Use of Mental Health Services Soared During Pandemic

By the end of August 2022, overall use of mental health services was almost 40% higher than before the COVID-19 pandemic, while spending increased by 54%, according to a new study by researchers at the RAND Corporation.

During the early phase of the pandemic, from mid-March to mid-December 2020, before the vaccine was available, in-person visits decreased by 40%, while telehealth visits increased by 1000%, reported Jonathan Cantor, PhD, and colleagues at RAND, and at Castlight Health, a benefit coordination provider, in a paper published online August 25 in JAMA Health Forum.

Between December 2020 and August 2022, telehealth visits stayed stable, but in-person visits creeped back up, eventually reaching 80% of pre-pandemic levels. However, "total utilization was higher than before the pandemic," Cantor, a policy researcher at RAND, told Medscape Medical News. 

"It could be that it's easier for individuals to receive care via telehealth, but it could also just be that there's a greater demand or need since the pandemic," said Cantor. "We'll just need more research to actually unpack what's going on," he said.

Initial per capita spending increased by about a third and was up overall by more than half. But it's not clear how much of that is due to utilization or to price of services, said Cantor. Spending for telehealth services remained stable in the post-vaccine period, while spending on in-person visits returned to pre-pandemic levels.

Cantor and his colleagues were not able to determine whether utilization was by new or existing patients, but he said that would be good data to have. "It would be really important to know whether or not folks are initiating care because telehealth is making it easier," he said.

The authors analyzed about 1.5 million claims for anxiety disorders, major depressive disorder, bipolar disorder, schizophrenia, and posttraumatic stress disorder, out of claims submitted by 7 million commercially insured adults whose self-insured employers used the Castlight benefit.

Cantor noted that this is just a small subset of the US population. He said he'd like to have data from Medicare and Medicaid to fully assess the impact of the COVID-19 pandemic on mental health and of telehealth visits, also.

"This is a still-burgeoning field," he said, about telehealth. "We're still trying to get a handle on how things are operating, given that there's been so much change so rapidly."

Meanwhile, 152 major employers responding to a large national survey this summer said that they’ve been grappling with how COVID-19 has affected workers. The employers include 72 Fortune 100 companies and provide health coverage for more than 60 million workers, retirees, and their families.

Seventy-seven percent said they are currently seeing an increase in depression, anxiety, and substance use disorders as a result of the pandemic, according to the Business Group on Health's survey. That's up from 44% in 2022.

Going forward, employers will focus on increasing access to mental health services, the survey reported.

"Our survey found that in 2024 and for the near future, employers will be acutely focused on addressing employees’ mental health needs while ensuring access and lowering cost barriers," said Ellen Kelsay, president and CEO of Business Group on Health, in a statement.

The study was supported by grants from the National Institute of Mental Health and the National Institute on Aging. Co-author Dena Bravata, a Castlight employee, reported receiving personal fees from Castlight Health during the conduct of the study. Co-author Christopher Whaley, a RAND employee, reported receiving personal fees from Castlight Health outside the submitted work.

JAMA Health Forum. Published online August 25, 2023. Abstract.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in publications including JAMA and Smithsonian.com. You can find her on X @aliciaault.

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Cite this: Use of Mental Health Services Soared During Pandemic - Medscape - Aug 28, 2023.