Remote delivery of mental health care across the U.S. has increased dramatically

Reviewed by Emily Henderson, B.Sc.Sep 3 2020

The COVID-19 pandemic has spurred a remarkable number of psychologists across the United States to shift to delivering mental health care to patients remotely, according to a national study led by researchers at Virginia Commonwealth University.

The study, "The COVID-19 Telepsychology Revolution: A National Study of Pandemic-Based Changes in U.S. Mental Health Care Delivery," which was published in the journal American Psychologist, involved a survey of 2,619 licensed psychologists across the country and found that the amount of clinical work performed via telepsychology had increased 12-fold since the pandemic began.

Prior to the pandemic, psychologists reported performing 7.07% of their clinical work with telepsychology. During the pandemic, that number has soared to 85.53%. And 67.32% of psychologists reported conducting all of their clinical work with telepsychology, the study found.

"I was shocked to see how quickly telepsychology was adopted," said lead author Brad Pierce, a doctoral student in the Department of Psychology in the College of Humanities and Sciences.

The shift from 7% of clinical work to more than 85% represents a lot of heavy lifting in a very short time. There was a concerted effort among the community to identify and remove long-standing barriers. Psychologists sought out additional training, equipment was purchased, and policies were adjusted at every level to facilitate telehealth and telepsychology."

Brad Pierce, Study Lead Author and Doctoral Student, Department of Psychology, College of Humanities and Sciences

Pierce is part of the Social Justice in Disability and Health Lab at VCU, which aims to understand and dismantle barriers to psychological services confronted by underserved groups with disabilities and chronic health conditions. As part of that work, the lab has conducted studies into the adoption of telepsychology and its potential to address disparities in health care.

"I was proud of the mental health care community's response to COVID-19 when the need for physical distancing became apparent," Pierce said. "People still need psychological services, and the community rolled up their sleeves and got to work. Our team recognized a revolution was taking place and we wanted to gain insight about these changes as they were occurring."

After the pandemic ends, the study found, many psychologists anticipate they will continue to treat patients remotely. According to the study, psychologists projected they would continue to perform 34.96% of their clinical work with telepsychology.

"I'm hopeful that these trends show that psychology as a field is able to adapt to the needs of both providers and patients," said co-author Grace McKee, Ph.D., a Mid-Atlantic Mental Illness Research Education and Clinical Center Advanced Psychology Fellow at the Central Virginia VA Health Care system, and who is affiliated with the Department of Psychology at VCU.

Of course the initial wave of telepsychology during the pandemic has been out of necessity, but our findings suggest to me that there are benefits to continue offering it in the future even when it is safe to attend in person."

Telepsychology can be more convenient for both providers and patients, McKee said, particularly for people who may have difficulty attending in person -- whether because of financial or transportation limitations, conflicts with work schedules, responsibilities like caring for children or family members, or mobility issues due to illness or disability.

At the same time, she said, many psychologists and patients may prefer in-person treatment, and many patients lack access to the technology and to a private, safe space needed to use telepsychology.

"I think the flexibility to offer both in-person and telepsychology services is critical in being able to meet patients' needs and making psychological services more accessible," McKee said.

While the researchers found a significant shift to telepsychology, the trend was not uniform across the profession.

Psychologists working in outpatient treatment facilities saw particularly high increases, with a more than 26-fold increase in telepsychology use during the pandemic, the study found. Meanwhile, psychologists working in Veterans Affairs medical centers only reported a sevenfold increase, likely due in part to the high rates of telepsychology use in VA medical centers before the pandemic.

A larger increase in the adoption of telepsychology was seen among women, among psychologists who had access to training in telepsychology and supportive organizational policies, and among psychologists who worked in settings specializing in relationship issues, anxiety and women's issues.

"Historically, women have tended to provide the bulk of child care. We think it's possible that women psychologists with children may have needed to use telepsychology at higher rates in order to continue to provide child care in the home, especially when most schools and day cares were closed," McKee said.

"In contrast, men may have had the ability to continue some degree of in-person clinical work, particularly if they had a partner who was able to provide child care."

The lowest increases in telepsychology were found among psychologists working in rural areas and in settings that specialized in treating antisocial personality disorder, performing testing and evaluation, and treating rehabilitation populations.

Paul Perrin, Ph.D., an associate professor in the Department of Psychology and director of the Social Justice in Disability and Health Lab, said the study documents a "literal revolution in mental health care delivery taking place before our eyes amidst the COVID-19 pandemic."

"No other event in modern history has altered to this extent the landscape of psychological service provision," said Perrin, who is also a co-author of the study and a jointly appointed research psychologist at the Central Virginia Veterans Affairs Health Care System.

"Many of the barriers to telepsychology use that have been touted for years have now been dramatically lessened or even fully removed, and we are seeing an unprecedented rollout of technology-based mental health treatment. The field of psychology has put forth a substantial effort to adapt to the demands of the pandemic and unmet mental health needs that are being uncovered across the U.S."

Perrin noted one important limitation of the study: It reflects the rapid and widespread adoption of telepsychology, but does not reveal the extent to which that shift is meeting the mental health care needs of patients, particularly groups of people that experience disparities in health care.

"I believe that much more needs to be done in terms of bringing evidence-based practice to populations often marginalized in traditional mental health care," Perrin said.

"The practice of telepsychology assumes a lot of things like patient access to technology, internet or telephone, and even to payment options for telepsychology. Despite the potential of telepsychology to rise to some of the mental health needs laid bare during the pandemic, there are still many limitations and barriers to its use that need to be worked out."