, one of the few changes implemented during the PHE that will stay for sure is that Medicare patients will continue to receive telehealth services, including audio-only services, for mental/behavioral health care in their homes in any part of the country if certain conditions are met. Some of the initial restrictions that were the barrier to tele-mental health access to Medicare beneficiaries are coming back like in-person visits within 6 months of initial assessment and every 12 months following.  We have yet to see how states will set the Medicaid reimbursements for tele-behavioral health services.

Resources:

• Mental Health Treatment Among Adults Aged 18–44: United States, 2019–2021
•  Mental Health By the Numbers
• Telehealth policy changes after the COVID-19 public health emergency

[1] https://www.nimh.nih.gov/health/publications/what-is-telemental-health

[2] https://www.cdc.gov/nchs/data/databriefs/db444.pdf