Effect of telemental health adoption on mental health services utilization in federally qualified health centers.

Abstract

Introduction: Mental health issues disproportionately affect rural and low-income populations, where access to prevention and treatment is limited. Implementing telemental health services (TMHS) in Federally Qualified Health Centers (FQHCs) could improve accessibility to mental healthcare. This study assessed the effect of TMHS on mental health services utilization in FQHCs, comparing centers with and without TMHS and examined differences in TMHS effect between FQHCs that adopted TMHS before and during the pandemic.

Methods: The study utilized FQHC-level data from Uniform Data Systems annual performance reports (N = 9540 FQHC-year) and county-level demographic, health status, and provider characteristic data from 2016 to 2022. A two-way fixed effects model was applied to examine the effect of TMHS on mental health visit rates, supplemented by the Sun and Abraham difference-in-differences estimator. The analysis included both pre-COVID and during-COVID TMHS adopters.

Results: FQHCs offering TMHS showed 1.04 times increase in overall mental health visit rates compared to those without TMHS. Centers serving higher proportions of Medicaid-insured (1.07 times) and low-income (below 200% FPL; 1.05 times) populations showed even higher visit rates. During-COVID TMHS adopters showed a significant increase (1.05 times), particularly in urban areas, whereas rural adopters did not see significant changes.

Conclusion: FQHCs offering TMHS showed increased mental health visit rates, especially among low-income and Medicaid-insured populations. FQHCs that adopted TMHS during the pandemic experienced a marked rise in mental health visits, but rural-urban disparities persist, highlighting the ongoing challenges in expanding access to mental healthcare in rural settings.