Mental Health and Substance Use Treatment Telehealth Shifts During COVID-19 by Race, Ethnicity, and Population Density.

Abstract

Objective: Telehealth can increase health care utilization for substance use disorder (SUD) and mental health (MH) services, particularly for underserved populations. We examined shifts to telehealth for SUD and MH services during the COVID-19 public health emergency and whether they occurred similarly by race, ethnicity, and population density.

Methods: We used data from the 2021 to 2022 National Survey on Drug Use and Health, focusing on adults with an SUD and/or MH condition in the past year. Estimated prevalence of SUD and MH appointments shifting from in-person to telehealth and used adjusted logistic regression models to examine differences by race, ethnicity, and population density. Sample sizes ranged from 2,440 to 9,695 (∼11-42 million weighted), depending on condition and outcome.

Results: Approximately 26% of adults with an SUD reported their SUD appointments shifted to telehealth, whereas 66% of adults with an MH condition reported their MH appointments shifted to telehealth. Black (59%) and Latinx (61%) adults with an MH condition were significantly less likely to report appointment shifts to telehealth than White adults (69%, p < 0.01 for both). Individuals in less populated areas were significantly less likely to report their SUD and MH appointments shifted to telehealth, compared with those in highly populated areas.

Conclusion: Shifts to telehealth were less common for SUD than MH appointments. Rates differed by race and ethnicity. Telehealth was underutilized by those in less populated areas. Research to identify barriers for telehealth services and strategies to ensure telehealth equity in the present day are needed.