PPRNet Clinical summary: Who Accesses Telemental Health, Hybrid, or In-Person Mental Health Care?

Since the COVID-19 pandemic, there has been a rapid increase in the use of telemental health care. Telemental health care visits in the U.S. increased from 0.4% pre-pandemic to 46.1% in 2020. Telemental health care can save time, overcome transportation barriers, and provide greater confidentiality, but there is concern that this modality is not equitably accessible to all patients. Research suggests that this modality is as effective as in-person care. In this study, Olfson and colleagues sought to better understand the distribution of telemental health, in-person, and hybrid (telemental health and in-person) health care use. They did so by describing the sociodemographic and clinical characteristics of a U.S. nationally representative sample of adult mental health outpatients accessing care. They relied on the 2021-2022 Medical Expenditure Panel Survey in the U.S., which is a representative sample of households. The survey included 4720 participants who answered questions on demographics, clinical characteristics, and access to mental health care. Approximately one-fourth (27.8%) of mental health outpatients received all telemental health care, 21.5% received hybrid care, and 50.6% received all in-person care. The percentage of patients receiving all telemental health care was higher for younger (aged 18-44 years; 31.7%; 95%CI, 29.0-34.3) than middle age (aged 45-64 years; 24.2%; 95%CI, 21.1-27.4) or older (age > 65 years; 19.4%; 95%CI, 16.1-22.7) adults, high school (23.1%95%CI, 20.4-25.8) and college (34.5%; 95%CI, 31.5-37.5) graduates than those without a high school diploma (19.9%; 95%CI, 13.7-26.1), patients with incomes >400% federal poverty level (33.8%; 95%CI, 30.9-36.7) than lower income (range, 20.6% to 23.7%), and urban (29.2%; 95%CI, 27.0-31.3) than rural (14.0%; 95%CI, 8.6-19.3) residence. Patients with less than moderate distress (29.2%; 95%CI, 26.1-32.3) were also more likely than those with serious distress (21.2%; 95%CI, 16.7-25.6) to use all telemental health. Compared to patients receiving medication alone (15.4%; 95%CI, 12.5-18.3), those receiving psychotherapy with medication (25.9%; 95%CI, 23.2-28.6) or without medication (41.6%; 95%CI, 38.0-45.2) were more likely to use all telemental health. There were no significant differences in telemental health use based on race or ethnicity.

Practice Implications 

Telemental health remains a common means of receiving outpatient mental health care in the U.S. The most likely groups to use this modality are younger, more educated, less distressed, urban, higher-income individuals who are receiving psychotherapy and not medication exclusively. These results point to disparities likely related to broadband access and digital literacy skills. Before offering telemental health, clinicians should consider patients' capacity to access or make use of this mode of care.

Olfson, M., McClellan, C., Zuvekas, S.H., & Blanco, C. (2026). Telemental health, hybrid, and in-person outpatient mental health care in the U.S. JAMA Psychiatry, 83(1), 59–67. doi:10.1001/jamapsychiatry.2025.3575.