“Telehealth Is a Double-Edged Sword”: Understanding Mental Health Providers’ Attitudes Towards Telemental Health Three Years into the COVID-19 Pandemic

Abstract

The onset of the COVID-19 pandemic resulted in various federal, state, and regulatory policy changes that expanded telehealth flexibilities under most health coverage plans. Additionally, the unique nature of the pandemic made in-person health care unsafe. As a result, there was the widespread adoption of telehealth across a variety of healthcare specialties, providers, and practices. Notably, mental health services saw a large and persistent growth in telehealth that outpaced and outlasted growth seen for other types of healthcare services. As the pandemic recedes, many temporary telehealth flexibilities have been discontinued or are set to expire soon. As a result, the future of telehealth and telemental health is in jeopardy. However, this moment of uncertainty presents policymakers with a unique opportunity to enact meaningful and permanent changes to help shape the future of telehealth.

This study aims to qualitatively assess provider attitudes toward telemental health (TMH) three years after the onset of the pandemic. Using semi-structured interviews, I ask each provider how their utilization of TMH has evolved, how they assess the clinical efficacy of THM, what they perceive as common advantages and challenges, and what key policy priorities they want policymakers to consider. After analyzing my findings, I develop policy considerations that legislators can draw from to inform their future actions on TMH.

My findings suggest that mental health providers have broadly positive attitudes toward TMH and intend to continue offering virtual appointments moving forward. The dominant advantage of TMH was that it improved access to care and prevented certain disruptions. The key challenge to TMH was that some patients did not have access to a private and confidential space. Providers expressed mixed feelings regarding whether TMH enhanced or diminished the therapeutic alliance and the quality of their work-life balance. Drawing from these findings, I develop and present policy implications in four areas: coverage of TMH, reimbursement for TMH services, broadband access, and provider licensing.