Nonprofits that provide mental health services have a powerful new supporting data source for their fundraising- and mission-related activities. Pandemic-era research shows an increase in demand for telephonic mental-health services and substance abuse issues throughout the United States.
Telephone-based health services boomed during the coronavirus pandemic, with both the volume of calls and the nature of complaints presenting differently during the past two-plus years. Mental health calls increased even quickly than overall volume, becoming the top concern cited, according to a new study which offers indicators of where support services had been and still are needed.
By January 2022, three of the top five provider specialties were for social workers, psychiatrists and psychologists. During that month, one hour of psychotherapy was the highest telehealth procedure code both nationally and in every U.S. region. In contrast, only the Northeast had psychotherapy visits in its top five telehealth procedures during January 2020, prior to the pandemic, according to The Evolution of Telehealth during the COVID-19 Pandemic, a report from Fair Health, a nonprofit focused on bringing transparency to medical pricing practices and health insurance options. The New York City-based organization has tracked month-to-month changes in telehealth service use since spring 2020.
The overall increases in telehealth use were initially, and dramatically, felt during the earliest months of the pandemic. At that time, nationwide “shelter in space” requirements, combined with fears of medical centers as virus transmission vectors, generated a 4,347% telehealth claim line increase between the pre-pandemic month of March 2019 and March 2020. Initially much of the increase came within the Northeast, where the pandemic first gained a toehold among the U.S. population.
By April 2020, telehealth use had jumped 8,336% compared to April 2019, following increased restrictions and lockdowns throughout the United States. Telehealth lines were being used for a wider range of maladies, reflecting both a lack of access to health services traditionally administered in person as well as new concerns, especially adverse mental health conditions, generated by the pandemic. During spring 2020, developmental disorders, hypertension, and joint or soft tissue maladies ranked among the top five conditions addressed by telehealth. None of these had been in the top five a year earlier.
Throughout summer 2020, urban use of telehealth services outpaced rural use both nationally and in each region. Diagnoses rates, however, began to change. In the South and the West, exposure to communicable diseases ranked fifth as a diagnosis, as more patients in these regions began expressing exposure concerns to telephone health workers. By July 2020, substance abuse issues in the Northeast, which had been shouldering the worst of the initial wave to date, emerged as a top-five diagnosis.
By fall 2020 the rate of increases in calls had begun to slow, as lockdowns took hold and contagion-related calls began to slow. That trend reversed in October, coinciding with a national surge in COVID-19 cases. COVID-19 itself did not crack the regional lists of top five diagnoses until November 2020, when it was the fourth-most-made diagnosis in the Midwest region. A month later, it was the top diagnosis both nationally and in every regional breakout.
As in-person services opened up, vaccines became available and the pandemic’s disruptions became normalized, telehealth service use fluctuated. During 2021, half of the months saw drops in use from the previous month, compared with previous patterns of constant use escalation. Use rates remained higher than before the pandemic, and tended to bump up with the emergence of the Delta and Omicron variants. Mental health-related calls, however, retained their position at or near the top of concerns both nationally and within most regions.
A drop in telehealth use during February 2021 mapped to vaccine rollouts, and by the end of the month COVID-19 was no longer a top-five diagnosis nationally or regionally. But other disorders, including some lifestyle maladies, took its place, including hypertension, substance abuse within the Midwest region, developmental disorders in the South and Diabetes mellitus and endocrine and metabolic disorders in the West. Through all this, mental health concerns retained their place atop national and regional lists.
By early spring 2021, telehealth use began to decline from its heights as non-mental-health and in-person services began to be available in onsite settings. But even though the overall numbers were declining, psychotherapeutic and psychiatric use continued to rise. As of April, mental health conditions made up 58.6% of calls, up from 57% a month earlier. These conditions were accompanied by upticks in the misuse of opioids and stimulants, especially in the Midwest and Northeast.
The decline in overall telehealth use continued during the summer, only to reverse in August in all regions except for the Midwest. Increases in use were particularly high in the South, where the coronavirus Delta variant had taken hold. Long COVID concerns, as well as maladies experienced by COVID survivors, helped drive rises in acute respiratory diseases, which accounted for 2.9% of claims in June and 4.2% in August.
The Delta variant brought COVID-19 back to the top-five list of diagnoses in August 2021 for the first time since January. But summer 2021 was marked by increases in mental health diagnoses, with generalized anxiety disorder, major depressive disorder and adjustment disorders also on the list. By August, post-traumatic stress disorder appeared among the top-five mental health diagnoses in the Northeast.
The brief hiatus between the decline of the Delta variant and the rise of the Omicron variant saw telehealth use fluctuate during fall 2021, and COVID-19 dropped off the national top-five list, replaced by substance use disorders. As the Omicron variant took hold toward the latter part of 2021, substance abuse disorders fell off the list.
By December 2021, normal holiday season increases in mental health concerns prompted an overall increase in telehealth services, as did the emergency of the seemingly vaccine-resistant Omicron variant. But while mental health concerns remained atop diagnoses lists, the percentage share they represented fell, and in the South dipped below 50% of calls.
Throughout winter 2021-2022, the Omicron variant spurred increases in telehealth service use. Mental health issues remained the top diagnoses both nationally and among all regions. But by February 2022, new COVID-19 cases were declining and the concern feel out of the top-five diagnoses lists, with substance abuse and developmental disorders replacing it regionally and nationally. As of March – the last month covered by the study – telehealth use had begun to decline, reflecting reductions in the number of cases of COVID, and the severity of those reported. Mental health issues continued to lead the list of diagnoses both nationally and regionally.
“These findings reflect the changing nature of telehealth and how it has become a material component of the nation’s healthcare system,” the report authors wrote, adding that they hope their tracking data “will continue to serve as a resource for policy makers, researchers, payors, providers and others seeking to understand and keep pace with the nation’s evolving healthcare landscape. A full copy of the report is available here.