32% of Behavioral Health Patients Do Not Get the Visit Type They Want

September 06, 2023 - The demand for behavioral healthcare has skyrocketed, but a new study shows that nearly one-third of behavioral healthcare patients do not get their preferred choice between telehealth and in-person visits.

The study, published in Health Affairs, was conducted by researchers at nonprofit research organization RAND Corporation and Harvard University and funded by the National Institute for Mental Health.

The researchers conducted a nationally representative survey of 2,071 United States adults in February and March. Of these, 571 had used behavioral health services in the prior year. The researchers also interviewed 26 people with bipolar disorder or depression. The survey and interviews explored patients' experiences with selecting telehealth or in-person care for behavioral health services and their perceptions about their choice in the decision.

The study shows that 80.1 percent of the 423 people who received individual therapy participated in telehealth visits the previous year. In comparison, only 41.6 percent of these respondents received care in person.

On the other hand, of the 373 people seeking medication-related visits, 54.4 percent participated in telehealth, while 57.9 percent participated in in-person visits.

Further, the researchers found that 30.6 percent of respondents receiving therapy said their clinician offered only one visit modality. About 21.6 percent said their clinician offered only telehealth, while 9 percent said they provided only in-person care.  

With respect to medication visits, 33.2 percent said that their clinician only offered one visit modality, with 20.3 percent saying they offered in-person visits and 12.9 percent saying they offered telehealth visits.

About 24.2 percent of people receiving therapy and 34.9 percent receiving medication said their provider decided the visit modality. While a majority of survey respondents agreed that their clinician considered their preference when determining the modality and they got the type of visit they preferred, significant minorities did not agree. Approximately 32 percent of patients said they did not get the type of visit they preferred most of the time, and 45 percent believed their clinician did not consider their preference when deciding the visit type.

"These findings suggest that patients' modality preferences need to be a greater consideration in both clinical discussions and policy decisions," said Jessica Sousa, study lead author and a senior policy analyst at RAND, in a press release.

The interviews revealed that most people would like a choice in visit type. For instance, while many liked the convenience and easy access of telehealth, others noted that in-person care was better for creating rapport with clinicians and helped ensure that the patient and clinician were entirely focused on the visit.

Not only that, but the lack of choice also resulted in patients feeling disconnected and less attuned to the clinician, particularly among those who preferred in-person care.

"Expanding telehealth increases access to care, but telehealth alone might not be sufficient," Sousa said. "Ideally, patients should have access to some amount of in-person care, given that many prefer it or may need it."

As telehealth continues to be commonly used for behavioral healthcare delivery, studies show some downsides to virtual care use.

Another study published in July revealed that behavioral health patients face several challenges when using telehealth technology, resulting in higher no-show rates.

The researchers compared no-show rates for telehealth visits and in-person care using EHR data from outpatient clinics in rural Louisiana between May 1, 2022, and January 31, 2023. The study included 3,318 appointments that took place in person and 6,397 that took place via telehealth.

The no-show rate for the telehealth group was 17 percent, while the rate for the in-person care group was 13 percent.