MENTAL HEALTH CARE SURGED IN PANDEMIC

Visits increased 39% while spending on care rose 54%

Use of mental health care increased substantially during the coronavirus pandemic, as teletherapy lowered barriers to regular visits, according to a large study of insurance claims published Friday in JAMA Health Forum.

From March 2020 to August 2022, mental health visits increased by 39 percent, and spending increased by 54 percent, the study found. Its examination of 1,554,895 claims for clinician visits also identified a tenfold increase in the use of telehealth.

The study covers visits for around 7 million adults throughout the country who receive health insurance through their employers, so it excludes many patients with very severe mental illnesses, and it does not cover acute or residential care.

The increases are likely to be sustained, even as insurers weigh the benefit of continuing to pay more, said Christopher M. Whaley, a health care economist at Rand Corp. and an author of the study.

“This is a huge cost, and we pay for that cost through increased premiums and higher deductibles,” said Whaley, an associate professor at Brown University.

On the other hand, he added, patients with unmet mental health needs are less likely to take their medications and more likely to turn to emergency rooms in crisis, behaviors that also shift large costs onto insurance pools.

“The insurer’s challenge, and what we should think about as a health care system, is what cost is actually bigger,” Whaley said.

Most of the mental health visits were for anxiety and depression, which made up 45 percent and 33 percent of the total visits, respectively; post-traumatic stress disorder visits made up 10 percent; bipolar disorder, 9 percent; and schizophrenia, 2.6 percent.

Of the five diagnoses, anxiety disorders saw the steepest increase in visits during the pandemic, of 73.7 percent. PTSD visits increased by 37 percent, bipolar disorder visits by 32 percent and depression visits by 31.9 percent. Schizophrenia visits did not change.

Researchers were surprised to discover that the use of telehealth for mental health did not decline with the end of the pandemic, as it did in other areas of medicine.

The rise in use of mental health services reflects both receding stigma and a lowering of practical barriers to mental health visits, said Dr. Robert L. Trestman, chair of psychiatry at Virginia Tech’s Carilion School of Medicine, who oversees a psychiatric system in western Virginia.

In his own system, Trestman said, the pandemic years brought an “incredible increase in billing” for patients with anxiety and depression. Historically, nearly half of all people with symptoms of these disorders have not received mental health care, he said.

As more people seek care, the numbers “are actually more consistent with the underlying epidemiology that we might expect,” he said.