New Bill to Expand Home-Based Virtual Mental, Substance Use Care

December 11, 2023 - Two United States representatives have introduced a new bill that aims to expand access to at-home virtual mental health and substance use services in rural communities.

Introduced by Andrea Salinas (D-OR) and Diana Harshbarger (R-TN), the Home-Based Tele-mental Health Care Act of 2023 would provide grants to support the delivery of mental health and substance use services in the homes of rural US residents, particularly those working in farming, fishing, and forestry occupations.

“Traditional telemental health models involve care delivered to a patient at an originating clinical site from a specialist working at a distant site,” the bill states. “Having the ability to reach mental health professionals from a place of comfort, such as home, from a personal device may reduce challenges faced in rural areas and amongst Triple-F [farming, fishing, and forestry] workers.”

The bill mandates that the Secretary of Health and Human Services (HHS), in coordination with the rural health liaison of the Department of Agriculture, award these grants. The legislation authorizes up to $10 million each fiscal year for the grants through 2027.

“As a community pharmacist for over three decades in one of the country’s most rural Congressional Districts, I understand the challenges patients face in underserved areas,” said Harshbarger in a press release. “By expanding access to telemental health services, this common-sense legislation will help improve patient outcomes.”

The grant recipients must not only deliver home-based telemental health services to covered populations, but they must also develop metrics to measure the quality and impact of home-based telemental health services compared to traditional in-person care.

The National Rural Health Association, American Psychological Association, and American Psychiatric Association, among others, have endorsed this legislation.

“This important legislation creates a telemental health demonstration program designed to address specific behavioral health and substance use needs for folks in farming, fishing, and forestry occupations,” Alan Morgan, CEO of the National Rural Health Association, said in the press release. “This bill will increase access to behavioral health and substance use services for our most rural and medically underserved populations.”

The Home-Based Tele-mental Health Care Act of 2023 is a companion bill to one introduced in the US Senate by Sens. Mike Rounds (R-SD) and Tina Smith (D-MN) in April.

More than one in five rural Americans reported having a mental illness in 2022. According to the 2022 National Survey on Drug Use and Health, approximately 7.7 million adults in nonmetropolitan areas (23 percent) reported having mental illness in 2022, and 1.9 million adults (5.7 percent) reported having serious thoughts of suicide during the year.

However, access to mental healthcare in rural America is severely lacking. About 65 percent of rural counties do not have a psychiatrist, and 81 percent do not have a psychiatric nurse practitioner, Mental Health America notes.

Telehealth has helped extend access to mental healthcare during the pandemic. According to data from market research firm Trilliant Health, only 1 percent of all behavioral health visits were performed via telehealth before the pandemic. But by the second quarter of 2022, 32.8 percent of all visits were conducted through telehealth, representing a 45-fold increase.

More recent data indicates that telehealth is still widely used to provide mental healthcare.

At the beginning of the month, Epic Research published the results of an analysis of 475 million telehealth and in-person visits between the second quarter Q2 of 2019 and the third quarter (Q3) of 2023.

The proportion of telehealth visits peaked across all specialties in Q2 2020, with the highest telehealth use rates in mental health (65.5 percent). By Q3 2023, 37 percent of mental health visits were occurring virtually.